Sindhvananda Wacharin, Urusopone Pakorn, Sriprajittichai Pin, Indrambarya Toonchai
Department of Anesthesiology, Chulalongkorn Hospital, Bangkok 10330, Thailand.
J Med Assoc Thai. 2005 Nov;88(11):1557-62.
Open uncomplicated appendectomy is known for low to medium degree of postoperative pain and a short hospital stay. Based on multimodal pain therapy, non-opioid analgesics have widely been a part in pain control. Parecoxib and tramadol have advantages over traditional opioids that are causing less nausea or vomiting, respiratory depression and sedation. As a result, the authors aimed to compare parecoxib and tramadol regarding quality of pain control after open appendectomy. Fifty patients, underwent open appendectomy with spinal anesthesia, were randomized to receive either parecoxib or tramadol (n = 25 each). Parecoxib 40 mg and tramadol 50 mg IV were administered twice, when closing the peritoneum and at 12 h later Doses of rescued meperidine for 24 h were recorded. Pain score, sedation, nausea or vomiting and satisfaction scores were assessed at 6, 12 and 24 h after operation. The mean rescued doses of meperidine were 4.6 +/- 10.9 and 18.6 +/- 21.0 mg in parecoxib and tramadol groups respectively (p = 0.005). There was a significantly higher pain score at 24 h (p = 0.01) and sedation score at 6 h (p = 0.003) in the tramadol group. Parecoxib provided a lower pain and sedation scores and lesser meperidine consumption than tramadol for post-appendectomy pain.
Parecoxib, as a primary analgesic, is better in analgesia and has less sedation than tramadolfor post-appendectomy pain.
开放式单纯性阑尾切除术以术后疼痛程度低至中度和住院时间短而闻名。基于多模式疼痛治疗，非阿片类镇痛药已广泛用于疼痛控制。帕瑞昔布和曲马多比传统阿片类药物具有优势，引起的恶心、呕吐、呼吸抑制和镇静作用较少。因此，作者旨在比较帕瑞昔布和曲马多在开放式阑尾切除术后的疼痛控制质量。50例行脊髓麻醉下开放式阑尾切除术的患者被随机分为接受帕瑞昔布或曲马多治疗（每组n = 25）。在关闭腹膜时及12小时后分别静脉注射帕瑞昔布40mg和曲马多50mg两次。记录24小时内抢救用哌替啶的剂量。在术后6、12和24小时评估疼痛评分、镇静程度、恶心或呕吐情况以及满意度评分。帕瑞昔布组和曲马多组哌替啶的平均抢救剂量分别为4.6±10.9mg和18.6±21.0mg（p = 0.005）。曲马多组在24小时时疼痛评分显著更高（p = 0.01），在6小时时镇静评分显著更高（p = 0.003）。对于阑尾切除术后疼痛，帕瑞昔布比曲马多提供更低的疼痛和镇静评分，且哌替啶消耗量更少。
作为主要镇痛药，帕瑞昔布在阑尾切除术后疼痛的镇痛效果上优于曲马多，且镇静作用更小。
