Yilmazer Cuneyt, Sener Mesut, Yilmaz Ismail, Erkan Alper Nabi, Cagici Can Alper, Donmez Asli, Arslan Gulnaz, Ozluoglu Levent Naci
Baskent University, Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey.
Auris Nasus Larynx. 2007 Dec;34(4):471-5. doi: 10.1016/j.anl.2006.11.013. Epub 2007 Mar 6.
The most frequent complaint of patients after septoplasty is severe pain felt during removal of nasal packing placed on the operation. Various methods have been described to decrease pain and to increase patient comfort during removal of nasal packing. However, these methods are not practical. There has been an increase in the number of studies on pre-emptive analgesia use for postoperative pain relief. The aim of this study was to determine whether pre-emptive analgesia decreased pain during removal of Merocel packs placed in septoplasties.
This is a double-blind randomized, placebo-controlled study. The study included 121 patients who underwent elective septoplasty in our otorhinolaryngology clinic. The patients were randomly assigned into two groups: study and placebo groups. The study and placebo groups received two tablets of diflunisal 500 mg and placebo, respectively, two and a half hours before removal of nasal packing. Visual analog scale (VAS) values immediately after and 5 min after removal of nasal packing, effects of the procedure on patient comfort and its side-effects were evaluated separately.
VAS values immediately after the removal of nasal packs significantly decreased in the study group (p<0.001), but there was no significant difference in VAS values obtained after the procedure between the study and placebo groups. Patient discomforts were significantly lower in the diflunisal group (p<0.001).
It can be concluded that pre-emptive analgesia decreases pain during removal of nasal packing placed in septoplasties and increases patient comfort.
鼻中隔成形术后患者最常见的主诉是取出术中放置的鼻腔填塞物时感到剧痛。已有多种方法被描述用于减轻取出鼻腔填塞物时的疼痛并提高患者舒适度。然而，这些方法并不实用。关于使用超前镇痛缓解术后疼痛的研究数量有所增加。本研究的目的是确定超前镇痛是否能减轻鼻中隔成形术中取出美罗培南填塞物时的疼痛。
这是一项双盲随机、安慰剂对照研究。该研究纳入了121例在我们耳鼻喉科门诊接受择期鼻中隔成形术的患者。患者被随机分为两组：研究组和安慰剂组。在取出鼻腔填塞物前两个半小时，研究组和安慰剂组分别服用两片500毫克双氯芬酸和安慰剂。分别评估取出鼻腔填塞物后即刻及5分钟后的视觉模拟量表（VAS）值、该操作对患者舒适度的影响及其副作用。
研究组取出鼻腔填塞物后即刻的VAS值显著降低（p<0.001），但研究组和安慰剂组术后获得的VAS值无显著差异。双氯芬酸组患者的不适感显著更低（p<0.001）。
可以得出结论，超前镇痛可减轻鼻中隔成形术中取出鼻腔填塞物时的疼痛并提高患者舒适度。
