Cakan Turkay, Inan Nurten, Culhaoglu Safiye, Bakkal Kursat, Başar Hulya
Department of Anesthesiology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.
J Neurosurg Anesthesiol. 2008 Jul;20(3):169-73. doi: 10.1097/ANA.0b013e3181705cfb.
Paracetamol, a centrally acting inhibitor of cyclooxygenase, has less gastrointestinal and platelet-inhibiting side effects and is clinically better tolerated than nonsteroidal anti-inflammatory drugs. Therefore, it will be ideally suited for postoperative pain relief. In this prospective, double-blind, randomized, placebo-controlled study, we evaluated the analgesic efficacy, opioid-sparing effect and effects on opioid-related adverse effects of intravenous (IV) paracetamol in combination with IV morphine after lumbar laminectomy and discectomy. Forty patients were divided into 2 groups (n=20 each) to receive either paracetamol 1 g (group 1) or 0.9% NaCl 100 ml (group 2) at the end of the operation and at 6-hour intervals over 24 hours. IV patient-controlled analgesia with morphine was used as a rescue analgesic in both groups. Pain was evaluated at rest and on movement at the 1st, 2nd, 4th, 6th, 12th, 18th, and 24th hours using a visual analog scale. Hemodynamic parameters, morphine usage, patient satisfaction, and probable side effects were also evaluated. Pain scores at rest and on movement at the 12th, 18th, and 24th hours were significantly lower in group 1 (P<0.001). Morphine consumption was not statistically significantly different between the groups (P>0.05). Vomiting in group 2 was significantly higher (P=0.027). Significantly more patients in the paracetamol group rated their pain management as excellent (45% vs. 5%). Although repeated IV paracetamol usage after lumbar laminectomy and discectomy did not demonstrate a significant opioid-sparing effect, it did decrease visual analog scale scores at certain evaluation times and incidence of vomiting and increase patient satisfaction.
对乙酰氨基酚是一种中枢性环氧化酶抑制剂，胃肠道和血小板抑制副作用较少，临床耐受性优于非甾体抗炎药。因此，它非常适合用于术后疼痛缓解。在这项前瞻性、双盲、随机、安慰剂对照研究中，我们评估了静脉注射（IV）对乙酰氨基酚联合IV吗啡在腰椎椎板切除术和椎间盘切除术后的镇痛效果、阿片类药物节省效应以及对阿片类药物相关不良反应的影响。40例患者分为2组（每组n = 20），在手术结束时及术后24小时内每6小时分别接受1 g对乙酰氨基酚（第1组）或100 ml 0.9%氯化钠溶液（第2组）。两组均使用IV患者自控吗啡镇痛作为补救镇痛措施。在第1、2、4、6、12、18和24小时，使用视觉模拟量表评估静息和活动时的疼痛情况。还评估了血流动力学参数、吗啡用量、患者满意度以及可能的副作用。第1组在第12、18和24小时静息和活动时的疼痛评分显著更低（P<0.001）。两组间吗啡消耗量无统计学显著差异（P>0.05）。第2组呕吐发生率显著更高（P = 0.027）。对乙酰氨基酚组中认为疼痛管理优秀的患者明显更多（45%对5%）。尽管腰椎椎板切除术和椎间盘切除术后重复静脉注射对乙酰氨基酚未显示出显著的阿片类药物节省效应，但在某些评估时间确实降低了视觉模拟量表评分以及呕吐发生率，并提高了患者满意度。
