Ohnesorge Henning, Bein Berhold, Hanss Robert, Francksen Helga, Mayer Laura, Scholz Jens, Tonner Peter H
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Eur J Anaesthesiol. 2009 Aug;26(8):648-53. doi: 10.1097/EJA.0b013e328329b0fd.
Intravenously administered paracetamol is an effective analgesic in postoperative pain management. However, there is a lack of data on the effect of intravenous (i.v.) paracetamol on pain following soft tissue surgery.
Eighty-seven patients undergoing elective breast surgery with total i.v. anaesthesia (propofol/remifentanil) were randomized to three groups. Group para received 1 g i.v. paracetamol 20 min before and 4, 10 and 16 h after the end of the operation. Group meta and plac received 1 g i.v. metamizol or placebo, respectively, scheduled at the same time points. All patients had access to i.v. morphine on demand to achieve adequate pain relief.
No significant difference in total morphine consumption between groups was detectable. The proportion of patients who did not receive any morphine in the postoperative period was significantly higher in group para (42%) than in group plac (4%). Ambulation was significantly (P < 0.05) earlier in group para (4.0 +/- 0.2 h) than in groups meta (4.6 +/- 0.2 h) and plac (5.5 +/- 1.0 h). No differences were observed between groups meta and plac. There were no differences between groups with regard to incidence of postoperative nausea and vomiting or changes in vigilance.
Neither i.v. paracetamol nor i.v. metamizol provided a significant reduction in total postoperative morphine consumption compared with placebo in the management of postoperative pain after elective breast surgery. Administration of paracetamol resulted in a significant reduction in the number of patients needing opioid analgesics to achieve adequate postoperative pain relief.
静脉注射对乙酰氨基酚是术后疼痛管理中一种有效的镇痛药。然而，关于静脉注射对乙酰氨基酚对软组织手术后疼痛的影响，目前缺乏相关数据。
87例接受丙泊酚/瑞芬太尼全静脉麻醉的择期乳腺手术患者被随机分为三组。对乙酰氨基酚组在手术结束前20分钟以及术后4、10和16小时静脉注射1克对乙酰氨基酚。间甲氨基酚组和安慰剂组在相同时间点分别静脉注射1克间甲氨基酚或安慰剂。所有患者可按需静脉注射吗啡以实现充分的疼痛缓解。
各组间吗啡总消耗量无显著差异。对乙酰氨基酚组术后未接受任何吗啡的患者比例（42%）显著高于安慰剂组（4%）。对乙酰氨基酚组患者术后首次下床活动时间（4.0±0.2小时）显著早于间甲氨基酚组（4.6±0.2小时）和安慰剂组（5.5±1.0小时）（P<0.05）。间甲氨基酚组和安慰剂组之间未观察到差异。各组在术后恶心呕吐发生率或警觉性变化方面无差异。
在择期乳腺手术后的疼痛管理中，与安慰剂相比，静脉注射对乙酰氨基酚和静脉注射间甲氨基酚均未显著降低术后吗啡总消耗量。对乙酰氨基酚的给药显著减少了需要阿片类镇痛药以实现充分术后疼痛缓解的患者数量。
