Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea.
World J Surg. 2010 Mar;34(3):521-6. doi: 10.1007/s00268-009-0346-2.
Postoperative pain following endoscopic thyroidectomy, although less severe than after open methods, is still a source of marked discomfort and surgical stress. This clinical trial was conducted to determine if repeated intravenous paracetamol could decrease postoperative pain and rescue analgesic requirements after robot-assisted endoscopic thyroidectomy via the transaxillary approach.
This prospective, randomized, double-blinded, and placebo-controlled study enrolled 124 women 21-60 years of age who were scheduled for elective gasless robot-assisted endoscopic thyroidectomy via the transaxillary approach. The patients were given placebo or 1 g of paracetamol as a 100 ml solution infused over 15 min 1 h before the induction of anesthesia, and then at 6-h intervals for the following 24 h.
Postoperative pain scores were significantly lower at 1, 3, 6, and 24 h after surgery in the paracetamol group than in the placebo group. Significantly fewer patients in the paracetamol group received rescue analgesics compared to the placebo group (9.5% vs. 65.6%, respectively). First analgesic time was similar in the two groups. Postoperative nausea (44.3% vs. 22.2%) and vomiting (21.3% vs. 6.3%) were more frequent in the placebo group than in the paracetamol group. Other postoperative side effects, including sedation, confusion, and pruritus, were similar in the two groups.
We concluded that repeated administration of 1 g of intravenous paracetamol over 24 h is easy, effective, safe, and well tolerated for pain management in patients with moderate to severe postoperative pain after gasless robot-assisted endoscopic thyroidectomy performed via the transaxillary approach.
内镜甲状腺手术后的疼痛虽然比开放手术轻，但仍是引起明显不适和手术应激的原因。本临床试验旨在确定重复静脉注射对乙酰氨基酚是否可以减少经腋窝入路机器人辅助内镜甲状腺切除术患者的术后疼痛并减少术后镇痛需求。
这是一项前瞻性、随机、双盲、安慰剂对照研究，纳入了 124 名年龄在 21-60 岁之间的女性，她们计划接受经腋窝入路无气机器人辅助内镜甲状腺切除术。患者在麻醉诱导前 1 小时给予安慰剂或 1g 对乙酰氨基酚，溶于 100ml 溶液中，输注 15 分钟，然后在接下来的 24 小时内每 6 小时输注一次。
与安慰剂组相比，对乙酰氨基酚组在术后 1、3、6 和 24 小时的术后疼痛评分显著降低。与安慰剂组相比，对乙酰氨基酚组接受解救性镇痛的患者明显较少（分别为 9.5%和 65.6%）。两组的首次镇痛时间相似。与安慰剂组相比，对乙酰氨基酚组术后恶心（44.3%对 22.2%）和呕吐（21.3%对 6.3%）更为频繁。两组的其他术后副作用，包括镇静、意识混乱和瘙痒，相似。
我们得出结论，经腋窝入路无气机器人辅助内镜甲状腺切除术后，24 小时内重复给予 1g 静脉注射对乙酰氨基酚简便、有效、安全且耐受性良好，可有效治疗中重度术后疼痛患者。
