Emergency Department, Catholic University of the Sacred Hearth, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2010 Jul;14(7):629-34.
The management of pain in polytrauma patients is mandatory. While non-steroidal anti-inflammatory drugs (NSAIDs) represent the most used drugs in polytrauma patients, their use may be associated with an increased risk of haemorrhage. Opioids may represent a valid alternative to NSAIDs either alone or in combination with acetaminophen. Whether their efficacy is comparable to that produced by NSAIDs in polytrauma patients has never been studied.
60 polytrauma patients were enrolled for this study. 30 patients were treated with acetaminophen 1000 mg plus codeine 60 mg tid for 24 hours (Group A), while the remaining 30 with ketorolac 10 mg qid for 24 hours (Group B). Pain intensity has been evaluated using an analogical visual scale (VAS) ranging from 0 (no pain) to 10 (very severe pain). The level of pain was valuated at enrolment (TO) as well as after 2 (T2), 12 (T12) and 24 (T24) hours from the starting of the analgesic therapy. Results obtained by the group A were compared with those reported by the group B.
T0: Group A mean score was 6.4 +/- 1.5 compared with 6.6 +/- 1.5 of Group B (p= ns); T2: Group A mean score was 3.4 +/- 2.8, compared with 3.5 +/- 2.4 of group B (p = ns); T12: Group A mean score was 3.4 +/- 3.4, compared with 3.5 +/- 3 of Gorup B (p = ns); T24: Group A mean score was 2.9 +/- 1.5, compared to 3.0 +/- 1.6 of Group B (p = ns). All those drugs determined a significant reduction of pain intensity during the course of therapy.
Acetaminophen plus codeine is effective in pain control in polytrauma patients at least in our series. It may represent a valid alternative to NSAIDs, especially in patients with a documented haemorrhage or with a high hemorrhagic risk.
创伤后患者的疼痛管理是强制性的。虽然非甾体抗炎药（NSAIDs）是创伤后患者最常用的药物，但它们的使用可能会增加出血风险。阿片类药物单独或与对乙酰氨基酚联合使用可能是 NSAIDs 的有效替代品。它们在创伤后患者中的疗效是否与 NSAIDs 相当，尚未进行研究。
这项研究纳入了 60 名创伤后患者。30 名患者接受了对乙酰氨基酚 1000mg 加可待因 60mg tid 治疗 24 小时（A 组），而其余 30 名患者接受了酮咯酸 10mg qid 治疗 24 小时（B 组）。疼痛强度使用模拟视觉量表（VAS）进行评估，范围从 0（无疼痛）到 10（非常严重疼痛）。疼痛程度在入组时（TO）以及开始镇痛治疗后 2（T2）、12（T12）和 24（T24）小时进行评估。A 组的结果与 B 组的结果进行了比较。
TO：A 组平均评分为 6.4 ± 1.5，B 组为 6.6 ± 1.5（p=ns）；T2：A 组平均评分为 3.4 ± 2.8，B 组为 3.5 ± 2.4（p=ns）；T12：A 组平均评分为 3.4 ± 3.4，B 组为 3.5 ± 3（p=ns）；T24：A 组平均评分为 2.9 ± 1.5，B 组为 3.0 ± 1.6（p=ns）。所有这些药物在治疗过程中都显著降低了疼痛强度。
在我们的系列研究中，对乙酰氨基酚加可待因在创伤后患者的疼痛控制中是有效的。它可能是 NSAIDs 的有效替代品，尤其是在有出血记录或有高出血风险的患者中。
