Durak Pınar, Yağar Seyhan, Uzuner Ali, Kılıç Mehmet, Dilber Elif, Ozgök Ayşegül
Department of Anesthesiology and Reanimation, Türkiye Yüksek Ihtisas Education and Research Hospital, Turkey.
Agri. 2010 Jul;22(3):117-20.
Laparoscopic cholecystectomy is the first treatment choice for symptomatic gallstone disease. We compared the efficacy of intravenous (i.v.) paracetamol and intramuscular (i.m.) diclofenac Na(+) after laparoscopic cholecystectomy.
Following approval from the Local Ethics Committee and receipt of written informed consent, 40 ASA physical status I-II patients who underwent laparoscopic cholecystectomy were enrolled into the study. General anesthesia was standardized. The patients received 1 g i.v. Paracetamol (Group I, n: 20) or 75 mg diclofenac Na+ i.m. (Group II, n: 20) 15 minutes (min) before the end of the operation. Pain was assessed by numeric rating scale (NRS) after arrival in the postanesthesia care unit (PACU) (NRS 1) and at the 30th minute (NRS 2) and 1st hour (NRS 3) of the PACU stay. 10 mg i.v. Pethidine HCL was administered to the patient with NRS >5. The following measures were recorded: intensity of pain by NRS at arrival and after 30 and 60 min, total consumption of pethidine HCL, and nausea and vomiting.
All assessments were performed by an anesthesiologist blinded to the study protocol. NRS 3 scores were significantly higher in Group I than Group II (p<0.05). Opioid consumption was not different between the groups. Two patients in each group had postoperative nausea and vomiting; no other adverse effects were noted.
We recommend the use of i.v. Paracetamol as an opioid adjuvant. Regarding its use as a unique drug for postoperative pain therapy, further comparative studies with higher doses of paracetamol are needed.
腹腔镜胆囊切除术是有症状胆结石疾病的首选治疗方法。我们比较了腹腔镜胆囊切除术后静脉注射对乙酰氨基酚和肌肉注射双氯芬酸钠的疗效。
经当地伦理委员会批准并获得书面知情同意后，40例接受腹腔镜胆囊切除术的ASA身体状况I-II级患者被纳入研究。全身麻醉标准化。患者在手术结束前15分钟接受1g静脉注射对乙酰氨基酚（第一组，n：20）或75mg双氯芬酸钠肌肉注射（第二组，n：20）。在到达麻醉后护理单元（PACU）时（NRS 1）以及在PACU停留的第30分钟（NRS 2）和第1小时（NRS 3）通过数字评分量表（NRS）评估疼痛。对NRS>5的患者静脉注射10mg盐酸哌替啶。记录以下指标：到达时以及30和60分钟后的NRS疼痛强度、盐酸哌替啶的总消耗量以及恶心和呕吐情况。
所有评估均由对研究方案不知情的麻醉医生进行。第一组的NRS 3评分显著高于第二组（p<0.05）。两组之间的阿片类药物消耗量没有差异。每组有两名患者出现术后恶心和呕吐；未观察到其他不良反应。
我们建议将静脉注射对乙酰氨基酚用作阿片类药物辅助剂。关于其作为术后疼痛治疗的单一药物的使用，需要进一步进行更高剂量对乙酰氨基酚的比较研究。
