Abdulla Susanne, Eckhardt Regina, Netter Ute, Abdulla Walied
Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Kustrenaer Straße 98, 06406 Bernburg, Germany ; Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany ; Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
Pain Res Treat. 2012;2012:305821. doi: 10.1155/2012/305821. Epub 2012 Nov 5.
Purpose. In a randomized, double-blind trial, the efficacy of nonopioid analgesics on postoperative piritramide consumption was compared for pain relief during the first 24 h in patients recovering from arthroscopic knee surgery. Methods. 120 patients were treated with normal saline and/or one of the nonopioid analgesics (parecoxib, metamizole, paracetamol) in addition to piritramide using the PCA pump. Beginning in the postanesthesia care unit (PACU), patients were asked to quantify their pain experience at rest while piritramide consumption was recorded. Results. Piritramide consumption upon arrival in the PACU was high in all groups. However, cumulative consumption in the parecoxib group was significantly lower than that in the placebo group at 6 and 12 h after surgery. At discharge from the PACU, VAS scores dropped in all groups and were significantly lower in the parecoxib group. In the PACU, satisfaction of the patients was moderate and improved with time after surgery. Conclusions. There was statistically significant opioid-saving effect by administering parecoxib with better VAS scores and satisfaction level compared to placebo. The high pain score in the PACU in all groups immediately after recovering from remifentanil-based anesthesia would be prevented if local anesthetics were administered intra-articularly as part of a multimodal analgesic approach.
目的。在一项随机双盲试验中，比较了非阿片类镇痛药对关节镜膝关节手术后恢复患者术后头24小时内哌替啶用量的影响，以评估其镇痛效果。方法。120例患者除使用PCA泵给予哌替啶外，还接受生理盐水和/或一种非阿片类镇痛药（帕瑞昔布、安乃近、对乙酰氨基酚）治疗。从麻醉后护理单元（PACU）开始，要求患者在记录哌替啶用量的同时，对静息时的疼痛体验进行量化。结果。所有组在到达PACU时的哌替啶用量都很高。然而，帕瑞昔布组在术后6小时和12小时的累积用量显著低于安慰剂组。从PACU出院时，所有组的VAS评分均下降，且帕瑞昔布组显著更低。在PACU中，患者的满意度为中等，且术后随时间有所改善。结论。与安慰剂相比，给予帕瑞昔布具有统计学显著的节省阿片类药物的效果，VAS评分和满意度更高。如果在多模式镇痛方法中关节腔内注射局部麻醉药，可预防所有组在瑞芬太尼麻醉苏醒后即刻在PACU出现的高疼痛评分。
