Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
J Pain Res. 2013 May 28;6:419-24. doi: 10.2147/JPR.S44819. Print 2013.
Postoperative pain leads to patient discomfort, decreased level of satisfaction, prolonged recovery, and higher health costs. Acute pain control therefore improves the overall quality of life in patients undergoing cesarean section. Pain relief is a fundamental human right, but there is no gold standard for post-cesarean section pain management.
To compare the efficacy of pentazocine and tramadol used in unimodal and multimodal (in combination with piroxicam) approach, in the management of post-cesarean section pain.
This study employed a random allocation design to compare the effectiveness of intramuscular pentazocine (60 mg) or tramadol (100 mg) as single analgesic agent and in combination with daily intramuscular piroxicam 20 mg, for the management of post-cesarean section pain during the immediate 12 hours after surgery. The primary outcome measure was control of postoperative pain, while the secondary outcome measures were the analgesic agent onset of action, duration of action, patient satisfaction, and maternal and neonatal adverse outcomes. Data obtained were entered into a predesigned sheet and analyzed with the Statistical Package for Social Sciences version 17. Means ± standard deviation (SD) were calculated for the quantitative variables, and the difference between two independent groups was compared using unpaired Student's t-test. The level of significance was set at 0.05.
A total of 120 patients were equally and randomly allocated to four study groups - two that received unimodal analgesia (the pentazocine group and the tramadol group) and two that received multimodal analgesia (the pentazocine-piroxicam group and the tramadol-piroxicam group). Among the unimodal groups, tramadol had a faster onset of action, but pentazocine had a longer duration of action and provided better control of pain. Among the multimodal groups, the combination of pentazocine with piroxicam was superior to the tramadol with piroxicam combination, and it was also more effective than pentazocine alone.
The multimodal approach of combining pentazocine with piroxicam is a safe, effective, and an acceptable mode of analgesia for post-cesarean section pain management, especially in a resource-constrained setting.
术后疼痛会导致患者不适、满意度降低、恢复时间延长和医疗费用增加。因此，控制急性疼痛可以提高剖宫产患者的整体生活质量。缓解疼痛是一项基本人权，但剖宫产术后疼痛管理尚无金标准。
比较匹罗昔康联合曲马多与单独使用（联合或不联合曲马多）用于剖宫产术后镇痛的效果。
本研究采用随机分组设计，比较肌肉注射哌替啶（60mg）或曲马多（100mg）作为单一镇痛药物，以及联合每日肌肉注射吡罗昔康 20mg 用于管理剖宫产术后 12 小时内的疼痛。主要结局指标为术后疼痛控制情况，次要结局指标为镇痛起效时间、作用持续时间、患者满意度以及母婴不良结局。所得数据输入预先设计的表格中，使用 SPSS 17 版统计软件包进行分析。定量变量计算均数±标准差（SD），采用配对 t 检验比较两组间差异。检验水准为 0.05。
共纳入 120 例患者，随机等分为四组，分别接受单纯镇痛（哌替啶组和曲马多组）或联合镇痛（哌替啶-吡罗昔康组和曲马多-吡罗昔康组）。在单纯镇痛组中，曲马多的起效时间较快，但哌替啶的作用持续时间较长，疼痛控制效果更好。在联合镇痛组中，哌替啶联合吡罗昔康的效果优于曲马多联合吡罗昔康，且优于单独使用哌替啶。
在资源有限的情况下，联合使用哌替啶和吡罗昔康的多模式镇痛是一种安全、有效且可接受的剖宫产术后镇痛方法。
