Kim Jin Hyung, Jang Sun Young, Kim Myung Jin, Lee Sang Yeul, Yoon Jin Sook
The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
Korean J Ophthalmol. 2013 Aug;27(4):229-34. doi: 10.3341/kjo.2013.27.4.229. Epub 2013 Jul 18.
To investigate the analgesic effect and incidence of postoperative nausea and vomiting (PONV) between the opioid fentanyl and the non-steroidal anti-inflammatory drug ketorolac in patients who underwent eye amputation surgery.
Retrospective observational case series. Eighty-two patients underwent evisceration or enucleation surgery by one surgeon over a 2-year period. Fentanyl by intravenous patient-controlled analgesia (IV-PCA) at 20 µg/kg with 12 mg/kg ondansetron or intravenous ketorolac at 2 mg/kg/day was administered to patients at postoperative days 0, 1, and 2. The pain score was measured using an 11-point visual analog scale (VAS). The incidence of severe nausea requiring anti-emetics and the incidence of vomiting were reviewed.
The mean postoperative VAS in the fentanyl group was significantly lower than that in the ketorolac group on the day of operation for both types of surgery (p = 0.001 and p = 0.004, respectively). At postoperative days 1 and 2, the mean VAS was not different between the two groups for either surgical type (p > 0.05 for both days). The mean VAS was significantly higher in eviscerated patients than in enucleated patients at postoperative days 0 and 1 in the fentanyl group (p = 0.023 and p = 0.016, respectively). However, this was not observed in the ketorolac group. The incidence of PONV was higher in the fentanyl group than in the ketorolac group, although this was not statistically significant for either surgical type (p > 0.05 for both groups).
Fentanyl was more effective as an analgesic than was ketorolac on the day of operation for both surgical types. There was no difference between the two analgesics on postoperative day 1. The analgesic effect of fentanyl in enucleated patients was significantly higher than in eviscerated patients at postoperative days 0 and 1. The use of fentanyl by IV-PCA was associated with greater PONV despite co-administration with anti-emetics, although this finding was not significant.
研究阿片类药物芬太尼与非甾体抗炎药酮咯酸在接受眼球摘除手术患者中的镇痛效果及术后恶心呕吐（PONV）的发生率。
回顾性观察病例系列研究。在2年期间，由一名外科医生对82例患者进行了眼内容剜除术或眼球摘除术。术后第0、1和2天，对患者采用静脉自控镇痛（IV-PCA）给予20μg/kg芬太尼加12mg/kg昂丹司琼，或静脉给予2mg/kg/天酮咯酸。使用11点视觉模拟量表（VAS）测量疼痛评分。回顾需要使用止吐药的严重恶心发生率和呕吐发生率。
对于两种手术类型，芬太尼组术后第1天的平均VAS均显著低于酮咯酸组（分别为p = 0.001和p = 0.004）。在术后第1天和第2天，两种手术类型的两组之间平均VAS无差异（两天p均>0.05）。在芬太尼组，术后第0天和第1天，眼内容剜除术患者的平均VAS显著高于眼球摘除术患者（分别为p = 0.023和p = 0.016）。然而，在酮咯酸组未观察到这种情况。芬太尼组的PONV发生率高于酮咯酸组，尽管两种手术类型的差异均无统计学意义（两组p均>0.05）。
对于两种手术类型，芬太尼在手术当天作为镇痛药比酮咯酸更有效。术后第1天两种镇痛药之间无差异。在术后第0天和第1天，芬太尼对眼球摘除术患者的镇痛效果显著高于眼内容剜除术患者。尽管联合使用了止吐药，但IV-PCA使用芬太尼与更高的PONV相关，尽管这一发现并不显著。
