成人活体肝移植供体中，从吗啡联合酮咯酸自控镇痛过渡到吗啡联合帕瑞昔布自控镇痛的研究：单中心经验

Transitional Study of Patient-Controlled Analgesia Morphine With Ketorolac to Patient-Controlled Analgesia Morphine With Parecoxib Among Donors in Adult Living Donor Liver Transplantation: A Single-Center Experience.

作者信息

Lim K-I, Liu C-K, Chen C-L, Wang C-H, Huang C-J, Cheng K-W, Wu S-C, Shih T-H, Yang S-C, Lee Y-E, Jawan B, Juang S-E

机构信息

Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Liver Transplantation Program and Surgery, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

出版信息

Transplant Proc. 2016 May;48(4):1074-6. doi: 10.1016/j.transproceed.2015.11.021.

DOI:10.1016/j.transproceed.2015.11.021

PMID:27320560

Abstract

BACKGROUND

In this study, as our center transitions from using patient-controlled analgesia (PCA) morphine with intravenous (IV) ketorolac to PCA morphine with IV parecoxib, the two regimens are compared in terms of quality of pain control.

METHODS

Post-operative pain management sheets were collected retrospectively among the living donors of liver transplantation during this transitional period. Group parecoxib was given plain PCA morphine. A single dose of IV parecoxib 40 mg was given 30 minutes before the end of surgery. Group ketorolac was given PCA morphine pre-mixed ketorolac with a concentration of 1.87 mg/mL. Daily and total morphine consumption, Visual Analog Score (VAS), and number of rescue attempts made up to 3 post-operative days, together with satisfaction score and incidence of side effects of PCA usage, were analyzed and compared by means of the Mann-Whitney U test; a value of P < .05 was regarded as significant, and data are given as mean ± SD.

RESULTS

Fifty patients were analyzed; group 1 comprised 21 patients and group 2 comprised 29 patients. There was no difference between group 1 and group 2 in terms of daily VAS. PCA morphine requirements were significantly lower at day 2 and day 3 in group 1. However, the total overall morphine usage and satisfactory score was not statistically different (P = .863, P = .052).

CONCLUSIONS

A single dose of IV parecoxib 40 mg can provide satisfactory pain control when paired with PCA morphine for donors undergoing living donor liver transplantation. The use of parecoxib in the multimodal analgesia regimen has similar efficacy, with possibly less morphine consumption, when compared with ketorolac.

摘要

背景

在本研究中，随着我们中心从使用静脉注射（IV）酮咯酸的患者自控镇痛（PCA）吗啡过渡到使用IV帕瑞昔布的PCA吗啡，对这两种方案的疼痛控制质量进行了比较。

方法

回顾性收集此过渡期间活体肝移植供体的术后疼痛管理记录。帕瑞昔布组给予普通PCA吗啡。在手术结束前30分钟静脉注射40mg单剂量帕瑞昔布。酮咯酸组给予浓度为1.87mg/mL的PCA吗啡预混酮咯酸。通过Mann-Whitney U检验分析和比较术后3天内的每日和总吗啡消耗量、视觉模拟评分（VAS）、抢救次数，以及PCA使用的满意度评分和副作用发生率；P值<0.05被视为具有统计学意义，数据以平均值±标准差表示。