Hanzawa Atsushi, Handa Toshiyuki, Kohkita Yoshihiko, Ichinohe Tatsuya, Fukuda Ken-Ichi
Department of Oral Health and Clinical Science, Division of Special Needs Dentistry and Orofacial Pain, Tokyo Dental College, Tokyo, Japan.
Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.
Anesth Prog. 2018 Spring;65(1):24-29. doi: 10.2344/anpr-65-01-02.
We compared the effects of preoperative administration of diclofenac sodium, celecoxib, and acetaminophen on postoperative pain in patients undergoing minor oral surgery under general anesthesia. One hundred twenty-eight patients were randomly divided into 4 groups preoperatively treated with diclofenac sodium 50 mg, celecoxib 400 mg, acetaminophen 1000 mg, or placebo. Postoperative pain was managed using intravenous patient-controlled infusion of fentanyl. Assessments included levels of postoperative pain by using visual analog scale (VAS) scores at 4, 5, and 6 hours after administration of the test drug; consumption of fentanyl up to each time point; and time to first requirement for fentanyl. Our study demonstrated that, for diclofenac sodium and celecoxib in comparison with placebo, there were significantly lower VAS scores at 4, 5, and 6 hours after oral administration of the study drug; a longer period of time to first requirement for fentanyl after surgery; and less consumption of postoperative fentanyl. A similar analgesic effect versus placebo was noted for acetaminophen but only at the 5- and 6-hour time points. In contrast, no significant differences in VAS scores at 4 hours after administration or time to first requirement for fentanyl were observed between acetaminophen and placebo. Furthermore, no significant differences in measurements were observed between the study drugs at any time point. These findings suggest that oral administration of celecoxib 400 mg is suitable for controlling postoperative pain, and as effective as diclofenac sodium 50 mg. Acetaminophen 1000 mg also exerts analgesic effect with slower onset for postoperative pain.
我们比较了术前给予双氯芬酸钠、塞来昔布和对乙酰氨基酚对全身麻醉下接受小型口腔手术患者术后疼痛的影响。128例患者术前随机分为4组，分别接受50mg双氯芬酸钠、400mg塞来昔布、1000mg对乙酰氨基酚或安慰剂治疗。术后疼痛采用静脉自控输注芬太尼进行管理。评估包括在给予受试药物后4、5和6小时使用视觉模拟量表（VAS）评分评估术后疼痛程度；每个时间点的芬太尼消耗量；以及首次需要芬太尼的时间。我们的研究表明，与安慰剂相比，双氯芬酸钠和塞来昔布在口服研究药物后4、5和6小时的VAS评分显著更低；术后首次需要芬太尼的时间更长；术后芬太尼消耗量更少。对乙酰氨基酚与安慰剂相比有类似的镇痛效果，但仅在5小时和6小时时间点。相比之下，对乙酰氨基酚和安慰剂在给药后4小时的VAS评分或首次需要芬太尼的时间上没有显著差异。此外，在任何时间点，受试药物之间的测量结果均未观察到显著差异。这些发现表明，口服400mg塞来昔布适用于控制术后疼痛，且与50mg双氯芬酸钠效果相当。1000mg对乙酰氨基酚也对术后疼痛发挥镇痛作用，起效较慢。
