Yoshida Mitsuhiro, Shimizu Yoshitaka, Yoshida Keita, Mukai Akari, Doi Mitsuru, Irifune Masahiro
Lecturer, Section of Dental Anesthesiology, Department of Oral and Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan.
Assistant Professor, Department of Dental Anesthesiology, Program of Dental Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Oral Maxillofac Surg. 2018 Sep;76(9):1869-1872. doi: 10.1016/j.joms.2018.03.031. Epub 2018 Mar 28.
Management of postoperative pain is one of the most important components in postoperative care, because most patients have pain after dental surgery. The aim of this study was to evaluate whether acetaminophen could be an alternative to fentanyl in combination with a nonsteroidal anti-inflammatory drug (NSAID) as an analgesic after dental surgery in cases in which narcotic drugs were contraindicated.
Patients were 24- to 54-year-old men who underwent enucleation of a mandibular cyst under general anesthesia. The authors measured time from discontinuation of anesthetic administration until discharge from the operating room and postoperative pain during 4 hours after discharge. They compared these parameters between patients who were intravenously administered an NSAID such as flurbiprofen with fentanyl (NSAID/fentanyl group) and those administered an NSAID with acetaminophen (NSAID/acetaminophen group). Parametric data of time were analyzed using Student t test. Nonparametric data of the analgesic effect were analyzed using Mann-Whitney U test.
Time until discharge from the operating room after discontinuation of anesthetics in the NSAID/fentanyl group was significantly longer than that in the NSAID/acetaminophen group (P < .05). In contrast, there was no significant difference in analgesic effect between the NSAID/acetaminophen and NSAID/fentanyl groups (P > .05).
Although recovery time in the operating room of the flurbiprofen and acetaminophen group was markedly shorter than that of the flurbiprofen and fentanyl group, the postoperative analgesic effects of the 2 drugs were equipotent. Therefore, acetaminophen can be an alternative to fentanyl in cases in which narcotic drugs are contraindicated.
术后疼痛管理是术后护理中最重要的环节之一，因为大多数患者在牙科手术后会感到疼痛。本研究的目的是评估在麻醉药物禁忌的情况下，对乙酰氨基酚是否可作为芬太尼的替代品，与非甾体抗炎药（NSAID）联合用于牙科手术后的镇痛。
患者为24至54岁接受全身麻醉下下颌囊肿摘除术的男性。作者测量了从停止麻醉给药到离开手术室的时间以及出院后4小时内的术后疼痛情况。他们比较了静脉注射氟比洛芬等NSAID与芬太尼的患者（NSAID/芬太尼组）和静脉注射NSAID与对乙酰氨基酚的患者（NSAID/对乙酰氨基酚组）之间的这些参数。时间的参数数据采用Student t检验进行分析。镇痛效果的非参数数据采用Mann-Whitney U检验进行分析。
NSAID/芬太尼组停止麻醉后离开手术室的时间明显长于NSAID/对乙酰氨基酚组（P <.05）。相比之下，NSAID/对乙酰氨基酚组和NSAID/芬太尼组之间的镇痛效果没有显著差异（P >.05）。
尽管氟比洛芬和对乙酰氨基酚组在手术室的恢复时间明显短于氟比洛芬和芬太尼组，但两种药物的术后镇痛效果相当。因此，在麻醉药物禁忌的情况下，对乙酰氨基酚可作为芬太尼的替代品。
