Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, West Cancer Center, 7945 Wolf River Boulevard, Germantown, TN 38138, United States of America.
Gynecol Oncol. 2018 Oct;151(1):124-128. doi: 10.1016/j.ygyno.2018.08.015. Epub 2018 Aug 16.
Compare postoperative pain scores following hysterectomy in patients receiving perioperative celecoxib versus postoperative ketorolac as part of a multimodal pain regimen.
Patients undergoing hysterectomy were randomized to receive scheduled intravenous ketorolac in the immediate postoperative period or oral celecoxib prior to surgery and continued for a total seven days. All patients received a common multimodal pain protocol consisting of scheduled acetaminophen, gabapentin, and opioids as needed. Inpatient pain scores and postoperative opioid use were analyzed. A questionnaire regarding outpatient opioid use and return to normal activities of daily living (ADLs) was returned two weeks postoperatively.
192 patients were assessed for eligibility and 170 patients were randomized. Enrollment of patients undergoing open hysterectomy was closed prematurely for poor accruement (n = 32). 138 patients undergoing robotic hysterectomy were included were analyzed. There were no differences for inpatient pain scores (2.7 ± 1.9 v. 2.4 ± 1.6, p = 0.21). Average length of stay was similar between the two arms (11.6 ± 8.1 h v. 11.9 ± 7.6 h, p = 0.41). Patients in the celecoxib arm used less prescription opioids (6.0 ± 3.6 v. 8.1 ± 4.0, p = 0.001) and stopped using oral opioids earlier (3.8 ± 2.6 days v. 5.7 ± 2.8 days, p < 0.001). No differences were seen in inpatient opioid or anti-emetic usage, perioperative complications, or days to return to ADLs.
There was no difference in inpatient pain scores between patients who received celecoxib or ketorolac as part of multimodal pain control following robotic hysterectomy. Patients who received scheduled celecoxib for seven days after surgery used less prescription narcotics.
比较接受围手术期塞来昔布或术后酮咯酸作为多模式疼痛方案一部分的患者行子宫切除术的术后疼痛评分。
接受子宫切除术的患者被随机分配在术后立即接受计划静脉注射酮咯酸或手术前口服塞来昔布，并持续使用七天。所有患者均接受包括计划使用对乙酰氨基酚、加巴喷丁和按需使用阿片类药物的常见多模式疼痛方案。分析住院期间疼痛评分和术后阿片类药物使用情况。术后两周，患者返回一份关于门诊阿片类药物使用和恢复正常日常生活活动（ADL）的调查问卷。
对 192 名符合条件的患者进行了评估，170 名患者被随机分组。由于入组人数较少（n=32），提前关闭了开腹子宫切除术患者的入组。共纳入 138 名接受机器人子宫切除术的患者进行分析。两组患者的住院期间疼痛评分无差异（2.7±1.9 分比 2.4±1.6 分，p=0.21）。两组患者的平均住院时间相似（11.6±8.1 小时比 11.9±7.6 小时，p=0.41）。塞来昔布组患者使用的处方阿片类药物较少（6.0±3.6 分比 8.1±4.0 分，p=0.001），且更早停止使用口服阿片类药物（3.8±2.6 天比 5.7±2.8 天，p<0.001）。两组患者在住院期间阿片类药物或止吐药使用、围手术期并发症或恢复 ADL 的天数方面无差异。
在接受机器人子宫切除术的多模式疼痛控制方案中，接受塞来昔布或酮咯酸的患者的住院期间疼痛评分无差异。接受计划使用塞来昔布七天的患者术后使用的处方类阿片类药物较少。
