Liu S M, Yue Y
Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2018 Dec 25;98(48):3930-3935. doi: 10.3760/cma.j.issn.0376-2491.2018.48.005.
To compare the analgesic efficacy between preoperative single-dose ketamine, a short-acting medicine and parecoxib, a long-acting medicine for reducing analgesic consumption in the first 24 h after-operation. Eighty-one patients from Beijing Chaoyang Hospital undergoing laparoscopic uterus surgery between April and December 2015 were randomly divided into three groups: control group (group C), ketamine group (group K) and parecoxib sodium group (group P). All patients were anesthetized with general anesthesia and received sufentanil-based patient-controlled intravenous analgesia (PCIA). After induction and 10 min before incision, patients in group K, P and C were injected with intravenous 0.5 mg/kg ketamine, 40 mg parecoxib and 2 ml normal saline, respectively. The primary outcome was sufentanil consumption within 1 h and 24 h after surgery. Other outcomes included the visual analog scale (VAS) pain score at 0, 15, 30, 45min and 1, 2, 4, 8, 24 h after surgery, PCIA effective trigger times, and adverse reactions. The postoperative sufentanil consumptions within 1 h in group K and P were(4.420±1.836)μg and (2.878±1.984)μg, respectively, and consumptions within 24 h were(28.200±3.712)μg and (25.511±4.037)μg, respectively, which were significantly less than that in group C with (6.144±2.346)μg within 1 h and (31.505±7.042)μg within 24 h (=15.360, 8.406, all <0.05). Patients in group P needed less sufentanil than group K in 1 h after surgery (<0.05), however, the difference was not statistically significant in 24 h(>0.05). The PCIA trigger times were 2(3.75) in group C, 0(1.50) in group K, and 0(1.00) in group P. Group K and P had less PCIA trigger times compared to group C (all <0.05). Compared to group C, group K and P had lower VAS scores at 0, 15, 30 min after surgery and group P had lower VAS scores at 1, 15, 30, 45 min, 2 h after surgery, respectively (all <0.05). There were no differences between groups in the incidence of any adverse effects(all >0.05). A single injection of short-acting ketamine before laparoscopic uterus surgery, has the same efficacy as long-acting parecoxib for opioid-sparing effect in the first 24 h after-operation. However, parecoxib has better analgesic effect in the early postoperative period.
比较术前单剂量短效药物氯胺酮与长效药物帕瑞昔布在减少术后24小时内镇痛药物使用量方面的镇痛效果。选取2015年4月至12月在北京朝阳医院行腹腔镜子宫手术的81例患者，随机分为三组：对照组（C组）、氯胺酮组（K组）和帕瑞昔布钠组（P组）。所有患者均采用全身麻醉，并接受以舒芬太尼为基础的患者自控静脉镇痛（PCIA）。诱导后且切口前10分钟，K组、P组和C组患者分别静脉注射0.5mg/kg氯胺酮、40mg帕瑞昔布和2ml生理盐水。主要观察指标为术后1小时和24小时内舒芬太尼的用量。其他观察指标包括术后0、15、30、45分钟及1、2、4、8、24小时的视觉模拟评分（VAS）疼痛评分、PCIA有效触发次数及不良反应。K组和P组术后1小时内舒芬太尼用量分别为（4.420±1.836）μg和（2.878±1.984）μg，24小时内用量分别为（28.200±3.712）μg和（25.511±4.037）μg，均显著低于C组的术后1小时内（6.144±2.346）μg和24小时内（31.505±7.042）μg（=15.360，8.406，均<0.05）。P组术后1小时所需舒芬太尼少于K组（<0.第5页共6页 05），但24小时时差异无统计学意义（>0.05）。C组PCIA触发次数为2（3.75）次，K组为0（1.50）次，P组为0（1.00）次。K组和P组的PCIA触发次数少于C组（均<0.05）。与C组相比，K组和P组术后0、15、30分钟时VAS评分较低，P组术后1、15、30、45分钟及2小时时VAS评分较低（均<0.05）。各组间任何不良反应的发生率均无差异（均>0.05）。腹腔镜子宫手术前单次注射短效氯胺酮与长效帕瑞昔布在术后24小时内的阿片类药物节省效果相同。然而，帕瑞昔布在术后早期的镇痛效果更好。
