Ilyas Asif M, Miller Andrew J, Graham Jack G, Matzon Jonas L
Orthopedics. 2019 Mar 1;42(2):110-115. doi: 10.3928/01477447-20190221-02. Epub 2019 Feb 27.
The goal of this study was to evaluate 3 common oral analgesics-oxycodone (OXY), ibuprofen (IBU), and acetaminophen (ACE)-for pain management following carpal tunnel release (CTR) and trigger finger release (TFR) surgery. Outcome measures were pain scores, capsule consumption patterns, and satisfaction. Carpal tunnel or trigger finger patients indicated to undergo primary, unilateral release received 10 capsules of either OXY (5 mg), IBU (600 mg), or ACE (500 mg) postoperatively. Medications were distributed in a randomized fashion, with both surgeons and patients blinded to the selected analgesic. Postoperatively, patients recorded pain level each day using a 0 to 10 visual analog scale, the number of capsules taken each day, and any adverse effects experienced. Medication distribution among the 188 patients completing the study was 62 OXY, 64 IBU, and 62 ACE. Surgical distribution was 76 TFR, 61 endoscopic CTR, and 51 open CTR. Overall, the mean total number of capsules consumed from postoperative days 0 through 5 for OXY, IBU, and ACE was 3.2, 4.0, and 3.1, respectively (P>.05). Mean worst daily pain score for the OXY, IBU, and ACE groups was 2.9, 2.5, and 2.5, respectively (P<.05). On subgroup analyses by procedure type, the only difference was found in the open CTR group, with the highest daily pain scores noted in the OXY group (P<.05). Nine of the 11 patients experiencing an adverse reaction also came from the OXY group. There were no reoperations or allergic reactions in any group. In this study, no clinically significant difference in pain experience or capsule consumption based on postoperative opioid vs nonopioid medication was identified. Adverse events were highest in the OXY group. In lieu of opioids, the authors suggest prescribing nonopioids first following TFR and CTR surgery. In addition, they advise prescribing 5 to 10 or fewer pills postoperatively regardless of the analgesic selected. [Orthopedics. 2019; 42(2):110-115.].
本研究的目的是评估三种常见口服镇痛药——羟考酮（OXY）、布洛芬（IBU）和对乙酰氨基酚（ACE）——用于腕管松解术（CTR）和扳机指松解术（TFR）术后的疼痛管理。观察指标为疼痛评分、胶囊服用模式和满意度。拟接受初次单侧松解术的腕管综合征或扳机指患者术后接受10粒OXY（5毫克）、IBU（600毫克）或ACE（500毫克）胶囊中的一种。药物以随机方式分发，外科医生和患者均对所选镇痛药不知情。术后，患者每天使用0至10的视觉模拟量表记录疼痛程度、每天服用的胶囊数量以及经历的任何不良反应。完成研究的188例患者中，药物分配情况为62例使用OXY，64例使用IBU，62例使用ACE。手术分布情况为76例TFR，61例内镜CTR，51例开放CTR。总体而言，术后0至5天，OXY、IBU和ACE的平均总胶囊服用量分别为3.2粒、4.0粒和3.1粒（P>0.05）。OXY、IBU和ACE组的平均每日最严重疼痛评分分别为2.9、2.5和2.5（P<0.05）。按手术类型进行亚组分析时，仅在开放CTR组中发现差异，OXY组的每日疼痛评分最高（P<0.05）。11例出现不良反应的患者中有9例也来自OXY组。任何组均未进行再次手术或出现过敏反应。在本研究中，未发现基于术后阿片类药物与非阿片类药物的疼痛体验或胶囊服用量存在临床显著差异。OXY组的不良事件发生率最高。作者建议，在TFR和CTR手术后，先开具非阿片类药物而非阿片类药物。此外，他们建议无论选择何种镇痛药，术后均开具5至10粒或更少的药丸。[《矫形外科学》。2019年；42(2):110 - 115。]
