静脉注射对乙酰氨基酚和布洛芬对腰椎间盘手术术后疼痛和吗啡消耗量的影响：前瞻性、随机、双盲、安慰剂对照临床试验。

Efficacy of Intravenous Paracetamol and Ibuprofen on Postoperative Pain and Morphine Consumption in Lumbar Disc Surgery: Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

机构信息

Department of Anesthesiology and Reanimation, Inonu University Medical Faculty, Malatya, Turkey.

出版信息

Neurochirurgie. 2021 Nov;67(6):533-539. doi: 10.1016/j.neuchi.2021.04.019. Epub 2021 May 11.

DOI:10.1016/j.neuchi.2021.04.019

PMID:33989641

Abstract

OBJECTIVES

Effective postoperative pain management after lumbar disc surgery reduces complications and improves postoperative care. The purpose of this prospective, randomized, double-blind, placebo-controlled clinical study is to evaluate the effects of IV paracetamol and ibuprofen on postoperative pain, morphine consumption and side effects of morphine in patients who underwent lumbar disc surgery.

MATERIALS AND METHODS

Seventy-five patients aged 18-85 years scheduled for lumbar disk surgery with a single level laminectomy included in this study. All patients received morphine with an IV patient-controlled analgesia device during the first postoperative 24hour. The patients were divided randomly and double-blinded into three groups (control, paracetamol and ibuprofen). The demographic characteristics and procedure data, VAS score, cumulative morphine consumption, opioid-related side effects were recorded.

RESULTS

There was no significant difference regarding to demographic characteristics, comorbidities, and durations of anesthesia and surgery. There was a significant difference between all groups regarding to total morphine consumption (P<0.001). IV ibuprofen significantly reduced the total morphine consumption in comparison with control and paracetamol (P<0.001). Repeated measures ANOVA showed in all periods of the study that VAS score was significantly lower in ibuprofen (P<0.001), but not in paracetamol (P=0.394) in comparison with control. There was no difference between groups regarding postoperative heart rate, mean arterial pressure, nausea-vomiting, pruritus and urinary retention.

CONCLUSIONS

This study showed that pain scores and morphine consumption, but not the side effects of patient-controlled analgesia during 24hours after the lumbar disk surgery, were significantly reduced by IV ibuprofen as a supplemental analgesic when compared with controls and paracetamols.

摘要

目的

腰椎手术后有效的术后疼痛管理可减少并发症并改善术后护理。本前瞻性、随机、双盲、安慰剂对照临床研究的目的是评估静脉注射对乙酰氨基酚和布洛芬对接受腰椎间盘手术患者术后疼痛、吗啡消耗和吗啡副作用的影响。

材料和方法

本研究纳入了 75 名年龄在 18-85 岁之间、拟行单节段椎板切除术的腰椎间盘手术患者。所有患者在术后 24 小时内均接受静脉自控镇痛装置给予吗啡。患者随机分为三组（对照组、对乙酰氨基酚组和布洛芬组）并进行双盲分组。记录患者的人口统计学特征和手术资料、视觉模拟评分（VAS）、累积吗啡用量、阿片类药物相关副作用。

结果

三组患者在人口统计学特征、合并症、麻醉和手术持续时间方面无显著差异。三组患者的总吗啡用量存在显著差异（P<0.001）。与对照组和对乙酰氨基酚组相比，静脉注射布洛芬组显著减少了总吗啡用量（P<0.001）。重复测量方差分析显示，在研究的所有时期，与对照组相比，布洛芬组的 VAS 评分均显著降低（P<0.001），而对乙酰氨基酚组则无差异（P=0.394）。三组患者的术后心率、平均动脉压、恶心呕吐、瘙痒和尿潴留发生率无差异。