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哌替啶-酮咯酸联合用药在术后患者中比单独使用哌替啶提供更好的镇痛效果。

Meperidine-Ketorolac Combination Provides Better Analgesia than Meperidine Alone in Postoperative Patients.

作者信息

Umukoro Nelly N, Jamgbadi Shola S, Isamade Erdoo S

机构信息

Department of Anaesthesia, National Hospital Abuja, Abuja, Nigeria

Department of Anesthesiology, Indiana University Hospital, Indianapolis, USA.

出版信息

Clin Med Res. 2022 Aug 23;20(3):133-40. doi: 10.3121/cmr.2022.1628.

Abstract

BACKGROUND

Our study objective was to assess if multi-modal analgesia with meperidine-ketorolac combination provides superior analgesia or reduces opioid requirement following surgery compared to Meperidine alone.

DESIGN

Double-blind randomized controlled trial.

SETTING

Postoperative pain control in orthopedic ward after spinal anesthesia.

PATIENTS

American Society of Anesthesiology (ASA) risk I or II (ASA I/II) patients who had lower limb implant surgery (88) at our center from September 2014 to July 2015.

INTERVENTIONS

Patients were randomly assigned to receive either 1 mg/kg of intravenous (IV) meperidine and 30 mg of IV ketorolac (treatment group) or 1 mg/kg of IV meperidine (control group) post-surgery, administered every hour for the first 6 hours during the first 24 hours post-surgery. In addition, patients received intravenous meperidine on an 'as needed basis' during the first 24 hours of the postoperative period.

MEASUREMENTS

Outcomes were time-to-first analgesia request postoperatively; cumulative opioid dose in first 24 hours post-surgery; frequency of side effects; and patient satisfaction with pain relief using a Likert scale. Numerical rating scale (NRS) pain scores hourly for the first 6 hours, then the 8th, 12th, 16th, 18th and 24th hour post-surgery were assessed.

RESULTS

There was a significant delay in time of first request for analgesia (460 min vs 225 min; =0.03) and a reduction in opioid consumption in 24 hours (299 mg vs 325 mg; =0.01) in the meperidine/ketorolac group compared with the meperidine alone group which were both statistically significant. Patient satisfaction with pain relief was better in the treatment group (=0.01). Additionally, there were fewer side effects in the treatment group than in the control group but this was not statistically significant.

CONCLUSIONS

Adding ketorolac to meperidine reduced postoperative pain, reduced patient daily opioid requirement, increased patient satisfaction with pain relief, without increasing the frequency of side effects. Therefore, IV ketorolac addition to opioids may be a reasonable option in multimodal analgesic protocol.

摘要

背景

我们的研究目的是评估与单独使用哌替啶相比,哌替啶 - 酮咯酸联合多模式镇痛在术后是否能提供更好的镇痛效果或减少阿片类药物的用量。

设计

双盲随机对照试验。

设置

脊髓麻醉后骨科病房的术后疼痛控制。

患者

2014年9月至2015年7月在我们中心接受下肢植入手术的美国麻醉医师协会(ASA)I或II级(ASA I/II)患者(88例)。

干预措施

患者被随机分配在术后接受1mg/kg静脉注射(IV)哌替啶和30mg IV酮咯酸(治疗组)或1mg/kg IV哌替啶(对照组),术后前24小时的前6小时每小时给药一次。此外,患者在术后24小时内根据需要接受静脉注射哌替啶。

测量指标

结果包括术后首次镇痛需求时间;术后24小时内阿片类药物累积剂量;副作用发生频率以及使用李克特量表评估的患者对疼痛缓解的满意度。评估术后前6小时每小时、然后术后第8、12、16、18和24小时的数字评分量表(NRS)疼痛评分。

结果

与单独使用哌替啶组相比,哌替啶/酮咯酸组术后首次镇痛需求时间显著延迟(460分钟对225分钟;P = 0.03),24小时内阿片类药物消耗量减少(299mg对325mg;P = 0.01),两者均具有统计学意义。治疗组患者对疼痛缓解的满意度更高(P = 0.01)。此外,治疗组的副作用比对照组少,但这无统计学意义。

结论

在哌替啶中添加酮咯酸可减轻术后疼痛,减少患者每日阿片类药物需求量,提高患者对疼痛缓解的满意度,且不增加副作用发生频率。因此,在多模式镇痛方案中,静脉注射酮咯酸添加到阿片类药物中可能是一个合理的选择。

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