Reuben S S, Steinberg R B, Kreitzer J M, Duprat K M
Department of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
Anesth Analg. 1995 Jul;81(1):110-3. doi: 10.1097/00000539-199507000-00022.
Nonsteroidal antiinflammatory drugs (NSAIDs) interfere with the synthesis of inflammatory mediators and can supplement postoperative pain relief. We postulated that using the parenterally available NSAID ketorolac (K) as a component of intravenous regional anesthesia (IVRA) would suppress intraoperative tourniquet pain and enhance postoperative analgesia. Sixty patients were assigned randomly and blindly to receive either intravenous (i.v.) saline and IVRA with 0.5% lidocaine, IV K and IVRA 0.5% lidocaine, or i.v. saline and IVRA 0.5% lidocaine with K. The patients who received IVRA K reported significantly less intraoperative tourniquet pain, with lower verbal analog pain scores at 15 and 30 min after tourniquet inflation. Similarly, IVRA-K patients experienced less postoperative pain with lower visual analog scale (VAS) pain scores at 30 and 60 min, and required no fentanyl for control of early postoperative pain in the postanesthesia care unit (PACU). They also required fewer analgesic tablets in the first 24 h (1.9 +/- 1.4 Tylenol No. 3 tablets compared to the other two groups, 4.6 +/- 1.3 and 3.0 +/- 1.1; P < 0.05). We conclude that K improves IVRA with 0.5% lidocaine both in terms of controlling intraoperative tourniquet pain and by diminishing postoperative pain.
非甾体抗炎药（NSAIDs）可干扰炎症介质的合成，并能增强术后疼痛缓解效果。我们推测，将胃肠外可用的非甾体抗炎药酮咯酸（K）用作静脉区域麻醉（IVRA）的一个组成部分，会抑制术中止血带疼痛并增强术后镇痛效果。60例患者被随机、盲法分配，分别接受静脉注射（i.v.）生理盐水加0.5%利多卡因的IVRA、静脉注射K加0.5%利多卡因的IVRA，或静脉注射生理盐水加含K的0.5%利多卡因的IVRA。接受含K的IVRA的患者术中止血带疼痛明显减轻，在止血带充气后15分钟和30分钟时的语言模拟疼痛评分较低。同样，接受含K的IVRA的患者术后疼痛较轻，在30分钟和60分钟时视觉模拟量表（VAS）疼痛评分较低，且在麻醉后护理单元（PACU）不需要芬太尼来控制术后早期疼痛。他们在术后24小时内所需的止痛片也较少（与其他两组相比，为1.9±1.4片泰诺3号片，其他两组分别为4.6±1.3片和3.0±1.1片；P<0.05）。我们得出结论，K在控制术中止血带疼痛和减轻术后疼痛方面均能改善0.5%利多卡因的IVRA效果。
