Bartfield J M, Kern A M, Raccio-Robak N, Snyder H S, Baevsky R H
Department of Emergency Medicine Albany Medical College, NY 12208 USA.
Acad Emerg Med. 1994 Nov-Dec;1(6):532-8. doi: 10.1111/j.1553-2712.1994.tb02548.x.
To assess the use of parenteral ketorolac tromethamine (KT) in the emergency department (ED).
During a six-month period, KT was administered in an uncontrolled, nonblinded fashion to a series of ED patients experiencing acute pain. The patients rated pain on a previously validated visual analog pain scale before receiving KT. They repeated this procedure one hour after KT administration, prior to additional analgesia, or preceding release, whichever came first. Analgesic response was assessed by comparing pretreatment and posttreatment pain scores for the entire study population by the Wilcoxon rank sum test. Possible effects of specific variables (patient age, gender, race, indication for KT, route, dose, previous use of NSAIDs, and concurrent administration of muscle relaxants) were assessed using the Kruskal-Wallis test.
Of the 445 patients enrolled, 375 (84%) reported pain relief with KT, only seven (2%) worsened, and the remainder (14%) reported no change. Overall pain reduction was 37.6 +/- 27.2 (SD) mm (100-mm scale) for the entire study population. The pain scores obtained after KT administration were significantly lower than those obtained prior to KT administration (p < 0.001). The only variable that significantly influenced pain score reduction was indication for KT (p = 0.001). Nephrolithiasis and toothache patients had the largest mean reductions in pain. No significant side effect was reported.
Parenteral KT is a useful and safe analgesic for ED patients. The agent generally provides analgesia and is particularly promising for patients with nephrolithiasis or toothache.
评估急诊部使用胃肠外注射酮咯酸氨丁三醇（KT）的情况。
在六个月期间，以非对照、非盲法对一系列经历急性疼痛的急诊患者给予KT。患者在接受KT前，根据先前验证的视觉模拟疼痛量表对疼痛进行评分。在KT给药后一小时、给予额外镇痛前或出院前（以先发生者为准），他们重复这一过程。通过Wilcoxon秩和检验比较整个研究人群治疗前和治疗后的疼痛评分，评估镇痛反应。使用Kruskal-Wallis检验评估特定变量（患者年龄、性别、种族、KT适应证、途径、剂量、既往非甾体抗炎药使用情况以及同时使用肌肉松弛剂）的可能影响。
在纳入的445例患者中，375例（84%）报告使用KT后疼痛缓解，仅7例（2%）疼痛加重，其余（14%）报告无变化。整个研究人群的总体疼痛减轻为37.6±27.2（标准差）mm（100mm量表）。KT给药后获得的疼痛评分显著低于给药前（p<0.001）。唯一显著影响疼痛评分降低的变量是KT适应证（p = 0.001）。肾结石和牙痛患者的平均疼痛减轻最大。未报告明显副作用。
胃肠外注射KT对急诊患者是一种有用且安全的镇痛药。该药物一般可提供镇痛效果，对肾结石或牙痛患者尤其有前景。
