Liaw W J, Day Y J, Wang J J, Ho S T
Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 1995 Jun;33(2):73-7.
Among surgical modalities for treatment of palmar hyperhidrosis, endoscopic sympathectomy is the most popular choice in recent years. After surgery, the major complaint was anterior chest pain. This study was conducted to evaluate the analgesic efficacy and side effects of tenoxicam (a thienothiazine derivative) in combination with patient-controlled analgesia (PCA) using morphine in patients who received thoracic endoscopic sympathectomy.
Forty-one ASA class I patients who underwent endoscopic sympathectomy (T2 and T3 ganglia) were randomly divided into two groups. Operation was conducted under general anesthesia with single lumen endotracheal intubation. No narcotic was given during the operation except for fentanyl (3 micrograms/kg) during induction. After surgery, patients in group I received PCA morphine only and patients in group II received PCA morphine plus tenoxicam (20 mg, i.v.) immediately for pain relief. In addition, rescue analgesia with intramuscular meperidine (1 mg/kg) was available to each patient every 4 h prn. The intensity of pain was assessed with VAS pain score every 4 h for 24 h. The frequency of demand and doses of delivered PCA morphine were recorded.
Results showed no statistically significant difference between groups in respect of age, body height, body weight and pain scores. However, based upon similar qualitative pain relief, patients in group II revealed less demand for analgesic, less doses of morphine requirement and less side effects.
Tenoxicam may be an effective adjuvant to PCA morphine for postoperative pain control. This combination reduces the total consumption of PCA morphine with less side effects.
在内科治疗手掌多汗症的手术方式中，近年来内镜下交感神经切除术是最受欢迎的选择。术后，主要的主诉是胸前区疼痛。本研究旨在评估替诺昔康（一种噻吩并噻嗪衍生物）联合患者自控镇痛（PCA）使用吗啡在接受胸腔镜交感神经切除术患者中的镇痛效果和副作用。
41例接受内镜下交感神经切除术（T2和T3神经节）的ASA I级患者被随机分为两组。手术在全身麻醉下单腔气管插管下进行。除诱导期给予芬太尼（3微克/千克）外，术中未给予麻醉剂。术后，I组患者仅接受PCA吗啡，II组患者立即接受PCA吗啡加替诺昔康（20毫克，静脉注射）以缓解疼痛。此外，每位患者每4小时按需可使用肌肉注射哌替啶（1毫克/千克）进行补救镇痛。每4小时用视觉模拟评分法（VAS）评估疼痛强度，共评估24小时。记录PCA吗啡的需求频率和给药剂量。
结果显示两组在年龄、身高、体重和疼痛评分方面无统计学显著差异。然而，基于相似的定性疼痛缓解情况，II组患者对镇痛剂的需求更少，吗啡需求量更低，副作用也更少。
替诺昔康可能是PCA吗啡用于术后疼痛控制的有效辅助药物。这种联合用药减少了PCA吗啡的总消耗量，且副作用更少。
