Niemi L, Tuominen M, Pitkänen M, Rosenberg P H
Department of Anaesthesiology, Helsinki University Central Hospital, Finland.
Acta Anaesthesiol Scand. 1995 Jan;39(1):96-9. doi: 10.1111/j.1399-6576.1995.tb05599.x.
Non-steroidal anti-inflammatory drugs (NSAID) effectively reduce the need for opioid analgesia after various types of surgery. The efficacy of diclofenac and ketoprofen to relieve pain after maxillofacial surgery was compared in the present study. In a randomized and double-blind fashion, 90 ASA I-II patients (16-60 yrs) were studied, divided into three groups: Thirty patients received 1.0 mg.kg-1 diclofenac i.v. after general anaesthesia induction, before surgical incision, and four hours later the same dose was given i.m. Thirty patients received ketoprofen 1.35 mg.kg-1 i.v. and i.m., as above, and a third group of 30 patients received a comparable volume of saline i.v. and i.m. The patients received supplemental analgesia using a patient controlled analgesia apparatus; the rescue medication consisted of 0.03 mg.kg-1 oxycodone i.v. (four-hour maximum dose was 0.4 mg.kg-1) during the 24-hour follow-up. The three groups were comparable regarding the type of maxillofacial surgery (osteotomies vs. soft tissue surgery). Overall, there was a lower need for i.v. oxycodone during the 24-hour period in the diclofenac group (269 doses) than in the ketoprofen group and in the saline group (388 doses, each) (P < 0.01). The significantly lower number of oxycodone administrations in the diclofenac group was a result of a distinguishable difference, particularly during the first four hours after surgery. There was no statistically significant difference in the incidence of side effects of the analgesic therapy between the three groups.
非甾体抗炎药（NSAID）能有效减少各类手术后对阿片类镇痛药的需求。本研究比较了双氯芬酸和酮洛芬在颌面外科手术后缓解疼痛的疗效。以随机双盲方式对90例ASA I-II级患者（16 - 60岁）进行研究，分为三组：30例患者在全身麻醉诱导后、手术切口前静脉注射1.0 mg·kg-1双氯芬酸，4小时后肌肉注射相同剂量。30例患者按上述方法静脉注射和肌肉注射1.35 mg·kg-1酮洛芬，第三组30例患者静脉注射和肌肉注射等量生理盐水。患者使用患者自控镇痛装置进行补充镇痛；在24小时随访期间，急救药物为静脉注射0.03 mg·kg-1羟考酮（最大剂量为0.4 mg·kg-1）。三组在颌面外科手术类型（截骨术与软组织手术）方面具有可比性。总体而言，双氯芬酸组在24小时内静脉注射羟考酮的需求量（269剂）低于酮洛芬组和生理盐水组（每组388剂）（P < 0.01）。双氯芬酸组羟考酮给药次数显著减少是由于存在明显差异，尤其是在手术后的前四个小时。三组镇痛治疗副作用的发生率无统计学显著差异。
