Morrison N A, Repka M X
Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD 21287-9009.
Ophthalmology. 1994 May;101(5):915-8. doi: 10.1016/s0161-6420(94)31238-3.
Ketorolac is a new, parenteral, nonsteroidal, anti-inflammatory agent. The authors compare the effectiveness of a single intravenous dose of ketorolac with a single oral dose of either acetaminophen or ibuprofen in controlling postoperative pain in patients with strabismus.
A prospective, randomized, double-masked study was performed on 60 patients older than 12 years of age who were undergoing strabismus surgery. The patients were randomized into one of three single-dosage treatment groups: group 1 received oral acetaminophen (650 mg); group 2 received oral ibuprofen (600 mg); and group 3 received intravenous ketorolac (60 mg) intraoperatively and placebo capsules postoperatively. Pain and sedation levels were assessed at 2 and 5 hours after surgery by having the patient mark a standard 100-mm visual analog scale.
The ketorolac-treated patients had significantly less pain at both the 2- and 5-hour intervals after surgery compared with either the acetaminophen or ibuprofen groups (P = 0.001). There was no difference in the level of sedation among any of the three treatment groups.
Intravenous ketorolac given at the conclusion of surgery was more effective than either oral acetaminophen or oral ibuprofen given 30 to 45 minutes after strabismus surgery in controlling postoperative pain. Pain relief was achieved earlier by intravenous delivery than by oral agents. Greater pain relief with ketorolac was sustained 5 hours after surgery. This facilitates suture adjustment and earlier discharge. Similar pain control is possible for other ophthalmologic surgery. Because the oral medications used in this study were administered in capsules, the results may have been different if clinically available preparations had been tested.
酮咯酸是一种新型的胃肠外非甾体抗炎药。作者比较了单剂量静脉注射酮咯酸与单剂量口服对乙酰氨基酚或布洛芬在控制斜视患者术后疼痛方面的有效性。
对60例12岁以上接受斜视手术的患者进行了一项前瞻性、随机、双盲研究。患者被随机分为三个单剂量治疗组之一：第1组口服对乙酰氨基酚（650毫克）；第2组口服布洛芬（600毫克）；第3组术中静脉注射酮咯酸（60毫克），术后服用安慰剂胶囊。术后2小时和5小时，通过让患者在标准的100毫米视觉模拟量表上标记来评估疼痛和镇静水平。
与对乙酰氨基酚组或布洛芬组相比，接受酮咯酸治疗的患者在术后2小时和5小时的疼痛明显减轻（P = 0.001）。三个治疗组之间的镇静水平没有差异。
在手术结束时静脉注射酮咯酸比斜视手术后30至45分钟口服对乙酰氨基酚或口服布洛芬在控制术后疼痛方面更有效。静脉给药比口服制剂更早实现疼痛缓解。酮咯酸在术后5小时持续提供更大程度的疼痛缓解。这有利于缝线调整和更早出院。其他眼科手术也可能实现类似的疼痛控制。由于本研究中使用的口服药物是以胶囊形式给药的，如果测试临床可用制剂，结果可能会有所不同。
