Nuutinen L S, Laitinen J O, Salomäki T E
Department of Anaesthesiology, University Hospital of Kuopio, Finland.
Drug Saf. 1993 Nov;9(5):380-93. doi: 10.2165/00002018-199309050-00006.
The inadequacy of pain treatment has been demonstrated in many patient groups suffering from acute pain. The injectable nonsteroidal anti-inflammatory drugs (NSAIDs), including indomethacin, diclofenac, ketoprofen and ketorolac, provide relief from the pain associated with several different conditions. When administered alone or in combination with low doses of opioids, NSAIDs provide good pain relief after musculoskeletal trauma or operation. The main advantage of these agents is that they may form the first-line therapy for pain relief and thus decrease the need of opioids. This avoids respiratory depression which can be associated with opioids. In contrast to opioids, NSAIDs do not cause respiratory depression or have marked adverse effects on the central nervous system. However, they may be associated with adverse effects of the gastrointestinal tract, liver and kidneys, and may increase pre- and postoperative bleeding and cause allergic reactions. These effects are related to the ability of NSAIDs to inhibit prostaglandin synthesis. Use of NSAIDs has to be considered carefully in patients with asthma, allergy to aspirin and NSAIDs, atopy, peptic ulcer or bleeding disorders (such as abnormalities in blood coagulation or coagulation deficits). These considerations are especially important in elderly patients. Having taken these contraindications into account, many clinical studies have demonstrated that NSAIDs are at least as safe as opioids when administered in the short term. However, few studies have specifically monitored adverse effects or included patients over 65 to 70 years of age. In addition, patients with risk factors have often been excluded from the trials. Therefore, the risk-benefit ratio of NSAIDs requires further assessment.
在许多遭受急性疼痛的患者群体中，疼痛治疗的不足已得到证实。可注射的非甾体抗炎药（NSAIDs），包括吲哚美辛、双氯芬酸、酮洛芬和酮咯酸，可缓解与多种不同病症相关的疼痛。单独使用或与低剂量阿片类药物联合使用时，NSAIDs在肌肉骨骼创伤或手术后能提供良好的疼痛缓解效果。这些药物的主要优点是它们可作为缓解疼痛的一线治疗方法，从而减少对阿片类药物的需求。这避免了可能与阿片类药物相关的呼吸抑制。与阿片类药物不同，NSAIDs不会引起呼吸抑制，也不会对中枢神经系统产生明显的不良反应。然而，它们可能与胃肠道、肝脏和肾脏的不良反应相关，可能增加术前和术后出血，并引起过敏反应。这些影响与NSAIDs抑制前列腺素合成的能力有关。对于患有哮喘、对阿司匹林和NSAIDs过敏、特应性、消化性溃疡或出血性疾病（如凝血异常或凝血缺陷）的患者，必须谨慎考虑使用NSAIDs。这些考虑在老年患者中尤为重要。考虑到这些禁忌症后，许多临床研究表明，短期使用时NSAIDs至少与阿片类药物一样安全。然而，很少有研究专门监测不良反应，或纳入65至70岁以上的患者。此外，有风险因素的患者通常被排除在试验之外。因此，NSAIDs的风险效益比需要进一步评估。
