Ramirez-Ruiz M, Smith I, White P F
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas 75235-9068, USA.
J Clin Anesth. 1995 Sep;7(6):481-5. doi: 10.1016/0952-8180(95)00058-p.
To evaluate the comparative efficacy and side effect profile of ketorolac 60 mg, dezocine 6 mg, and fentanyl 100 micrograms when used as analgesic supplements to a propofol infusion during monitored anesthesia care (MAC).
Randomized, double-blind, placebo-controlled study.
Ambulatory surgery facility at a university medical center.
80 outpatients undergoing breast biopsy or inguinal herniorraphy procedures under MAC.
All patients received midazolam 2 mg intravenously (IV) followed by 1 ml of the study medication containing either dezocine 3 mg IV, ketorolac 30 mg IV, fentanyl 50 micrograms IV, or normal saline. A propofol infusion was initiated at 75 micrograms/kg/min and then varied to maintain a stable level of sedation (i.e., Observer Assessment of Alertness/Sedation scale score of 3). An additional 1 ml of the same study medication was administered IV 2 to 3 minutes prior to infiltration of the local anesthetic solution. During the operation, supplemental (rescue) medication consisted of fentanyl 25 micrograms IV, bolus injections in all four treatment groups.
Propofol infusion and supplemental fentanyl dosage requirements, oxygen saturation values, respiratory rates, recovery times, and postoperative side effects were recorded. Visual analog scales were used to assess sedation, anxiety, pain, and nausea preoperatively (baseline), upon entry into the postanesthesia care unit, and at 30-minute intervals until discharge. The fentanyl and dezocine groups required lower average infusion rates of propofol to maintain a stable level of sedation than the control (saline) group. The saline and ketorolac groups required rescue analgesic medication more frequently and/or larger supplemental dosages of fentanyl than the two opioid analgesic treatment groups. Compared with the three analgesic treatment groups, postoperative pain scores were only marginally higher in the control group. Ketorolac-treated patients had consistently (but not significantly) shorter recovery times to oral intake, ambulation, and discharge than those in the dezocine or fentanyl groups. No postoperative nausea, vomiting, or pruritus was reported in the ketorolac group.
Compared with ketorolac 60 mg, fentanyl 100 micrograms and dezocine 6 mg produced a greater decrease in the propofol sedation requirement during MAC. However, the use of ketorolac in combination with propofol for MAC was associated with an improved recovery profile.
评估在麻醉监护（MAC）期间，60毫克酮咯酸、6毫克地佐辛和100微克芬太尼作为丙泊酚输注镇痛补充剂的相对疗效和副作用情况。
随机、双盲、安慰剂对照研究。
大学医学中心的门诊手术设施。
80例在MAC下接受乳房活检或腹股沟疝修补手术的门诊患者。
所有患者静脉注射2毫克咪达唑仑，随后静脉注射1毫升研究药物，其中包含3毫克地佐辛、30毫克酮咯酸、50微克芬太尼或生理盐水。以75微克/千克/分钟的速度开始丙泊酚输注，然后根据情况调整以维持稳定的镇静水平（即警觉/镇静观察量表评分为3）。在局部麻醉溶液浸润前2至3分钟，再静脉注射1毫升相同的研究药物。手术期间，补充（急救）药物为所有四个治疗组均静脉注射25微克芬太尼。
记录丙泊酚输注量、补充芬太尼剂量、血氧饱和度值、呼吸频率、恢复时间和术后副作用。使用视觉模拟量表在术前（基线）、进入麻醉后护理单元时以及直至出院每30分钟评估镇静、焦虑、疼痛和恶心情况。与对照组（生理盐水组）相比，芬太尼组和地佐辛组维持稳定镇静水平所需的丙泊酚平均输注率较低。与两个阿片类镇痛治疗组相比，生理盐水组和酮咯酸组更频繁地需要急救镇痛药物和/或更大剂量的补充芬太尼。与三个镇痛治疗组相比，对照组术后疼痛评分仅略高。与地佐辛组或芬太尼组相比，酮咯酸治疗的患者在恢复经口进食、行走和出院方面的时间持续较短（但无显著差异）。酮咯酸组未报告术后恶心、呕吐或瘙痒。
与60毫克酮咯酸相比，100微克芬太尼和6毫克地佐辛在MAC期间使丙泊酚镇静需求降低幅度更大。然而，酮咯酸与丙泊酚联合用于MAC与更好的恢复情况相关。
