Parke T J, Lowson S M, Uncles D R, Daughtery M O, Sitzman B T
Department of Anesthesiology, University of Virginia, Charlottesville 22908, USA.
Eur J Anaesthesiol. 1995 Nov;12(6):549-53.
Seventy-seven women who underwent routine vaginal or abdominal hysterectomy were randomly allocated to receive intravenous ketorolac 30 mg either 30 min before surgical incision (pre-emptive group, n = 37), or at the end of the surgical procedure (post-surgical group, n = 40). The patients received routine post-operative care, which included morphine by patient-controlled analgesia, 1 mg per demand with a lockout of 6 min and a background infusion of 1 mg h-1. In addition, pain was assessed at 12 and 24 h using a 100 mm visual analogue scale (VAS), both at rest and on coughing. At 24 h, the median VAS at rest was 24 mm (range 0-80) in the pre-emptive group and 28 mm (range 0-100) in the post-surgical group. The average morphine consumption rate over the first 24 h was 1.9 mg h-1 (SD +/- 0.6) in the pre-emptive group, and 2.2 mg hr-1 (SD +/- 1.1) in the post-surgical group. There were no significant differences on univariate testing. Subsidiary stepwise multiple regression modelling identified age, weight, type of hysterectomy, and the timing of ketorolac administration as significant explanators of post-operative morphine consumption. A statistically significant pre-emptive analgesic effect was therefore identifiable, but the clinical significance is uncertain in relation to the other influences on post-operative analgesic requirements.
77例行常规阴道或腹部子宫切除术的女性被随机分为两组，一组在手术切口前30分钟静脉注射30毫克酮咯酸（超前镇痛组，n = 37），另一组在手术结束时静脉注射30毫克酮咯酸（术后组，n = 40）。患者接受常规术后护理，包括患者自控镇痛使用吗啡，按需给予1毫克，锁定时间为6分钟，背景输注速度为1毫克/小时。此外，在术后12小时和24小时，使用100毫米视觉模拟评分法（VAS）评估静息和咳嗽时的疼痛程度。术后24小时，超前镇痛组静息时VAS中位数为24毫米（范围0 - 80），术后组为28毫米（范围0 - 100）。超前镇痛组术后首24小时吗啡平均消耗率为1.9毫克/小时（标准差±0.6），术后组为2.2毫克/小时（标准差±1.1）。单因素检验无显著差异。辅助逐步多元回归模型确定年龄、体重、子宫切除术类型和酮咯酸给药时间是术后吗啡消耗量的显著解释因素。因此，可以确定存在统计学上显著的超前镇痛效果，但相对于其他影响术后镇痛需求的因素，其临床意义尚不确定。
