Tauzin-Fin P, Delort-Laval S, Guenard Y, Krol-Houdek M C, Muscagorry J M, Maurette P
Département d'anesthésie-réanimation III, hôpital Pellegrin-Tondou, Bordeaux, France.
Ann Fr Anesth Reanim. 1996;15(1):41-6. doi: 10.1016/0750-7658(96)89401-9.
To compare the analgesic effect of subcutaneous buprenorphine alone and in combination with propacetamol and ketoprofen following urologic surgery.
Open randomized clinical trial.
Sixty ASA II/III patients undergoing urologic surgery.
The patients were randomized into three groups to receive either buprenorphine (0.3 mg subcutaneous) on demand (group 1, n = 20), or a combination of buprenorphine (0.3 mg)-propacetamol (2 g)-ketoprofen (100 mg) by intravenous route over 2 hours followed by an infusion of propacetamol (2 g) and ketoprofen (100 mg) at a constant rate over. The remaining 22 hours (group 2, n = 20), or the same loading dose as in group 2 prolonged by a continuous infusion of buprenorphine (0.3 mg), propacetamol (2 g) and ketoprofen (100 mg) over the same period (group 3, n = 20). Visual analogue scale pain scores (0-10) were assessed every hour during the 24 hours of the study. When the VAS score exceeded 5, an additional dose of 0.3 mg of buprenorphine was administered.
Groups were similar for age, surgery, anaesthesia and initial pain levels. Compared to group 1, the onset of analgesia was earlier in groups 2 and 3 at the 1st hour (P < 0.05); the level of analgesia was lower at the 3rd hour (P < 0.05). The maintenance of this analgesia level required constant buprenorphine administration. Buprenorphine requirements were decreased to 56% and 37% in groups 2 and 3 respectively, compared to group 1 (P < 0.05). Incidence of nausea and vomiting was lowered to 15% in group 3 (P < 0.05).
A combination of buprenorphine, propacetamol and ketoprofen provides effective postoperative analgesia with a low incidence of nausea and vomiting and decreased requirements of buprenorphine.
比较泌尿外科手术后皮下单独使用丁丙诺啡以及丁丙诺啡与对乙酰氨基酚和酮洛芬联合使用的镇痛效果。
开放性随机临床试验。
60例接受泌尿外科手术的美国麻醉医师协会（ASA）II/III级患者。
将患者随机分为三组，按需接受丁丙诺啡（0.3毫克皮下注射）（第1组，n = 20），或在2小时内静脉注射丁丙诺啡（0.3毫克）-对乙酰氨基酚（2克）-酮洛芬（100毫克），随后在剩余22小时内持续静脉输注对乙酰氨基酚（2克）和酮洛芬（100毫克）（第2组，n = 20），或与第2组相同的负荷剂量，但在同一时期持续输注丁丙诺啡（0.3毫克）、对乙酰氨基酚（2克）和酮洛芬（100毫克）（第3组，n = 20）。在研究的24小时内，每小时评估视觉模拟评分法（VAS）疼痛评分（0 - 10分）。当VAS评分超过5分时，额外给予0.3毫克丁丙诺啡。
三组患者在年龄、手术、麻醉和初始疼痛水平方面相似。与第1组相比第2组和第3组在第1小时镇痛起效更早（P < 0.05）；在第3小时镇痛水平更低（P < 0.05）。维持这种镇痛水平需要持续给予丁丙诺啡。与第1组相比，第2组和第3组丁丙诺啡需求量分别降至56%和37%（P < 0.05）。第3组恶心和呕吐发生率降至15%（P < 0.05）。
丁丙诺啡、对乙酰氨基酚和酮洛芬联合使用可提供有效的术后镇痛，恶心和呕吐发生率低，且丁丙诺啡需求量减少。
