Pavy T J, Gambling D R, Merrick P M, Douglas M J
Department of Anaesthesia, University of British Columbia, Vancouver, Canada.
Anaesth Intensive Care. 1995 Oct;23(5):555-9. doi: 10.1177/0310057X9502300504.
This double-blind, randomized study was designed to evaluate the use of indomethacin (Indocid, MSD) following caesarean delivery performed under spinal anaesthesia. Thirty ASA I-II women presenting for elective caesarean were recruited. Spinal anaesthesia was performed in a standard manner using hyperbaric bupivacaine, fentanyl and morphine. At the completion of surgery, subjects were administered two rectal suppositories, followed by 12-hourly suppositories for six doses (three days). The study group received 100 mg indomethacin suppositories and controls were given placebo (Anusol). Data collected included Visual Analog Scale (VAS) pain scores at rest and with movement, VAS scores for nausea and itch, and analgesic use. Demographic data were similar in the two groups. Median time to first analgesia (TTFA) was nine hours in the control group v. 39.5 hours in the indomethacin group (P < 0.003). Additional analgesic requests throughout the postoperative period were less in women who received indomethacin: 4 v 11 (P < 0.001). Women who received indomethacin had significantly less pain on the first postoperative day, especially on movement: mean VAS 1.4 v 5.1 (P < 0.00001). There were no reported adverse neonatal or maternal effects from the use of indomethacin. Rectal indomethacin use following caesarean delivery leads to significantly improved pain relief compared with placebo. The combination of spinal morphine and rectal indomethacin leads to high-quality postoperative analgesia.
这项双盲随机研究旨在评估在脊麻下行剖宫产术后使用吲哚美辛（消炎痛，默克雪兰诺公司生产）的效果。招募了30例拟行择期剖宫产的ASA I-II级女性患者。采用标准方法使用重比重布比卡因、芬太尼和吗啡进行脊麻。手术结束时，给受试者使用两枚直肠栓剂，随后每12小时使用一次栓剂，共六剂（三天）。研究组接受100毫克吲哚美辛栓剂，对照组给予安慰剂（安那素）。收集的数据包括静息和活动时的视觉模拟评分（VAS）疼痛评分、恶心和瘙痒的VAS评分以及镇痛药使用情况。两组的人口统计学数据相似。对照组首次镇痛的中位时间（TTFA）为9小时，而吲哚美辛组为39.5小时（P<0.003）。在整个术后期间，接受吲哚美辛治疗的女性额外的镇痛需求较少：4例对11例（P<0.001）。接受吲哚美辛治疗的女性在术后第一天疼痛明显减轻，尤其是活动时：平均VAS评分1.4对5.1（P<0.00001）。未报告使用吲哚美辛对新生儿或产妇有不良影响。剖宫产术后使用直肠吲哚美辛与安慰剂相比，能显著改善疼痛缓解情况。脊麻吗啡与直肠吲哚美辛联合使用可实现高质量的术后镇痛。
