White P F, Joshi G P, Carpenter R L, Fragen R J
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA.
Anesth Analg. 1997 Jul;85(1):37-43. doi: 10.1097/00000539-199707000-00007.
This multicenter study compared the analgesic efficacy and side effects of ketorolac and hydrocodone-acetaminophen when administered orally after ambulatory arthroscopic or laparoscopic tubal ligation procedures. After awakening from general anesthesia, 252 patients experiencing moderate or severe postoperative pain were randomly assigned to receive one of three analgesic treatments according to a placebo-controlled, double-blind protocol. Group 1 (n = 83) received oral ketorolac 10 mg every 6 h for up to 3 days, Group 2 (n = 82) received hydrocodone 7.5 mg plus acetaminophen 750 mg every 6 h for up to 3 days, and Group 3 (n = 87) received placebo capsules followed by ketorolac 10 mg every 6 h for up to 3 days. Severity of pain was recorded using a 4-point categorical score and visual analog scale (VAS) at 0.5 h and subsequently at hourly intervals for 6 h, as well as daily for up to 3 days. Pain relief was recorded using a 5-point categorical scale at the same time points. In the patients undergoing arthroscopic surgery, both ketorolac and hydromorphone-acetaminophen provided superior pain relief compared with the placebo. Although the categorical summed pain intensity difference (SPID), VAS SPID, and total pain relief scores were higher in the ketorolac group compared with the hydrocodone-acetaminophen group, the differences were not statistically significant. In the patients undergoing laparoscopic tubal ligation surgery, the three treatment groups displayed similar responses to the study medications. However, the ketorolac group scored higher in terms of overall tolerability than the hydrocodone-acetaminophen group. In conclusion, there was no difference in the efficacy between oral ketorolac and hydrocodone-acetaminophen combination in controlling pain after outpatient arthroscopic surgery procedures. Neither oral analgesic proved to be very effective after laparoscopic tubal ligation.
这项多中心研究比较了酮咯酸和氢可酮-对乙酰氨基酚在门诊关节镜或腹腔镜输卵管结扎手术后口服时的镇痛效果和副作用。全身麻醉苏醒后，252例中度或重度术后疼痛患者根据安慰剂对照、双盲方案随机分配接受三种镇痛治疗之一。第1组（n = 83）每6小时口服10 mg酮咯酸，最多服用3天；第2组（n = 82）每6小时口服7.5 mg氢可酮加750 mg对乙酰氨基酚，最多服用3天；第3组（n = 87）先服用安慰剂胶囊，然后每6小时口服10 mg酮咯酸，最多服用3天。使用4分分类评分和视觉模拟量表（VAS）在0.5小时记录疼痛严重程度，随后每小时记录一次，共记录6小时，以及每天记录一次，最多记录3天。在相同时间点使用5分分类量表记录疼痛缓解情况。在接受关节镜手术的患者中，与安慰剂相比，酮咯酸和氢吗啡酮-对乙酰氨基酚均提供了更好的疼痛缓解。虽然酮咯酸组的分类总疼痛强度差（SPID）、VAS SPID和总疼痛缓解评分高于氢可酮-对乙酰氨基酚组，但差异无统计学意义。在接受腹腔镜输卵管结扎手术的患者中，三个治疗组对研究药物的反应相似。然而，酮咯酸组在总体耐受性方面的得分高于氢可酮-对乙酰氨基酚组。总之，口服酮咯酸和氢可酮-对乙酰氨基酚组合在控制门诊关节镜手术后疼痛方面的疗效没有差异。两种口服镇痛药在腹腔镜输卵管结扎术后均未证明非常有效。
