Schug S A, Sidebotham D A, McGuinnety M, Thomas J, Fox L
Department of Pharmacology, School of Medicine, University of Auckland, New Zealand.
Anesth Analg. 1998 Aug;87(2):368-72. doi: 10.1097/00000539-199808000-00024.
Opioids play a fundamental role in the management of postoperative pain, but their use is associated with a number of side effects, including nausea and vomiting, sedation, and respiratory depression. Co-administration of a nonopioid has been proposed as a method of reducing opioid intake and minimizing side effects. Sixty-one ASA physical status I and II patients were enrolled in a double-blind, randomized, placebo-controlled, parallel study to investigate the effect of a combination of acetaminophen and morphine after open reduction and internal fixation of acute limb fractures. Patients were randomized to receive either oral acetaminophen (1 g every 4 h) or placebo as an adjuvant to morphine by patient-controlled analgesia (PCA) postoperatively. They were assessed daily for 72 h or until the PCA was discontinued according to standardized guidelines. The outcome variables collected were pain scores (11-point scale), amount of morphine self-administered, duration of PCA use, compliance with study design, incidence of nausea and sedation, and overall patient satisfaction. The acetaminophen group had lower pain scores on Day 1 (2.1 vs 3.3; P = 0.03) and a shorter average duration of PCA use (35.8 vs 45.5 h; P = 0.03). Overall patient satisfaction was also significantly greater in the acetaminophen group (8.7 vs 7.9; P = 0.04). These data suggest that acetaminophen is a useful adjunct to morphine PCA.
This study assesses the benefit of combining two analgesics for the treatment of postoperative pain. Such a combination improves the quality of pain relief and patient satisfaction.
阿片类药物在术后疼痛管理中发挥着重要作用，但其使用与多种副作用相关，包括恶心、呕吐、镇静和呼吸抑制。联合使用非阿片类药物已被提议作为减少阿片类药物摄入量并将副作用降至最低的一种方法。61例美国麻醉医师协会（ASA）身体状况为I级和II级的患者参与了一项双盲、随机、安慰剂对照、平行研究，以调查对急性肢体骨折进行切开复位内固定术后对乙酰氨基酚与吗啡联合使用的效果。患者被随机分组，术后通过患者自控镇痛（PCA）接受口服对乙酰氨基酚（每4小时1克）或安慰剂作为吗啡的辅助用药。根据标准化指南，对他们进行72小时的每日评估，或直至PCA停用。收集的结果变量包括疼痛评分（11分制）、自行使用吗啡的量、PCA使用时间、对研究设计的依从性、恶心和镇静的发生率以及患者总体满意度。对乙酰氨基酚组在第1天的疼痛评分较低（2.1对3.3；P = 0.03），且PCA的平均使用时间较短（35.8对45.
