不同时间点应用氯诺昔康术后镇痛效果比较

背景非类固醇类抗炎药已经广泛应用于急性和慢性疼痛的治疗.氯诺昔康作为一种静脉应用的新型非类固醇类抗炎药,其在手术后疼痛治疗方面的研究还不是很深入.目的评价氯诺昔康分别在术前、术中和术后3个不同时间点给药的术后镇痛效果.设计完全随机对照研究,受试对象和术后观察者双盲.地点和对象本研究在中南大学湘雅三医院麻醉科完成,对象为2003-04/09住院已诊断为子宫肌瘤并拟行经腹子宫切除术患者60例.干预通过抽签的方法将受试对象随机分配为4组术前用药组,即在手术开始切皮前静脉注射氯诺昔康8 mg;术中用药组,即在手术中估计缝合皮肤前0.5 h静脉注射氯诺昔康8 mg;术后用药组,即在手术结束后4 h静脉注射氯诺昔康8 mg;对照组,即在进行术后疼痛评分前未给予任何镇痛药物.主要观察指标术后6 h采用视觉模拟评分法(VAS)评分,同时评价术后恶心、呕吐、嗜睡和尿潴留的发生率.结果术前用药组和术中用药组VAS评分较低,分别为1.53±0.56和1.18±0.44,与对照组VAS评分(6.43±0.69)相比有较好的镇痛效果(t=2.462,2.585,P＜0.05),而术后用药组的VAS评分较高(4.78±0.92),与对照组相比较,没有明显的统计学差异(P＞0.05).结论氯诺昔康在疼痛出现之前给药比在疼痛出现之后给药有较为确切的疗效.

Timing of lornoxicam administration in relation to its postoperative analgesic effects

BACKGROUND: Non-steroidal anti-inflammatory drugs are widely used in the clinical management of acute and chronic pain. The post-operative analgesic effect of lornoxicam, a new non-steroidal anti-inflammatory drug,has not been fully explored.OBJECTIVE: To compare post-operative analgesic effects of lornoxicam administered before, during and after the operation, respectively.DESIGN: A double-blinded randomized controlled trial was conducted.SETTING and PARTICIPANTS: Sixty female patients with uterine myoma scheduled for abdominal hysterectomy in the Third Xiangya Hospital of Central South University were enrolled in this study.INTERVENTIONS: The 60 female patients were randomly assigned into 4 equal groups by drawing lots, namely the preoperative group, in which the patients received intravenously lomoxicam(8 mg) precisely before the incision; intraoperative group, in which lornoxicam were given in the same manner 30 minutes before the end of operation; postoperative group, in which lornoxicam was administered 4 hours after operation. Another 15 patients constituted the control group without any analgesic interventions before evaluation of the postoperative pain.MAIN OUTCOME MEASURF S: All the 60 patients were visited 6 hours after operation to investigate the postoperative pain with visual analogne scales(VAS) . The occurrence of nausea, vomiting, dizziness and urinary retention were also assessed.RESULTS:In the preoperative and intraoperative groups, good postoperative analgesic effect was achieved with lower VAS scores(1.53 ±0. 56 and 1.18 ±0.44, respectively) than that in the control group(6. 43 ±0. 69, P ＜0. 05) . Postoperative group had a VAS score of 4. 78 ± 0. 92, showing no significant difference from that in the control group( P ＞ 0. 05).CONCLUSION: Lornoxicam has better postoperative analgesic effect when administered before the onset of pain, in comparison with its administration after that.