静脉氟比洛芬酯与硬膜外曲马多用于剖宫产术后疼痛的镇痛效果比较

Comparison of intravenous flurbiprofen axetil and epidural tramadol for postoperative pain after cesarean section

目的比较静脉注射氟比洛芬酯和硬膜外注射曲马多单独和联合应用的4种用药方式对剖宫产手术术后疼痛的镇痛效果。方法80例在腰麻硬膜外联合阻滞下行择期剖宫产的产妇被随机分为4组,每组20例:FT组在胎儿娩出夹闭脐带即刻(T1)静脉注射氟比洛芬酯50mg,关腹膜时(T2)硬膜外注射曲马多100mg;FF组在T1和T2时点分别静脉注射氟比洛芬酯50mg;T组仅在T2时点硬膜外注射曲马多100mg;F组仅在T2静脉注射氟比洛芬酯50mg。观察术后2、4、8、12、24h的疼痛视觉模拟评分(visual analog scales,VAS),记录术后需要实施补救镇痛的产妇例数及补救镇痛的次数,记录产妇24h内恶心或呕吐的情况及泌乳发动时间。结果4组产妇术后2h的VAS比较无统计学差异,而术后4、8、12和24hFF组明显低于其余3组(P<0.05),而其余3组间差异无统计学意义。F组有7例,T组有4例,FT组有2例术后使用镇痛药,FF组无产妇术后需要补救镇痛,4组比较有统计学差异(P=0.0149)。恶心呕吐的发生率4组间差异无统计学意义。4组产妇术后泌乳发动时间比较无统计学差异(F=0.54,P=0.657)。结论剖宫产手术胎儿娩出即刻及关腹时分别给予静脉氟比洛芬酯脂微球注射液能有效缓解术后疼痛,减少术后镇痛药的需要,是一种安全有效的镇痛方法。

Objective To assess the effect and safety of mono and combination of intravenous flurbiprofen axetil （FP） and epidural tramadol on postoperative pain after cesarean section. Methods Eighty parturients undergoing selected cesarean section with combined epidural spinal anesthesia were randomly allocated into 4 groups （n=20 in each）： Group FT treated with intravenous FP 50 mg immediately after the umbilical cord was clamped （T1） and epidural tramadol at the time of suturing peritonaeum （T2）; Group FF treated with intravenous FP 50 mg at T1 and T2; Group T treated with epidural tramadol 100 mg at T2, and Group F treated with FP 50 mg at T2. Postoperative pain was assessed by parturients using visual analog scales （VAS） at 2, 4, 8, 12, 24 h after surgery. The cases that patients required rescued analgesia were recorded as well as the times of analgesics administration. The events of nausea and vomiting within 24 hours as well as the time of first breast-feeding were observed. Results All groups were similar in VAS at 2 hours after surgery, but were statistically significant different at 4, 8, 12 and 24 hours. Group FF showed significant lower VAS than the other 3 groups. However, no significant difference of VAS was observed among the other 3 groups. Rescued analgesia was administered once after surgery to 7 cases in Group F, 4 in Group T, and 2 in Group FT. No patient in Group FF required rescued analgesia. There was significant difference in the rate of rescued analgesia post surgery among the 4 groups （P=0.0149）. No significance in the incidence of nausea and vomiting was observed in 4 groups. There was no significant difference in the time of first breast-feeding after surgery in the 4 groups （F=0.54,P=0.657）. Conclusions Intravenous flurbiprofen axetil administration immediately after the umbilical cord is clamped and at the time of closing peritonaeum in cesarean section could relieve postoperative pain and reduce postoperative rescue analgesic requirement without increasing the incidence of nausea and vomiting.