超前镇痛在骨科术后疼痛治疗中的应用

Preemptive analgesia for orthopaedic postoperative pain management

目的研究超前镇痛在骨科术后疼痛治疗中的应用效果。方法 2010年5月至2011年1月,将收治入院行骨科手术的163例18～70岁各类骨折患者随机分成两组,试验组83例接受超前镇痛治疗:塞来昔布400 mg术前晚间顿服,术后帕瑞昔布每12小时40mg im应用2d,若镇痛效果不佳则给予曲马多100mg im,可反复给予;对照组80例接受常规镇痛治疗:患者疼痛评分≥4分时给予帕瑞昔布40 mg im,间隔12h可再用一次,镇痛效果不佳则给予曲马多100 mg im,可反复给予。术后2 d内每3小时对患者进行疼痛评分,记录每例患者的评分结果、曲马多使用量、对照组帕瑞昔布使用量及药物不良反应。结果试验组最高疼痛评分平均值明显低于对照组,两组统计学分析显示差异有统计学意义(P<0.01)。试验组曲马多平均使用量、药物不良反应明显低于对照组。对照组帕瑞昔布平均使用量低于试验组。结论塞来昔布及帕瑞昔布用于超前镇痛可显著减轻患者术后疼痛,药物不良反应轻微,值得临床推广应用。

Objective To evaluate the effect of preemptive analgesia for orthopaedic postoperative pain management. Methods From May 2010 to January 2011,163 catagmatic patients aged from 18 to 70 who needed operation were randomly divided into two groups：test group（83 patients）and control group（80 patients）.Test group were applied preemptive analgesia for pain management：400 mg celecoxib was given by oral the night before operation and 40 mg parecoxib was given by intramuscular twice a day and last for two days after operation.If the pain score was still≥4 fifteen minutes after parecoxib injection.100 mg tramadol was added by intramuscular and could be repeated.Control group were given normal pain management;40 mg parecoxib was given by intramuscular when the pain score was≥4.ana could be repeated in an interval of 12 hours.If the pain score was still≥4 fifteen minutes after parecoxib injection.100 mg tramadol was added by intramuscular and could be repeated.During the two days after operation,pain scores were evaluated every 3 hours,every patient＇s pain scores,usage amount of tramadol,usage amount of parecoxib of the control group and the side effect of the drugs were recorded.Results Compared with the control group,the patients in test group had significantly lowered pain scores in the average of maximal pain scores and the average of summation pain scores（P〈0.01）.The average usage of tramadol and the drug＇s side effect in test group were much lower than those in control group.The average usage of parecoxib in control group were lower than those in the test group.Conclusions Preemptive analgesia with the application of celecoxib and parecoxib can significantly reduce the postoperative pain of catagmatic patients without increasing the drug＇s side effect,it is worth clinical applying.