氯诺昔康与帕瑞昔布钠在下肢骨科手术术后镇痛效果的比较

Comparation of analgesic effects of lornoxicam with parecoxib on lower limb surgery of orthopedics

目的比较氯诺昔康、帕瑞昔布钠联合阿片类镇痛药对下肢骨折手术患者术后镇痛效果。方法 90例拟行胫骨骨折手术患者均使用腰硬联合麻醉,根据术后镇痛方式不同随机分为三组:C组(对照组)手术结束后常规接上电子静脉镇痛泵镇痛。L组(氯诺昔康组)手术结束前静脉输注氯诺昔康8mg,连接电子静脉镇痛泵。镇痛泵中加入氯诺昔康32mg,其余配方同C组。P组(帕瑞昔布钠组)在手术结束后常规接上电子镇痛泵镇痛,回病房后肌肉注射注射帕瑞昔布钠40mg,术后继续给予40mg帕瑞昔布钠q12h,至术后48h。静脉镇痛泵的配方同C组。镇痛不足时由病房医生根据患者疼痛情况给予哌替啶50mg肌肉注射。记录三组术后4、8、12、24、36、48h的疼痛评分及副作用。记录三患者术后24h镇痛泵的芬太尼用量、按压总次数和有效次数。结果术后各个观察时点NRS评分C组和L组均显著高于P组(P<0.01),术后各个观察时点NRS评分C组与L组差异没有显著性(P>0.05)。术后镇痛泵按压次数和24h芬太尼用量C组和L组均显著大于P组(P<0.05)。结论对于术后中、重度疼痛的患者帕瑞昔布钠复合阿片类静脉镇痛较氯诺昔康能获得较为满意的镇痛效果。

Objectlve To compare the analgesic efficacy of lornoxicam with parecoxib combined opioid analgesics on lower limb surgery of orthopedics. Methods Totally 90 patients undergoing surgery of tibial fractures under combined epidural - spinal anesthesia were randomized to divided into three groups according to method of analgesia. Group C ： we provided all patients with a patient -controlled analgesia（PCA） pump via an i.v. line after operation. Group L：we provided all patients with lornoxicam 8mg before the operation was over and a PCA pump via an i.v. line after operation. The PCA pump was added lornoxicam 32mg, and the other drugs were same to group C in the PCA pump. Group P： we provided all patients with a PCA pump like group C via an i.v. line, parecoxib 40mg after operation and parecoxib 40 mg q12 h until 48h after operation. Adjuvant analgesic was IM pethidine. All patients documented pain intensity on a numerical rating scale （NRS）scores from 0 （no pain） to 10 （worst pain） at 4, 8, 12,24,36 and 48h after surgery. We documented postoperative fentanyl consumption, PCA button press times and effective button press times at 24h after surgery. Results There was significantly less NRS scores in group P comparing group C and group L at rest 4,8,12,24, 36,48h after surgery（ P 〈0. 01）. There was no significant difference of NRS scores in group C vs group L at 4,8,12, 24,36,48h after operation（ P 〉 0. 05）. The postoperative fentanyl consumption and PCA button press times in group C and group L were more than that of group P（ P 〈 0. 05）. Conclusions Parecoxib combined opioid analgesics is more effective in controlling postoperative severe pain than lornoxicam combined opioid analgesics in lower limb surgery of orthopedics.