依托考昔超前镇痛对阻生牙拔除术后疼痛的影响

Influence of preemptive analgesia with etoricoxib on three types of pain after extraction of impacted teeth

目的评估预防性使用依托考昔产生的超前镇痛对阻生牙拔除术后3种类型疼痛(伤口疼痛、咽喉疼痛、张口疼痛)的影响。方法选取武汉大学口腔医学院金银潭门诊部2020年5至10月收治的单侧下颌第三磨牙阻生患者60例(60颗),按照随机对照原则分为依托考昔组和对照组,每组30例(30颗)。术前30 min分别给予两组患者60 mg依托考昔或安慰剂维生素C片100 mg。通过数值评分法(numeric rating scale,NRS)统计患者在拔牙术后2、4、6、8、10、12、24 h疼痛评分,并记录24 h内使用应急镇痛药物的总剂量,Kaplan-Meier生存曲线和Log-Rank法比较两组患者术后首次应用应急镇痛药物的间隔时间及例数。结果手术后2、4、6、8、10、12、24 h依托考昔组患者伤口疼痛、咽喉疼痛及张口疼痛的NRS评分均显著低于对照组(P<0.05)。24 h内依托考昔组使用应急镇痛药物剂量[(0.7±0.7)粒]显著低于对照组[(1.4±0.9)粒](P<0.01)。Kaplan-Meier曲线表明依托考昔组首次应用镇痛药物的间隔时间(11.5 h)显著长于对照组(3.5 h)(P<0.01)。结论依托考昔具有显著的超前镇痛作用,能减少阻生牙拔除术后疼痛及应急镇痛药物的使用。

Objective To evaluate the effect of preventive use of etocoxib-induced preemptive analgesia on three types of pain(wound pain,swallowing pain,mouth opening pain)after extraction of impacted teeth.Methods In this study,60 patients(60 teeth)with impacted mandibular third molars in Department of Jinyintan Outpatient,School of Stomatology,Wuhan University from May to October 2020 were enrolled.The patients were numbered by SPSS 21.0 and randomly divided into two groups.The odd number was included in the etocoxib group,and the even number was included in the control group,with 30 cases in each group.Patients in the two groups were given etocoxib 60 mg or placebo vitamin C 100 mg 30 min before operation.Pain at 2,4,6,8,10,12,and 24 hours after tooth extraction was recorded with numeric rating scale(NRS)score.The total dose of ibuprofen rescue intake was recorded.Kaplan-Meier curves and Log-Rank analyses were used to evaluate the proportion of patients without rescue analgesic.Results The NRS scores of wound pain,swallowing pain and mouth opening pain in the etoricoxib group were lower than those in the control group within 24 hours after tooth extraction(P<0.05).The total dose of emergency analgesics in the etoricoxib group[(0.7±0.7)dose]was lower than that in the control group[(1.4±0.9)dose](P<0.01).The mean time between first application of analgesics was 11.5 hours in etoricoxib group and 3.5 hours in the placebo group,respectively(P<0.05).Conclusions This study revealed that etoricoxib has a substantial preemptive analgesic effect,resulting in the reduced use of analgesics after third molar removal.