罗非昔布和依他昔布在妇科小手术中的预先性镇痛效果

目的比较环氧化酶-2(COX-2)抑制剂罗非昔布和依他昔布应用于妇科小手术的预先性镇痛效果.方法采用随机、双盲、安慰剂对照研究,选取在日间病房行妇科人工流产吸宫术的60例患者,将其随机分成3组,每组20例,分别在术前口服安慰剂、或罗非昔布50 mg、或依他昔布120 mg.术后15、30、60min及出院时,出院后6、24h分别记录患者的视觉模拟评分(VAS),对于镇痛不足的患者予以芬太尼(恢复室内)和扑热息痛(回家后),并记录其用量.术后24 h评估患者对镇痛治疗的满意度.结果在术后60min,依他昔布组VAS低于罗非昔布组(P＜0.05);术后6 h罗非昔布组和依他昔布组VAS评分显著低于安慰剂组(P＜0.05,P＜0.01).术后24 h罗非昔布组和依他昔布组均无患者主诉腹痛.其他时间点各组间VAS差异无显著性.各组患者在恢复室内芬太尼用量无差异,但患者回家后扑热息痛的用量罗非昔布组(0.2 g/人)和依他昔布组(0.05 g/人)明显低于安慰剂组(1.21g/人)(P＜0.01),且依他昔布组用量低于罗非昔布组(P＜0.05).各组患者的恢复过程差异无显著性.术后24 h依他昔布组镇痛满意度(96±7)显著高于其他两组(P＜0.01).结论在人工流产吸宫术患者术前应用罗非昔布和依他昔布可以降低术后6 h的VAS,并减少其他镇痛药物的用量,二者之间依他昔布的效果更加明显.

Comparison of preemptive analgesia efficacy between etoricoxib and rofecoxib in ambulatory gynecological surgery

OBJECTIVE: To compare the preemptive analgesia efficacy between two cycloxygenase-2 inhibitors, rofecoxib and etoricoxib in the ambulatory uterine evacuation patients. METHODS: In this randomized, double-blinded, placebo-controlled trial 60 patients were randomly divided into three groups and received a single dose of placebo, rofecoxib 50 mg, or etoricoxib 120 mg, respectively, before operation. Patient's visual analogue score (VAS) was rated postoperatively at 15 min, 30 min, 60 min, time-to-discharge, 6 h and 24 h. Fentanyl (in post-anesthesia care unit) and paracetamol (at home) were supplementary analgesics and the dosage was also recorded. Patient's satisfaction score was rated at 24 h postoperatively. RESULTS: Etoricoxib 120 mg and rofecoxib 50 mg were significantly superior to placebo at 6 h postoperatively (P < 0.05) while there was no significant differences of VAS at other time points. The amounts of Fentanyl used in post-anesthesia care unit were similar in three groups, but paracetamol taken at home was much less in rofecoxib group and etoricoxib group than in placebo group (P < 0.01). Compared to rofecoxib, etoricoxib provided better pain relief after discharge (P < 0.05). The overall pain management satisfaction score was significantly higher in etoricoxib group (96 +/- 7) than in other groups (P < 0.01). CONCLUSION: Preemptive rofecoxib 50 mg and etoricoxib 120 mg may significantly decrease VAS at 6 h postoperatively, and reduce the usage of analgesics in ambulatory uterine evacuation patients. Etoricoxib 120 mg offeres better pain relief at home compared with rofecoxib 50 mg.