Intramuscular ketorolac versus oral ibuprofen for pain relief in first-trimester surgical abortion: a randomized clinical trial

Objective

Oral nonsteroidal antiinflammatory medications (NSAIDs) have been shown to reduce pain with first-trimester surgical abortion compared to placebo, but it is unclear if one NSAID is better than another. Some providers administer intramuscular ketorolac, though data regarding its efficacy in abortion are limited. This study was designed to compare oral ibuprofen to intramuscular ketorolac for pain management during first-trimester surgical abortion.

Study Design

This was a randomized, double-blind, controlled trial. Women undergoing first-trimester surgical abortion with local anesthesia were randomized to preprocedural oral ibuprofen, 800 mg given 60–90 min preprocedure, or intramuscular ketorolac, 60 mg given 30–60 min preprocedure. The primary outcome was pain with uterine aspiration on a 21-point, 0–100, numerical rating scale. Secondary outcomes included pain with cervical dilation, postoperative pain and patient satisfaction.

Results

Ninety-four women were enrolled; 47 were randomized to ibuprofen and 47 to ketorolac. The groups did not differ with regards to demographics, reproductive history or Depression Anxiety Stress Scale scores. Mean pain scores for suction curettage did not differ between groups (52.3 vs. 56.2, p=.53). There was also no difference in pain with cervical dilation (41.6 vs. 45.4, p=0.48) or postoperative pain (22.3 vs. 15.0 p=.076), though patients in the ketorolac group experienced significantly greater arm pain than those who received a placebo injection (30.4 vs. 15.6, p<.001). Satisfaction with pain control did not differ significantly by group.

Conclusions

Intramuscular ketorolac does not offer superior pain control compared to oral ibuprofen for first-trimester surgical abortion.

Implications

Intramuscular ketorolac does not offer superior pain control over oral ibuprofen during first-trimester surgical abortion, is more expensive and causes patients significant arm discomfort. Its use should therefore be reserved for patients who cannot tolerate oral NSAIDs.     

A randomized controlled trial comparing the efficacies of ketorolac and parecoxib for early pain management after total knee arthroplasty

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to reduce pain after orthopedic surgery. Currently, selective COX-2 inhibitors can provide effective pain reduction with less platelet inhibition compared with conventional NSAIDs. We aimed to compare the analgesic effect and perioperative blood loss (PBL) after total knee arthroplasty (TKA) between ketorolac and parecoxib administration.MethodsWe conducted a prospective randomized controlled study of 100 unilateral TKAs. The ketorolac group of 50 patients received an intraoperative periarticular injection (PAI) with 100 mg of bupivacaine and 30 mg of ketorolac. Afterwards, 30 mg of ketorolac was intravenously injected every 12 h until 48 h. In the parecoxib group of 50 patients, 20 mg of parecoxib was added to PAI, and the first intravenous dose was 20 mg followed by 40 mg every 12 h. The primary outcomes were visual analog scales (VASs) of postoperative pain, amount of morphine consumption, PBL, and blood transfusion rate.ResultsThe ketorolac group had a significantly lower VAS pain score than the parecoxib group at 6 h after TKA (2.38 ± 2.52 vs. 4.12 ± 2.86, P < 0.01). Thereafter, the VAS of both groups and total morphine consumption at 24 and 48 h were comparable. The PBLs of the ketorolac and parecoxib groups were 529.72 ± 263.02 and 402.40 ± 191.47 ml, respectively (P = 0.01). However, the blood transfusion rates between groups were not different.ConclusionParecoxib provides comparable analgesic effects to ketorolac. Additionally, perioperative use of parecoxib is safe and is associated with significantly less blood loss after TKA.     

羟考酮降低剖宫产术中卡前列素氨丁三醇所致不良反应的效果

目的观察羟考酮降低剖宫产术中卡前列素氨丁三醇不良反应的效果。方法选取2018年3月至2019年3月廊坊市第四人民医院产科诊治的80例宫缩乏力剖宫产产妇为研究对象,将其随机分为观察组和对照组,每组40例产妇。两组产妇均于胎儿娩出后立即行卡前列素氨丁三醇250μg宫体注射。观察组产妇镇痛泵输入0.5mg·kg-1羟考酮,对照组产妇于胎儿娩出后静脉注射生理盐水2 mL。观察两组产妇卡前列素氨丁三醇注射后2 min(T1)、5 min(T2)、10 min(T3)平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)。记录两组产妇术后6h、12h、24h时的视觉模拟疼痛评分(visual analogue scale,VAS)静息痛评分和Ramsay镇静评分,以及两组产妇不良反应发生情况。结果①两组产妇T1、T3时MAP、HR、SpO2比较,其差异均无统计学意义(均P>0.05),观察组产妇T2时MAP、HR明显低于对照组产妇,其差异均具有统计学意义(均P<0.05)。②观察组产妇6h、12h、24 h时的VAS评分明显低于对照组产妇,其差异均具有统计学意义(均P<0.05);12h时的Ramsay评分明显高于对照组产妇,其差异具有统计学意义(P<0.05)。③观察组产妇恶心、呕吐、面部潮红、胸闷憋气、血压升高、头痛眩晕的发生率明显低于对照组产妇,其差异均具有统计学意义(均P<0.05)。结论羟考酮对剖宫产术中卡前列素氨丁三醇所致的不良反应有一定防治作用,有利于产妇生命体征的稳定,具有确切的镇痛和镇静效果。     

不同选择性环氧合酶抑制剂对瑞芬太尼麻醉后痛觉过敏的影响

目的探讨不同选择性环氧合酶抑制剂对瑞芬太尼麻醉后痛觉过敏的影响。方法选择瑞芬太尼维持的全麻下行全子宫切除术的患者60例,根据麻醉诱导前15 min用药不同分为2组,A组30例给予帕瑞昔布钠40mg,B组30例给予酮咯酸氨丁三醇30 mg,观察术后15、30 min的疼痛评分和术后4、8、12、24 h的疼痛评分,病人自控镇痛(PCA)按压次数、镇痛药物消耗量。结果 A组在术后15 min疼痛评分小于B组(P<0.05);术后4 h内A组的镇痛药物消耗量和PCA按压次数均少于B组(P<0.05)。结论麻醉诱导前给予帕瑞昔布钠相比酮咯酸氨丁三醇能更有效地抑制瑞芬太尼所致的痛觉过敏。     

酮咯酸氨丁三醇联合间苯三酚治疗肾绞痛的分析

目的:观察酮咯酸氨丁三醇联合间苯三酚治疗肾绞痛的疗效.方法:121例肾绞痛患者随机分为治疗组61例和对照组60例.治疗组给予肌肉注射酮咯酸氨丁三醇60 mg,随后予间苯三酚40mg静脉滴注;对照组给予肌肉注射曲马多100 mg,后予山莨胆碱10 mg静脉滴注.分别观察2组用药后30～60 min的镇痛效果、不良反应和6...     

急性疼痛前列腺素与VAS疼痛评分的相关性研究

目的:观察由于手术造成组织损伤所致急性疼痛的程度与前列腺素水平是否相关。方法:选择ASAI~II级的择期妇科手术病人80例,随机分为:前列腺素抑制组(K组,n=40),无前列腺素抑制组(N组,n=40)。两组患者均分别于手术开始前5min静脉给予酮洛酸(Ketorolac)30mg及等容积生理盐水,而后均在手术结束时(t1)、术后4h(t2)和术后24h(t3)抽取静脉血2mL,采用放免法测定血浆6-Keto-PGF1а浓度;并在术后4h、24h进行镇痛效果评价(VAS评分)。结果:①N组各时间点血浆6-Keto-PGF1а浓度明显高于K组,有统计学意义;②N组各时间点VAS疼痛评分明显高于K组,有统计学意义。结论:手术创伤所致疼痛与机体前列腺素水平具有明显相关性,抑制前列腺素水平可以有效控制术后疼痛。     

酮咯酸氨丁三醇联合舒芬太尼用于子宫全切术后镇痛的研究

目的：在妇科子宫全切术中联合应用酮咯酸氨丁三醇和舒芬太尼静脉自控镇痛（PICA）,评价其镇痛效果及临床可行性。方法：选择妇科子宫全切术术后行静脉自控镇痛患者40例,随机分为两组,舒芬太尼组（A组）20例,舒芬太尼复合酮咯酸氨丁三醇组（B组）20例。术后24h持续监测SpO2、ECG、NBP,并进行VAS评分,观察可能出现的不良反应。结果：两组镇痛效果比较,无显著性差异（P〉0.05）,但B组患者头昏、恶心、呕吐以及瘙痒等副作用明显低于A组（P〈0.05）。结论：舒芬太尼复合酮咯酸氨丁三醇与单纯舒芬太尼比较,能明显减弱舒芬太尼产生的头昏、恶心、呕吐以及瘙痒等副作用,并且可以增强舒芬太尼的镇痛效果,减少舒芬太尼的用量。     

宫体注射卡前列素氨丁三醇治疗低蛋白血症伴宫缩乏力性产后出血的临床研究

目的观察宫体注射卡前列素氨丁三醇注射液治疗低蛋白血症伴宫缩乏力性产后出血的临床疗效。方法将100例低蛋白血症伴宫缩乏力性产后出血患者分成对照组和观察组各50例,对照组给予常规治疗;观察组在对照组治疗方式的基础上,给予宫体注射卡前列素氨丁三醇注射液治疗。观察2组疗效、产后出血情况及不良反应。结果观察组总有效率96.00%,高于对照组的82.00%,差异具有统计学意义(P<0.05);观察组产后2 h、24 h出血量均少于对照组,差异具有统计学意义(P<0.01),2组不良反应发生率比较无显著差异性。结论宫体注射卡前列素氨丁三醇注射液治疗低蛋白血症伴宫缩乏力性产后出血疗效肯定,安全性高,值得临床推广。     

酮咯酸氨丁三醇胶囊溶出度测定方法的研究

目的建立酮咯酸氨丁三醇胶囊溶出度测定方法。方法以水为溶出介质,转速为50 r.min-1,分光光度法检测,检测波长为322 nm。结果酮咯酸氨丁三醇在3.16~12.64μg.mL-1浓度与其吸收度呈良好线性关系(r=0.999 5),平均回收率为99.01%,RSD为0.20%。结论该方法操作简便,准确可靠。     

卡贝缩宫素与欣母沛用于阴式分娩预防产后出血疗效观察

目的探讨卡贝缩宫素与欣母沛在阴式分娩中预防产后出血的临床效果,为临床治疗方案的选择提供理论依据。方法本研纳入2016年1~11月我院产科接收的有产后出血高危因素的产妇240例。按数字法随机分为两组,观察组(娩出后给予卡贝缩宫素)120例,对照组(胎儿娩出后应用欣母沛)120例,比较两组产妇产后2 h、4h出血量、分娩前后血红蛋白浓度下降幅度及两组不良反应情况。结果两组产时、产后2 h、4 h出血量比较差异无统学计意义(P0.05);两组分娩前后血红蛋白浓度变化比较差异无统学计意义(P0.05);观察组药物不良反应(恶心、呕吐、腹痛、面部潮红)发生率明显低于对照组(P0.05)。结论与欣母沛相比,卡贝缩宫素在预防阴式分娩产后出血方面有相同的疗效,且卡贝缩宫素不良反应较少。