- 期刊
Postoperative Intramuscular Dextromethorphan Injection Provides Postoperative Pain Relief and Decreases Opioid Requirement after Hemorrhoidectomy
痔瘡手術後給予Dextromethorphan肌肉注射可以降低術後疼痛及類鴉片藥物的需求
摘要
背景：痔瘡切除術後的疼痛常令病患痛苦難當。最近的研究已顯示在術中注射止咳藥dextromethorphan(DM)，一種NMDA接受器拮抗劑，具有止痛的效果。本實驗的目的是檢測在痔瘡切除術後肌肉注射DM，是否也具有止痛的效果，以改善痔瘡術後的疼痛並可降低鴉片藥物的需求及副作用。 方法：本實驗選擇六十位ASAⅠ-Ⅱ預備要接受痔瘡切除的病人，隨機分爲二組。實驗組病人在術後接受肌肉注射DM40mg和CPM20mg；對照組病人在術後接受肌肉注射CPM20mg。術後病人若要求止痛則給予肌肉注射pethidine(1mg/kg)。術後我們觀察48小時，並記錄病人第一次要求注射pethidine的時間、pethidine的總消耗量、最痛的分數及pethidine引起的副作用等。 結果：第一次pethidine注射的時間在對照組和實驗組分別爲5.4±1.6和17.8±3.7小時。Pethidine的總消耗量則分別爲139.5±11.5（對照組）和77.5±12.2（實驗組）毫克。需要pethidine止痛的人數分別爲29（對照組）和21（實驗組）人。而有注射pethidine的病人其VAS最痛的分數分別爲7.5±0.2（對照組）和7.1±0.2（實驗組）。至於pethidine引起的副作用則分別爲7（對照組）及1（實驗組）人。 結論：我們發現術後肌肉注射DM可降低痔瘡術後的疼痛、並延後第一次pethidine注射的時間，且pethidine的消耗量及pethidine引起的副作用均明顯的降低。
並列摘要
Background: Previous studies have shown that dextromethorphan (DM) produces an analgesic/antihyperalgesic effect. This study was designed to examine whether postoperative DM intramuscular (IM) injection could reduce post-hemorrhoidectomy pain. Methods: At the end of surgery, patients in the study group (n=30) were given an intramuscular injection of 40 mg DM and 20 mg chlorpheniramine (CPM) while in the study group (n=30), the patients were given intramuscular 20 mg CPM only. Pethidine (1 mg/kg, IM) was prescribed for postoperative pain relief if required. The time to first pethidine injection, total pethidine consumption, worst pain score, and pethidine-related side effects were recorded for 48 h postoperatively. Results: The time from the end of operation to the first pethidine injection was 5.4±1.6 h and 17.8±3.7 h (P=0.006) in the control group and the study group, respectively. Total pethidine consumption was 139.5±11.5 mg and 77.5±12.2 mg (P＜0.001) in the control group and the study group, respectively. The worst VAS score was 7.5±0.2 and 7.1±0.2 (P=0.09) in the control and the study groups, respectively. The number of patients who required pethidine injection was 29 and 21 (P＜0.005) in the control and the study groups, respectively. The number of patients who suffered pethidine-related side effects was 7 and 1 (P＜0.025) in the control and the study groups, respectively. Conclusions: We found that intramuscular DM given at the end of operation could provide good postoperative pain relief and decrease the pethidine requirement after hemorrhoidectomy.
延伸閱讀
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