- 期刊
Intravenous Tenoxicam Reduces Dose and Side Effects of PCA Morphine in Patients after Thoracic Endoscopic Sympathectomy
胸內視鏡交感神經切除術後靜脈注射Tenoxicam可減低自控式嗎啡止痛之劑量及副作用
摘要
Background: Among surgical modalities for treatment of palmar hyperhidrosis, endoscopic sympathectomy is the most popular choice in recent years. After surgery, the major complaint was anterior chest pain. This study was conducted to evaluate the analgesic efficacy and side effects of tenoxicam (a thienothiazine derivative) in combination with patient-controlled analgesia (PCA) using morphine in patients who received thoracic endoscopic sympathectomy. Methods: Forty-one ASA class I patients who underwent endoscopic sympathectomy (T2 and T3 ganglia) were randomly divided into two groups. Operation was conducted under general anesthesia with single lumen endotracheal intubation. No narcotic was given during the operation except for fentanyl (3 μg/kg) during induction. After surgery, patients in group I received PCA morphine only and patients in group II received PCA morphine plus tenoxicam (20 mg, i.v.) immediately for pain relief. In addition, rescue analgesia with intramuscular meperidine (1 mg/kg) was available to each patient every 4 h prn. The intensity of pain was assessed with VAS pain score every 4 h for 24 h. The frequency of demand and doses of delivered PCA morphine were recorded. Results: Results showed no statistically significant difference between groups in respect of age, body height, body weight and pain scores. However, based upon similar qualitative pain relief, patients in group II revealed less demand for analgesic, less doses of morphine requirement and less side effects. Conclusions: Tenoxicam may be an effective adjuvant to PCA morphine for postoperative pain control. This combination reduces the total consumption of PCA morphine with less side effects.
並列摘要
背景：手汗症之手術治療方面，內視鏡胸交感神經切除術乃目前最好且最被廣泛運用之治療方式，其術後最主要之問題則是病患主訴胸前疼痛。本研究之目的乃針對接受胸交感神經切除術之病患，合併使用tenoxicam（一種thienothiazine衍生物）及病患自控式嗎啡止痛（PCA）系統，以探討其對病患自控式嗎啡止痛系統止痛強度，劑量，以及副作用等之影響。方法：四十一位ASA体位分等第I級之手汗症病患，於接受內視鏡胸交感神經切除術時，隨機將其分成兩組。每組皆以單管氣管內插管施行全身麻醉，除麻醉誘導時給予fentanyl 3 μg/kg外，手術中皆不給予任何其他嗎啡類藥物。兩組病患皆於手術後立即給予病患自控式嗎啡止痛系統，惟第二組同時又給予tenoxicam 20 mg靜注。然後每四小時評估其疼痛程度（visual analog pain scale），24小時後計算其一日需求次數與給予之藥量。結果：兩組病患在年齡，身高，体重方面及其每四小時之疼痛程度均無統計差異。雖然兩組之疼痛程度無顯著差異，但就24小時需求PCA之次數（demand）與給予量（doses of delivery）而言，第二組則有顯著的減少，而且其副作用亦較少。結論：因此，我們認為tenoxicam合併病患自控式嗎啡止痛系統來治療手汗症內視鏡胸交感神經切除術後之疼痛，可降低病患自控式嗎啡止痛系統嗎啡的使用量，且減少其副作用。
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