Diclofenac sodium及Tenoxicam在手術後疼痛之應用

Diclofenac Sodium and Tenoxicam for Postoperative Analgesia

合併使用類鴉片鎮痛劑及非類固醇消炎止痛劑能提供較佳止痛效果並減少副作用。本研究目的在評估以子宮全切除手術之術後疼痛為模型時，病患自控式止痛裝置（內含Morphir的合併diclofenac sodium肌肉注射或tenoxicam靜脈注射對手術後疼痛之止痛效果。共有78位接受全身麻醉切除子宮的病患進入本研究，手術後D75組（30人）給予diclofenacsodium75毫克，T20組（24人）給予tenoxicam20毫克，T40組（24人）給予tenoxicam40毫克，以治療手術後疼痛，另外以病患自動控制止痛裝置給予病人止痛。結果顯示當病患接受tenoxicam20毫克後，其使用病患自控式止痛裝置中的morphine量顯著較多，也有較顯著之疼痛指數。在副作用方面則無顯著差異，我們認為輔以病患自控式止痛裝置，肌肉注射diclofenacsodium75毫克或靜脈注射tenoxic四40毫克，對子宮全切除手術後止痛有相同效果，但tenoxicam20毫克則效果較差。

It's been well recognized that the combination of opioid agonist and non-steroid anti-inflammatory drugs (NSAIDs) may provide better analgesia and less adverse effects. This study compares diclofenac sodium (75mg) with two different doses of tenoxicam (20 and 40 mg) in combination with patient-controlled analgesia (PCA) morphine for patients undergoing abdominal total hysterectomy (ATH). Total 78 patients (n=30 in diclofenac group and n=24 in each tenoxicam group) were enrolled into this randomized, double-blind study. All patients received loading doses of assigned NSAID and morphine to relief visual analogue scores (VAS, 0-10) to less than 3 at post-operative recovery room (RR). PCA morphine was applied thereafter. Patients were evaluated before discharging from RR and every 8AM, 14PM and 20PM for 48 hours. VAS (resting and moving), side effects (dizziness, nausea/vomiting, and itching), and vital signs were recorded and analyzed. There were no differences among these groups in age, body weight, opioid dosage for surgical anesthesia, side effect incidence, and vital signs. Patients receiving tenoxicam 20 mg consumed more PCA morphine (655 ± 252 mg/kg) than patients receiving diclofenac sodium (526 ± 137 mg/kg) or tenoxicam 40 mg (484 ± 161 mg/kg). Patients receiving tenoxicam 20 mg suffered more pain [VAS, area under curve(AUC)/service hour, move, 2.97 ± 0.71] when compared to diclofenac group (2.31 ± 0.57) and tenoxicam 40 mg group (2.26 ± 0.63). We conclude that in patients receiving PCA morphine for post-ATH pain control, 40 mg tenoxicam, as well as 75 mg diclofenac sodium, provides better analgesia than 20 mg tenoxicam.