術前口服長效劑型Dextromethorphan可減少Pethidine在痔瘡切除手術後止痛之使用量

Oral Slow Release Dextromethorphan Premedication Provides a Pethidine Spare Effect on Posthemorrhoidectomy Pain Management

背景：先前的研究結果已經證實術前肌肉注射dextromethorphan可以提供預防性止痛之效果，有助手術後疼痛之處理。Regrow®為臨床上使用之長效持續釋放錠劑。我們想探究口服劑型dextromethorphan是否同樣具有良好預防性止痛之效果。結果若為真，則口服regrow將更使病人免除肌肉注射之苦而更具臨床使用之便利性。方法：75名預行痔瘡切除術之病人隨機分為控制組及實驗組（次分兩組），控制組病人術前服用安慰劑，實驗組病人服用regrow 120毫克或240毫克。手術後所有病人皆可根據疼痛程度要求pethidine作為止痛藥。我們分別紀錄術後第一次要求止痛藥之時間、pethidine止痛藥使用總量、最痛之疼痛分數及使用pethidine之相關副作用來比較兩組之間有無明顯差異。結果：服用安慰劑與regrow 120毫克及240毫克之病人觀察手術後兩天第一次要求止痛藥之時間依序為5.4 ± 3.1，6.5 ± 3.5 and 12.7 ± 5.7 小時、pethidine止痛藥使用總量依序為150 ± 12，132 ± 11.8and82 ± 12.5毫克、最痛之疼痛分數依序為7.2 ± 0.4，6.9 ± 0.2and5.5 ± 0.4、出現使用pethidine之相關副作用人數依序為5，3及0人。結論：病人預行痔瘡切除術之前，很便利的先口服regrow 240毫克可以獲得預防性止痛之益處，因此降低術後疼痛程度以及減少嗎啡類止痛藥用量。當然，嗎啡類止痛藥所伴隨之副作用同樣也會較少出現。

Background: In our previous study, we had demonstrated that intramuscular (i.m.) dextromethorphan (DM) could provide a preemptive analgesic effect and improve postoperative pain management. Regrow® is a long-duration slow-release oral dextromethorphan available for clinical use with good patient compliance. The present study was designed to examine whether oral regrow may also offer the same preemptive analgesic effect as i.m. DM does in postoperative pain management. Methods: Seventy-five patients, ASA status I and II, scheduled for hemorrhoidectomy were included and randomly assigned to the control and study groups. In the control group patients received placebo orally 8 h before surgical incision. In the study group, patients received regrow orally either 120 mg (R-120) or 240 mg (R-240) 8 h before skin incision. Pethidine (1 mg/kg, i.m.) was given for postoperative pain relief on demand. The time to first pethidine injection, total pethidine consumption, worst pain score, and pethidine-related side effects were recorded for two days. Results: The times to first pethidine injection were 5.4 ± 3.1, 6.5 ± 3.5 and 12.7 ± 5.7 h in the control, R-120 and R-240 groups, respectively. Total pethidine consumptions were 150 ± 12, 132 ± 11.8 and 82 ± 12.5 mg in the control, R-120 and R-240 groups, respectively. The worst visual analog scale pain scores were respectively 7.2 ± 0.4, 6.9 ± 0.2 and 5.5 ± 0.4 in the control, R-120 and R-240 groups during the 2-day observation. Five and three patients suffered pethidine-related side effects in the control and R-120 groups, respectively. Conclusions: This study revealed that premedication of oral regrow 240 mg provided a preemptive analgesic effect, thus reducing the severity of postoperative pain and pethidine requirement in post-hemorrhoidectomy patients.