術前注射得術泰與嗎啡在中耳手術術後止痛之比較

A Comparison of Intraoperative Parecoxib and Morphine in Attenuating Postoperative Pain after Middle Ear Surgery

鼓膜成型術是治療耳膜破損的手術方式，一般而言，術後疼痛可以使用鴉片類藥物或選擇性COX-2抑制劑。本研究目的為比較選擇性COX-2抑制劑（Parecoxib得術泰）和嗎啡於鼓膜成型術患者術後傷口疼痛的止痛效果及副作用。方法：本篇研究共收入60名患者，並將患者隨機分配到Parecoxib組（30人）或嗎啡組（30人）。割刀前兩組患者分別接受Parecoxib40mg或嗎啡50μgkg止痛。術中使用喉罩氣道並以sevoflurane2-496維持全身麻醉。術後分別在恢復室和術後30分鐘，1小時，4小時以及24小時這五個時間點，評倍術後疼痛和其他副作用。術後疼痛的嚴重程度以疼痛數字等級量表（NRS 0-10分，3為輕微，4-6分為中等，= 7分為嚴重疼痛）進行評估。同時也記錄術後副作用（噁心，嘔吐，搔癢，頭暈以及嗜睡）的發生率結果：共59名患完成試驗，兩組病人之基本資料相近，在五個測量時間點的術後疼痛程度亦沒有顯著差異，僅嗎啡組有一位病人需要額外術後輔助止痛藥物。統計結果顯示，Parecoxib組的術後噁心嘔吐副作用比嗎啡組少（Parecoxib組中3/30，發生率約10%對照嗎啡組11/29，發生率約37.9%，P'-001）。整體滿意度兩組平分秋色。結論：Parecoxib有相當於嗎啡的止痛效果，能有效減輕鼓膜成型術患者的術後疼痛且較少噁心嘔吐的副作用。

Background: Most patients suffer from mild to moderate postoperative pain on the first day after middle ear surgery. The purpose of this study is to compare the analgesic effects of parecoxib and morphine for postoperative pain in patients undergoing tympanoplasty. Methods: Sixty patients were randomly allocated into either Parecoxib or Morphine group. Both groups of patients received the medication (Parecoxib 40 mg or Morphine 50μg/kg) before skin incision. General anesthesia was maintained with sevoflurane 2-4% via laryngeal mask airway. Postoperative pain and side effects were measured immediately at postoperative care unit (PACU), and 30 minutes, 1 hour, 4 hours, 24 hours postoperatively. The severity of postoperative pain intensity was assessed by numeric rating scale (NRS 0~10, NRS scores ≤ 3 correspond to mild, scores of 4-6 to moderate and scores ≥7 to severe pain). The postoperative side effects (nausea, vomiting, itching, dizziness and somnolence) were also recorded. Results: Fifty-nine patients completed the study, with no significant difference of physical characteristics between the two groups being found. Most of the patients suffered from only mild postoperative pain after tympanoplasty. The parecoxib group depicted similar pain scores as did the morphine group at five postoperative time points. Only one patient in the morphine group required postoperative analgesics at PACU. Postoperative nausea and vomiting was less noted in the parecoxib group than in the morphine group (3/30, 10% vs. 11/29, 37.9%, p=0.01). Patient satisfaction of anesthesia did not differ between groups. Conclusion: Both parecoxib and morphine are effective to attenuate postoperative pain after tympanoplasty, with parecoxib allowing comparable analgesic effect as morphine, but with less postoperative nausea and vomiting side effects related to opioids.