Propacetamol輔助硬膜外自控式止痛改善剖腹產早期術後疼痛控制

The effect of propacetamol in post-cesarean pain control - a randomized controlled study

背景：多模式止痛用於急性疼痛可提供更好的鎮痛效果，並減少鴉片類藥物的不良反應。Propacetamol是乙醯胺酚的前藥，乙醯胺酚是用於急性疼痛的最廣泛使用的藥物。這項研究旨在研究Propacetamol在剖腹產後48小時內緩解疼痛的輔助效果。方法：我們設計一項前瞻性，隨機，安慰劑對照試驗，探討剖腹產後單次劑量靜脈使用propacetamol作為產婦硬膜外自控式止痛的輔助效果。產婦分為實驗組（propacetamol，P組）或對照組（生理食鹽水，C組），產婦於胎盤分娩後立即接受靜脈注射。主要結果為休息與活動的疼痛強度，疼痛強度以數字等級量表（0－10分）評估，評估時間為到達恢復室與術後2、6、24和48小時。此外，還記錄了自控式止痛的總劑量，止痛藥拯救劑量，運動阻斷，不良反應和產婦滿意度。結果：共有60名產婦納入，其中59名完成研究（實驗組30人，控制組29人）。在術後2小時內，實驗組的休息疼痛強度明顯低於控制組（p＝0.04）。兩組之間自控式止痛的總劑量和要求止痛藥拯救劑量的患者之間無顯著差異（p＞0.05）。兩組之間肌張力，不良反應和滿意度方面也沒有明顯差異（P＞0.05）。結論：硬膜外自控式止痛合併使用Propacetamol在剖腹產後2小時內提供更好的疼痛緩解。

Background: Multimodal analgesia for acute pain provides better analgesia and fewer adverse effects of opioids. Propacetamol is a pro-drug of paracetamol that is the most widely used drug for acute pain. The study aimed to investigate the adjuvant analgesic effect of propacetamol in post-cesarean section pain relief within 48 hours. Methods: We performed a prospective, randomized, placebo-controlled trial for single-dose intravenous propacetamol as an adjuvant to patient-controlled epidural analgesia (PCEA) after cesarean period. The parturients were allocated to additional propacetamol (Group P) or saline (Group C) injection immediately after the delivery of the placenta. Primary outcome was assessed by pain intensity at rest or during movement. We recorded postoperative pain scores by using the numeric rating scale (NRS 0-10) at postoperative care unit (PACU), 2, 6, 24 and 48 hours postoperatively. In addition, the total dosage of PCEA, rescue analgesic, motor block, adverse effects and maternal satisfaction were also recorded. Results: A total of 60 obstetric patients agreed to participate and 59 completed the study (n=30 in Group P and n=29 in Group C). Pain intensity at rest in Group P was significantly lower compared to Group C within the initial 2 hours (p=0.04). Overall dosage consumption of PCEA and patient-requested rescue analgesic did not differ significantly between the two groups (p>0.05). There was also no obvious difference between groups with respect to muscle tone, adverse effects and satisfaction (P>0.05). Conclusion: The combination of single-bolus intravenous 1 g propacetamol plus PCEA provided better pain relief at rest within 2 hours of administration.