مقایسه تأثیر شیاف دیکلوفناک سدیم، پاراستامول وریدی و ترکیب ان ها بر درد حاد بعد از عمل جراحی سزارین به روش بی حسی نخاعی
مجله آنستزیولوژی و مراقبتهای ویژه ایران,
Vol. 2 No. 117 (1401),
28 January 2023
Abstract
خلاصه: مقدمه: با توجه به شیوع بالای سزارین واهمیت کنترل درد پس از ان این مطالعه به بررسی تأثیر شیاف دیکلوفناک سدیم، پاراستامول وریدی و ترکیب ان ها بر درد حاد بعد از عمل جراحی سزارین پرداخته است. روش کار: 99 بیمار کاندید عمل جراحی سزارین به صورت تصادفی به سه گروه تقسیم شدند،جهت بی دردی پس از عمل در گروه A از شیاف دیکلوفناک سدیم + پمپ PCA حاوی دارونما،در گروه B از پمپ PCA حاوی پاراستامول وریدی + شیاف دارونما و در گروه C از پمپ PCA حاوی پاراستامول وریدی + شیاف دیکلوفناک سدیم استفاده شد.شدت درد پس از عمل با استفاده از مقیاس VAS (visual analogue scale) در ساعات (1و4و12و24)ارزیابی شد و مقدار اپیویید مصرفی جهت بی دردی پس از عمل ثبت گردید. نتایج: از نظر شدت درد، تفاوت معناداری در ساعات 1، 4، 12 و 24 پس از عمل بین گروه های A ، B و C مشاهده شد (05/0 p<). درد در گروه C در تمام ساعات به طور قابل توجهی کم تر از دو گروه دیگر بود(p<0.0001). در مقایسه ی گروه A و B در ساعات 1 و 4 پس از عمل درد در گروه A کم تر بود و در ساعات 12 و 24 شدت درد در گروه B کمتر از گروه A بود (05/0 p<). کمترین میزان مورفین مصرفی در دوره ی پس از عمل به ترتیب در گروه C ، B و A مشاهده شد (05/0 p<). نتیجه گیری: ترکیب شیاف دیکلوفناک و پمپ پاراستامول درد پس از عمل و نیاز به مخدررا به طور موثری کاهش می دهد، به علاوه شیاف دیکلوفناک در ساعات (1و4)بی دردی بیشتری نسبت به پمپ پاراستامول داشته است اما میزان کلی مصرف مخدر وریدی در گروه پمپ پاراستامول کمتر بوده است .
Keywords:
- درد حاد پس از عمل
- جراحی سزارین
- پاراستامول وریدی
- شیاف دیکلوفناک
- پمپ ضد درد
How to Cite
صفری هزاروند غ., گوشه س. م. ., جواهرفروش زاده ف. ., اولی پور ع., & Bakhtiari, N. (2023). مقایسه تأثیر شیاف دیکلوفناک سدیم، پاراستامول وریدی و ترکیب ان ها بر درد حاد بعد از عمل جراحی سزارین به روش بی حسی نخاعی. مجله آنستزیولوژی و مراقبتهای ویژه ایران, 2(117). Retrieved from https://journals.sbmu.ac.ir/isacc/index.php/iranesthesia/article/view/467
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14. Dodd JM, Hedayati H, Pearce E, Hotham N, Crowther CA. Rectal analgesia for the relief of perineal pain after childbirth: a randomised controlled trial of diclofenac suppositories. BJOG : an international journal of obstetrics and gynaecology. 2004 Oct;111(10):1059-64. PubMed PMID: 15383107. Epub 2004/09/24. eng.
15. Lim NL, Lo WK, Chong JL, Pan AX. Single dose diclofenac suppository reduces post-Cesarean PCEA requirements. Canadian journal of anaesthesia = Journal canadien d'anesthesie. 2001 Apr;48(4):383-6. PubMed PMID: 11339782
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18. Kehlet H, Wilmore D W. Multimodal strategies to improve surgicaloutcome. Am J Surg 2002; 183: 630–41.
19. Lim N L, Lo W K, Chong J L, Pan A X. Single dose diclofenac suppository
reduces post-Cesarean PCEA requirements. Can J Anaesth 2001; 48:
383–6.
20. Ng A, Parker J, Toogood L, Cotton B R, Smith G. Does the opioid-sparing
effect of rectal diclofenac following total abdominal hysterectomy benefit
the patient? Br J Anaesth 2002; 88: 714–6.
21. Akhavan Akbari G, Entezariasl M, Isazadehfar KH, Comparison of the Effects of Indomethacin, Diclofenac and Acetaminophen Suppositories on Pain Score and Pethidine Usage after Cesarean Section. Journal of Isfahan Medical School . Vol 30, No 179, May 2012.
22. Craig M, Jeavons R, Probert J, Benger J. Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department. Emergency medicine journal : EMJ. 2012 Jan;29(1):37-9. PubMed PMID: 21362724.
23. Memis D, Inal MT, Kavalci G, Sezer A, Sut N. Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit. Journal of critical care. 2010 Sep;25(3):458-62. PubMed PMID: 20189753.
24. Munishankar B, Fettes P, Moore C, McLeod GA. A double-blind randomised controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section. International journal of obstetric anesthesia. 2008 Jan;17(1):9-14. PubMed PMID: 17981455.
25. Cakan T, Inan N, Culhaoglu S, Bakkal K, Basar H. Intravenous paracetamol improves the quality of postoperative analgesia but does not decrease narcotic requirements. Journal of neurosurgical anesthesiology. 2008 Jul;20(3):169-73. PubMed PMID: 18580346.
26. Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. British journal of anaesthesia. 2005 Apr;94(4):505-13. PubMed PMID: 15681586.
2. Gadsden J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesthesia and analgesia. 2005 Nov;101(5 Suppl):S62-9. PubMed PMID: 16334493. Epub 2005/12/13. eng.
3. John JB. Postoperative pain. In: John JB, Chapman CR, Wilbert EF, editors. The management of pain. Philadelphia: Lea Febiger; 1999. p. 461-81.
4. Hosseini Jahromi SA, Hosseini Valami SM, Hatamian S. Comparison Between Effect of Lidocaine, Morphine and Ketamine Sprayon Post-Tonsillectomy Pain in Children. Anesth Pain. 2012;2(1):17–22.
5. Imani F, Rahimzadeh P, Faiz SHR. Comparison of the efficacy of adding clonidine, chlorpromazine, promethazine, and midazolam to morphine pumps in postoperative pain control of addicted patients. Anesth Pain. 2011;1(1):10–14.
6. Shoar S, Esmaeili S, Safari S. Pain Management After Surgery: A Brief Review. Anesth Pain. 2012;1(3):184–6.
7. Nesioonpour Sh, Akhondzdeh R, Pipelzadeh MR, Rezaee S, Nazaree E, Soleymani M. . The effect of preemptive analgesia with bupivacaine on postoperative pain of inguinal hernia repair under spinal anesthesia: a randomized clinical trial. Hernia. 2013;17:465-70 DOI 10.1007/s10029-012-1007-1
8. Imani F, Safari S. Pain Relief is an Essential Human Right”, We Should be Concerned about It. Anesth Pain. 2011;1(2):55–57.
9. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. British journal of anaesthesia. 2001 Jul;87(1):62-72. PubMed PMID: 11460814. Epub 2001/07/20. eng.
10. Memis D, Inal MT, Kavalci G, Sezar A, Sut N. Intravenous paracetamol reduced the use of opioids, extubation time and opioid-related adverse effect after major surgery in intensive care unit. J critical care. 2010;25(3):458–462. [PubMed]
11. Olofsson CI, Legeby MH, Nygards EB, Ostman KM. Diclofenac in the treatment of pain after caesarean delivery. An opioid-saving strategy. European journal of obstetrics, gynecology, and reproductive biology. 2000 Feb;88(2):143-6. PubMed PMID: 1069067
12. Ragavan N, Philip J, Balasubramanian SP, Desouza J, Marr C, Javle P. A randomized, controlled trial comparing lidocaine periprostatic nerve block, diclofenac suppository and both for transrectal ultrasound guided biopsy of prostate. The Journal of urology. 2005 Aug;174(2):510-3; discussion 3. PubMed PMID: 16006882.
13. Haq A, Patel HR, Habib MR, Donaldson PJ, Parry JR. Diclofenac suppository analgesia for transrectal ultrasound guided biopsies of the prostate: a double-blind, randomized controlled trial. The Journal of urology. 2004 Apr;171(4):1489-91. PubMed PMID: 15017205. Epub 2004/03/17. eng.
14. Dodd JM, Hedayati H, Pearce E, Hotham N, Crowther CA. Rectal analgesia for the relief of perineal pain after childbirth: a randomised controlled trial of diclofenac suppositories. BJOG : an international journal of obstetrics and gynaecology. 2004 Oct;111(10):1059-64. PubMed PMID: 15383107. Epub 2004/09/24. eng.
15. Lim NL, Lo WK, Chong JL, Pan AX. Single dose diclofenac suppository reduces post-Cesarean PCEA requirements. Canadian journal of anaesthesia = Journal canadien d'anesthesie. 2001 Apr;48(4):383-6. PubMed PMID: 11339782
16. Chandrasekharan NV, Dai H, Roos KL, Evanson NK, Tomsik J, Elton TS, et al. COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure, and expression. Proceedings of the National Academy of Sciences of the United States of America. 2002 Oct 15;99(21):13926-31. PubMed PMID: 12242329. Pubmed Central PMCID: PMC129799. Epub 2002/09/21. eng.
17. Warner TD, Mitchell JA. Cyclooxygenase-3 (COX-3): filling in the gaps toward a COX continuum? Proceedings of the National Academy of Sciences of the United States of America. 2002 Oct 15;99(21):13371-3. PubMed PMID: 12374850. Pubmed Central PMCID: PMC129677.
18. Kehlet H, Wilmore D W. Multimodal strategies to improve surgicaloutcome. Am J Surg 2002; 183: 630–41.
19. Lim N L, Lo W K, Chong J L, Pan A X. Single dose diclofenac suppository
reduces post-Cesarean PCEA requirements. Can J Anaesth 2001; 48:
383–6.
20. Ng A, Parker J, Toogood L, Cotton B R, Smith G. Does the opioid-sparing
effect of rectal diclofenac following total abdominal hysterectomy benefit
the patient? Br J Anaesth 2002; 88: 714–6.
21. Akhavan Akbari G, Entezariasl M, Isazadehfar KH, Comparison of the Effects of Indomethacin, Diclofenac and Acetaminophen Suppositories on Pain Score and Pethidine Usage after Cesarean Section. Journal of Isfahan Medical School . Vol 30, No 179, May 2012.
22. Craig M, Jeavons R, Probert J, Benger J. Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department. Emergency medicine journal : EMJ. 2012 Jan;29(1):37-9. PubMed PMID: 21362724.
23. Memis D, Inal MT, Kavalci G, Sezer A, Sut N. Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit. Journal of critical care. 2010 Sep;25(3):458-62. PubMed PMID: 20189753.
24. Munishankar B, Fettes P, Moore C, McLeod GA. A double-blind randomised controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section. International journal of obstetric anesthesia. 2008 Jan;17(1):9-14. PubMed PMID: 17981455.
25. Cakan T, Inan N, Culhaoglu S, Bakkal K, Basar H. Intravenous paracetamol improves the quality of postoperative analgesia but does not decrease narcotic requirements. Journal of neurosurgical anesthesiology. 2008 Jul;20(3):169-73. PubMed PMID: 18580346.
26. Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. British journal of anaesthesia. 2005 Apr;94(4):505-13. PubMed PMID: 15681586.
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