Randomisierter, doppelt - blinder und placebokontrollierter Vergleich der Effektivität von perioperativ verabreichtem intravenösem Paracetamol und / oder Parecoxib zur Analgesie nach Schilddrüsen- und Nebenschilddrüsenoperationen

Systemische Opioide gelten als Goldstandard bei der Behandlung stärkerer postoperativer Schmerzen. Opioidbedingte Nebenwirkungen wie Müdigkeit, Übelkeit und Erbrechen und Obstipation beeinträchtigen jedoch die Patientenzufriedenheit. Daher wird versucht, durch eine sog. multimodale Analgesie auch un...

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Bibliographic Details
Main Author: Krüger, Timo
Contributors: Wulf, Hinnerk (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2008
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Background and Goal of Study Non-opiod analgesia is commonly used as an analgesic basis for many types of surgery. If a combination of non-opioids improves analgesia is open to debate. Materials and Methods Following ethic committee approval and written informed consent 140 patients undergoing thyroid surgery without signs of renal, hepatic, pulmonary or bleeding disorders were randomised to receive one of the following treatments in a double-blind manner: Placebo (PL), Paracetamol (1g i.v. 30 min prior to end of surgery, 4g/day i.v.) (PC), Parecoxib (40mg i.v. bolus at the end of surgery and 40 mg i.v. bolus 8h postoperatively) (PX), or a combination of these non-opioids (PP). A standardised balanced anaesthesia using propofol, sufentanil and rocuronium for induction and desflurane plus remifentanil for maintenance was applied. A routine PONV-prophylaxis with dexamethasone (8mg) and dolasetron (12.5mg) was performed. Escape analgesia was achieved with PCA with piritramid (bolus: 2mg, lock-out: 10 minutes, 4-hour maximum dose: 20 mg). Opioid consumption and pain relief (using a numeric rating scale (NRS-11)) were measured at 0, 1, 8, and 24 hours postoperatively. Results and Discussions Demographic data, anaesthetic and surgical characteristics of the patients in the four groups did not differ. The postoperative NRS-pain scores showed a trend towards a lower pain intensity in the groups treated with parecoxib, but differences in the postoperative pain ratings were not of clinical relevance. Cumulative opioid consumption was significantly lower in all three treatment groups at 1 and 24h postoperatively (p<0.05) with no evidence for an additive effect of both non-opioid analgesics. Conclusion(s) Both iv-paracetamol and parecoxib show an opioid sparing effect of 39.6-49.4% and thus can both be recommended due to the documented lack of relevant side-effects. The combination of i.v.-paracetamol and parecoxib does not provide an additional analgesic effect.