Résumé
BACKGROUND: Several reports have suggested that preoperative nociceptive block with opioids and nonsteroidal antiinflammatory drugs (NSAIDs) may reduce postoperative pain. This study evaluated the effects of preemptive analgesia, the analgesic efficacy and safety of intravenous opioids and NSAIDs during the first 48 hours after lower abdominal surgery. METHODS: The 40 patients were randomized to either preemptive group or postincisional group. All subjects received IV bolus of 2 mg of morphine followed by continuous IV mixture (morphine 30 mg + ketorolac 90 mg + droperidol 2 mg in 90 ml of normal saline) via Baxter 2-Day Infusor(R). Evaluations included supplementary analgesics, analgesic pain assessment (visual analogue scale, VAS), time of first analgesic request, patient comfort (comfort scale), and side effects. RESULTS: There were no differences in number of patient requiring supplemental analgesic (3/20 vs 5/20), the time of first analgesic request (42.2 hours vs 37.5 hours), pain scores measured at each time, and patient comfort between two groups. There were minor complications such as nausea and somnolence in both groups, but no patients needed any treatment. CONCLUSIONS: Preemptive or postincisional morphine-ketorolac-droperidol infusion was equally effective for postoperative analgesia after lower abdominal surgery with minor complications. Further evaluation may be needed to determine whether preemptive analgesia has any advantages over postincisional analgesia.