Value of ketorolac tromethamine preemptive analgesia combined with postoperative transdermal fentanyl for perioperative analgesia in patients undergoing daytime anorectal surgery

doi:10.3877/cma.j.issn.2095-2015.2025.02.014

Abstract

Abstract:

Objective

To investigate the value of ketorolac tromethamine combined with postoperative transdermal fentanyl for perioperative analgesia in patients undergoing daytime anorectal surgery.

Methods

A prospective study was conducted on 120 patients with mixed hemorrhoids who underwent daytime anal surgery in Xinhua Hospital Affiliated to the School of Medicine，Shanghai Jiao Tong University from January 2020 to January 2022. They were divided into a control group （n=60） and an observation group （n=60） using a random number table method. All patients underwent intravenous tracheal intubation combined with lumbar anesthesia for stapler hemorrhoid mucosal circumcision. The control group received intravenous infusion of the same volume of physiological saline after anesthesia induction，and fentanyl transdermal patch was administered postoperatively. The observation group received preemptive analgesia with ketorolac tromethamine on the basis of the control group. The surgical outcomes，analgesic and sedative effects after needle extraction，changes in plasma stress hormone levels，and incidence of adverse reactions were compared between the two groups.

Results

There was no significant difference in the onset time of anesthesia between the two groups （P＞0.05）. The observation group had shorter recovery time for spontaneous urination and lower limb muscle strength compared to the control group，and the highest pain block plane time was longer than the control group，with statistically significant differences （P＜0.05）. At 10 min，1 h，2 h，6 h，and 12 h after needle extraction，the visual analogue scale score of the observation group was lower than that of the control group，while the Ramsay score was higher than that of the control group （P＜0.05）. After 5 min of needle extraction，the levels of norepinephrine，dopamine，and adrenaline in the observation group were lower than those in the control group（P＜0.05）. The observation of adverse reactions 24 hours after surgery showed that there was no significant difference in the incidence of adverse reactions between the two groups （P＞0.05）.

Conclusion

The application of ketorolac tromethamine preemptive analgesia and postoperative fentanyl transdermal patch in daytime anorectal surgery has significant analgesic and sedative effects，accelerates the time for patients to recover from spontaneous urination and lower limb muscle strength，and has inhibitory effect on stress hormones in plasma，with high safety.

Key words: Ketorolac tromethamine, Preemptive analgesia, Fentanyl transdermal patch, Perioperative analgesia, Daytime anorectal surgery

Jiawen Zheng, Zhongchuan Wang, Bin Zhao. Value of ketorolac tromethamine preemptive analgesia combined with postoperative transdermal fentanyl for perioperative analgesia in patients undergoing daytime anorectal surgery[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(02): 174-178.

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URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2025.02.014

https://zhxhbyyxzz.cma-cmc.com.cn/EN/Y2025/V15/I02/174

Figures/Tables 5

组别	例数	年龄（ $\overset{ˉ}{x}$ ± s ，岁）	性别［例（%）］		BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	病程（年， $\overset{ˉ}{x}$ ± s ）
组别	例数	年龄（ $\overset{ˉ}{x}$ ± s ，岁）	男	女	BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	病程（年， $\overset{ˉ}{x}$ ± s ）
对照组	60	41.23±6.21	32	28	21.85±2.66	7.50±0.85
观察组	60	40.41±6.62	34	26	22.84±2.69	7.43±0.81
χ ²/t 值		0.859	0.849		0.654	0.587
P 值		0.485	0.359		0.265	0.167

组别	例数	年龄（ $\overset{ˉ}{x}$ ± s ，岁）	性别［例（%）］		BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	病程（年， $\overset{ˉ}{x}$ ± s ）
组别	例数	年龄（ $\overset{ˉ}{x}$ ± s ，岁）	男	女	BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	病程（年， $\overset{ˉ}{x}$ ± s ）
对照组	60	41.23±6.21	32	28	21.85±2.66	7.50±0.85
观察组	60	40.41±6.62	34	26	22.84±2.69	7.43±0.81
χ ²/t 值		0.859	0.849		0.654	0.587
P 值		0.485	0.359		0.265	0.167

组别	例数	麻醉起效时间（min）	自主排尿恢复时问（h）	下肢肌力恢复时间（min）	最高痛觉阻滞平面时间（min）
对照组	60	3.67±0.86	16.34±1.30	140.45±25.68	11.45±3.34
观察组	60	3.57±0.83	11.23±1.34	82.26±20.33	16.41±3.34
t		1.037	6.342	5.600	5.651
P		0.091	0.001	0.002	0.002

组别	例数	时间	VAS 评分	Ramsay 评分
		T0	4.06±0.98	2.60±0.14
对照组	60	T1	4.37±0.94	2.45±0.10
		T2	4.40±0.86	2.12±0.14
		T3	5.87±0.56	1.90±0.10
		T4	3.83±0.58	3.47±0.33
		T5	2.04±0.41	2.28±0.17
		T0	1.13±0.51^a	2.75±0.30^a
观察组	60	T1	2.13±0.81^a	2.72±0.25^a
		T2	2.27±0.74^a	2.70±0.16^a
		T3	4.17±0.56^a	2.30±0.18^a
		T4	2.47±0.89^a	3.20±0.23^a
		T5	1.83±0.57	2.32±0.18
F			5.021/5.261	4.631/4.008
P			0.005/0.004	0.010/0.008

组别	例数	时间	E	NE	DA
对照组	60	麻醉前	47.65±11.56	292.64±32.61	54.23±10.47
		拔针后5 min	120.80±50.21	430.80±89.21	90.11±40.08
观察组	60	麻醉前	46.56±10.18	296.01±33.28	55.04±10.34
		拔针后5 min	92.22±25.24^a	372.34±90.11^a	72.56±26.37
t			5.410/5.880	6.050/6.920	4.250/5.551
P			0.007/0.005	0.002/0.001	0.011/0.006

组别	例数	苏醒期躁动	恶心呕吐	头痛	皮肤瘙痒	尿潴留	总发生率（%）
对照组	60	3（5.00）	2（3.33）	1（1.67）	1（1.67）	3（5.00）	10（16.67）
观察组	60	2（3.33）	3（5.00）	2（3.33）	0（0.00）	2（3.33）	9（15.00）

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