| Objective:Research painless ward management pattern in the application of trauma surgery which postoperative pain control in patients with fracture NRS pain score, satisfaction, early postoperative functional exercise time and the effect of postoperative hospital stay;Compare the analgesic effect of ketorolac tromethamine Injection and parecoxib sodium after fracture operation.Evaluate the two drugs clinical use valueMethod:1.Select 20 patients who underwent simple limbs long bone fracture surgery on the July 2014 to December 2014, which randomly divided into A and B two groups. Group A observation group 62 cases (45 cases of men and women 17 cases), Group B control group 8 cases (male 43 cases,15 cases).Group A patients:the painless ward management mode which adopt advanced analgesia and multimodal analgesia and individualized analgesic combination of analgesic model;Group B patients:pain management model of traditional, namely on-demand analgesic model, we began to pain assessment when patients complained of pain, according to the result of pain assessment, we will take corresponding measures to stop his pain.Compare two groups of patients with postoperative NRS score and the satisfactory degree of pain control, early postoperative function exercise time and postoperative hospital days indicators, and statistical analysis, comparing the difference between the observation index between two groups and the presence of statistical significance.2.Select families and traumatic orthopedic line between January 2015 and August 2015 fractures (pure limbs long bone fractures) undergoing surgery patients 164 cases, 164 cases of fracture patients were randomly divided into two groups:group A was given ketorolac tromethamine injection, group B was given parecoxib sodium. All the patients who was observed on the first day, the second day. the third day of NRS (Numoricai rating scale) highest score as the pain intensity, the consumption of pethidine hydrochloride, nausea and vomiting adverse reaction’s occur after operation.3.Painless ward technology is a part of the fast track surgery, with the development of the painless ward, fast track surgery will further extension, eventually bring a lot benefits for patients.Result:1. Group A (observation group), postoperative 3 days NRS score display-respectively (2.8±1.1), (2.4±0.9). (2.1±0.8)points and were significantly lower than group B (4.5±1.3). (5.7±1.1). (6.1 ±1.3) points, two groups are statistically significant (P< 0.05);Patients are not satisfied with pain control in 2 cases,42 cases were more satisfied and 18 cases were very satisfied, pain control degree of satisfaction was 96.7%;Group B patients are not satisfied with pain control in 30 cases, 25 cases were more satisfied,3 cases were very satisfied,Pain control degree of satisfaction was 48.3%, pain control satisfaction in both groups were statistically significant (P< 0.05).2.group A (Observe group).early postoperative functional exercise time, postoperative hospitalization days were 1.5 ± 0.3 days,6.4 ±1.2 days, compared with the control group B, early functional exercise 3.5 ±0.8 days, hospitalization days.8.9 ± 1.8 days.which were shortened, the difference between the two groups have statistical significance (P< 0.05).3.Group A (Ketorolac tromethamine injection) and Group B (Parecoxib sodium),The first day of NRS score were (2.83 ± 0.98:2.85 ± 1.01) respectively after fracture operation, and the pain score of two group were no significant difference (t=-0.157, P=0.875). The second day of NRS score were (2.49 ± 0.86;2.56 ± 0.90) respectively, two groups of pain score had no obvious difference (t=-0.530, P=0.597). the third day of NRS score were (2.12 ±0.74;2.29± 0.75) respectively, and the pain scores of two group were no significant difference (t=-0.839, P= 0.403). But the two groups of postoperative pain NRS score 72 hours were reduced gradually, two groups of analgesic were effective. two groups of pethidine hydrochloride consumption were (Z=-0.240, P= 0.810; Z=-0.964, P= 0.335; Z=-0.581, P= 0.561) for 3 days after fracture operation respectively, two groups were no significant differences by statistical comparison. Two groups of postoperative nausea and vomiting adverse reactions were no significant difference,either. (P= 0.367).Conclusion:1.After implementation of trauma surgery painlessly ward management mode, effectively reduce the fracture postoperative NRS score, improves the satisfaction of perioperative pain control. shortens the time and postoperative early functional exercise and the average hospitalization days, greatly improved the quality of life of patients, accelerate the patient recover.So painless ward model in the application of trauma surgery is safe and effective, worthy of being clinical recommend as a new model2.Use ketorolac tromethamine injection (60mg qd Vein pump) and parecoxib sodium(40mg bid intramuscular injection) for 3 days after fracture operation,.They can well improve analgesia effect which have exact, less adverse reaction and no obvious difference.What’s more,reduce the use of traditional opioid drugs.Ketorolac tromethamine and Parecoxib are worthy of being clinically used two kinds of injectable NSAID drugs. |
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