^ T^P CHf Y OLTCfC L A M S A N G 108 Tap 12 - Sd 7/2017
'I Hieu qua giam dau cua paracetamol ph6i hop codeine va
" meloxieam tren benh nhan 1 8 - 2 5 tu6i sau phSu thuat nho rang khon ham duoi theo Parant II
tti Pain reduction effectiveness of paracetamol combined with codeine and meloxieam in postoperative Parant II mandibular third molar
^ patients surgery
J Nguyen Phu Th5ng Truong Dgi hgc YHd Ngi Tomtit
Muc tiiu: Danh gia hieu qua giam dau eda thudc paracetamol phdi hpp vdi codeine (Efferalgancodeine) va meloxieam (Mobic) tren benh nhan p h l u thuat nhd rang khdn ham dudi. Ddi tdgng vd phdong phdp: D6\Xdgng nghien eUugdm42 benh n h l n c d rang khon ham dudi mpc lech theo
< Parant 11 cd ehi djnh nhd, dupe chia t h l n h 2 nhdm, m6t nhom sQdung Efferalgancodeine {nhom 1) va , nhdm cdn lai sU dung Mobie (nhdm 2). SQ dung thdng k& toan hoc de phan tich sd lieu thu thap duac.
Kitqud:B^nh nhan nQ chiem Uu the trong nhom nghidn cQu vdi ty le nU/nam bang 1,5/1. Theo doi ngly dau tien sau phau t h u l t , tai thdi diem sau uong thudc 0,5 gid, 6 nhom 1 dat hieu q u i giam dau tdt hon, sau 6 gid, nhdm 2 g i l m dau tdt hOn nhdm 1. Theo ddi ngay thQ 2, tai thdi diem 2 gid va 6 giQ, tac dung cCia Efferalgancodeine thap ban IVlobic. Ket ludn: Dau sau phau t h u l t nhd rang khon la trieu chQng thudng gap v l chiu anh hudng bdi nhieu yeu t d , d i e biet la trong 48 gid dau. De g i l m nhe trieu chiing dau cho benh n h i n , can sU phdi hop nhip nhang giQa ky t h u l t cCia ble sy phau thuat va cac thudc giam dau, n h I m dat duac hieu q u i dieu tn tdt nhat cho benh nhan.
Tdkhda: Phau thuat nhd rang khon, g i l m dau.
'^ Summary
Objective: This study is aimed at assessing the effeaiveness of two kinds of pain-killers after
^ extraction surgery of third molar patients. Subject and method: A sample of 42 patients was selected and assessed by clinical examination and radiographs, divided into two groups. The first group was i- administrated to use Efferalgancodeine and the second group used Mobic. Descriptive statistics were used to analyze the data. Result: Females were affected more than males with a sex ratio of 1.5/1. In the postoperative first day, for the first half an hour after using pain killer, Efferalgancodeine showed the dramatically stronger effectiveness than Mobic, but in following 6 hours, Mobic was more effective. In the following day, 2 hours and 6 hours after taking pills, Mobie gained the better result in pain reduction.
Conclusion: Pain is a major postoperative symptom in extraction surgery, resulted of many reasons, especially in the first 48 hours. Pain reduction is a challenge that usually requires coordinated care from oral surgeons and using reasonable pain killers.
Keywords: Extraction surgery, pain reduction.
Ngdynhdnbdi: 12/6/2017. ngdy chdp nhdn ddng: 19/6/2017
Ngudl phdn hdi: Nguyin Phu Thdng, Email: [email protected] - Truang Dgi hgc YHd Ngi
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N°7/2017
1 . Oat van de
Oau sau p h l u thuat nhd rang 8 ludn la van de g l y phien mudn cho benh nhan. Mdt sd nghien cUu mdi day cho thay r i n g benh n h i n sau nhd rang 8 dudi phau t h u l t lo lang hon nhieu so vdi trude nhd r i n g , ma phan Idn I I do nguyen n h i n dau g l y ra. Mdt sd nghien eUu cung nhan manh tdi sU can thiet de kiem soat dau sau phau t h u l t hieu qua ban vdi cle kidm tra sdm ehi ra r i n g : Han 80% benh n h i n d trong can dau t r i m trpng 48 gid d i u sau phau thuat [1], [2].
Va de giai quyet van de dau hien nay tren lam sing, cac bac sl cd r l t nhieu ele sU lUa chpn ve thudc g i l m dau nhU: Paracetamol cd hole khdng ket hop codeine, dan x u l t cua oxicam (mobic), d i n x u l t nhdm eoxib (vandeeoxib), dan x u l t acid phenylaeetie (voltaren - diclofenac)... Tuy nhien d nQde ta thi nhQng cdng trinh nghien eUu n l y ve van de n l y v i n chua nhidu. Vi v l y , chdng tdi tien hanh de tai nghien cUu vdi muc tidu: Nhdn xet hieu qud gidm dau cda paracetamol phoi hgp codeine vd meloxieam tgi cdc thdi diem khde nhau trong 48 gid ddu sau phdu thudt 2. Odi t u o n g va p h u o n g phap
2.1.Dditdg'ng
Gdm 42 benh n h i n ed r i n g khdn ham dudi mpc lech theo Parant II tQ 18 - 25 tudi, benh n h i n hop t i e , loai trU nhOng benh nhan ed benh ly ve than kinh khdng the tham gia nghien eUu, benh nhan cd benh t o l n than I n h hudng din tien trinh phau thuat (nhu dang trong tinh trang viem nhiem va mang thai...), benh n h i n ed tien sQ dj Ung vdi thude te, thude me, khang sinh v l g i l m dau.
2.2. Phdong phap
Nghien cUu thQ nghiem lam sang ed ddi chUng.
2.3. Cac bddc tien hanh nghien cdu Bude 1: Hdi benh va k h I m lam s i n g , can lam sing nhQng benh n h i n thda man tieu chuan lua chon eua nghidn cUu de thu t h l p thdng tin hanh ehinh va cle ndi dung phieu nghien cUu.
BUdc 2; Cle benh nhan du tieu ehuan tham gia nghien cQu duoc danh sd thQ tQ tQ 1 den 42, trong dd sd Id se dua v I o nhdm I sU dung Efferalgan Codein l l m thude g i l m dau va nhdm II la cle benh
nhan dupe d i n h sd c h i n se sQ dung Mobic lam thudc giam dau sau phau t h u l t nho rang 8 dudi. Q 2 nhdm deu dUOc ke thudc khang sinh va chong viem. Sau nhd benh n h i n duae ke dan thudc theo nhdm cOa minh, g i l i thfch ve nghidn cQu de tham gia hap t i e v l hudng dan sU dung thuoc.
Budc 3: Phdng van va d i n h gia mUc dd dau cGa benh nhan theo thang diem VAS [3], [4],
Budc 4: Nhap va xU ly sd lieu.
Budc 5: Tong hap sd lieu v l viet bao d o . 2.4. Xdlysdiieu
Tat e l benh I n nghien eUu sau khi kiem tra, cac sd lieu se dugc m l hda, nhap v l p h l n tieh theo ph^n mem thdng ke SPSS 16.0 va Stata 12.0.
3. Ket q u i
3.1. Ty le v4 gidi trong hai nhdm nghien ahj sddung thudc
B&ng 1 . T;^ le ve g i d i t r o n g hai nhdm sCfdung thudc
Nhom ^ ^ " - - ^ ^ Nhom 1 Nhom II Tong
Gi6i Nam
8 9 17
na
13 12 2S
Tong 21 21 42 Nhdn xet: Sd khac biet ve ty le gidi tinh trong hai nhdm nghien cQu la khdng cd y nghta thdng ke (p>0,05).
3.2. Thdi gian phau thuat trung binh cda hai nhdm
Bang 2. Thcfi g i a n p h a u t h u a t t r u n g binh cua hai n h d m siif d u n g thuoc Nhom
1 _ Efferalgan codeine ll_ Mobic
Tholi gian phdu thuat T (phiit)
441 457
n 21 21
t«(phut) 21 ± 2,36 21,8±3,19
P 0,19
Nhdn xet: Sd khIc biet ve thdi gian p h l u thuat trung binh cda hai nhdm khdng cd y nghla thdng ke (p>0,05).
104
TAP CHf Y DLTOC L A M SANG 108 Tap 12-56 7/2017
3.3. So sanh hieu qui glim dau cua hai nhdm sd dung thudc tai cac thdi diem sau udng thudc ngay thd nhdt
B5ng 3. Hieu q u a g i a m dau cua t h u o c t r e n hai n h o m b e n h n h a n sau u d n g t h u o c ngay thuT nhat
Nhom ^ ^ - ^ ^ 1 _ Efferalgan
codeine II Mobic
P
hiieu qua giam dau theo VAS Sau 0,5 gicf
n 21 21
Dtb 4,2 ±1,25 3,1 ± 1,09 0,002
Sau 2 gior n 21 21
D,b 4 ± 1 , 2 8 4,2 ± 0,93 0,34
Sau 6 gicr n 21 21
D,b 2,7 ± 1,35
4 ±1,02 0,0009 Nhdn xet: Hieu qua g i l m dau cda Efferalgan Codeine tai thdi diem 0,5 gid n g l y thQ nhat I I cao hon Mobic, SQ khIe biet ed y nghia thdng ke (p<0,01), tai thdi diem 2 gid ngay thU nhat la thap hdn IVlobic, nhung sU khac biet nay khdng cd y nghla thdng ke (p>0,05}, tai thdi diem 6 gid ngay thU n h l t la t h I p hon Mobie, SQ khac biet ed y nghla thdng ke (p<0,001).
3.4. So sanh mdc dd dau c^a hai nhom benh nhan tai cac thdi diem sau udng thuoc ngay thd hai B i n g 4. IHieu qua g i a m d a u cua t h u d c t r e n hai n h o m b e n h nhan sau u d n g thudc ngay thuf hai
Nhom ^ ^ ^ ^ ^ 1 _ Efferalgan
codeine IL Mobic P
hiieu qua giam dau theo VAS Sau 0,5 gioi
n 21 21
D,b 4,3 ±1,35
3,9 ±1,3 0,15
Sau 2 g i d n 21 21
D,b 4,3+1,06
5 ±0,77 0,01
Sau6glai n 21 21
Da 3 + 1,5 5,2 ±1,2 0
Nhdn xit: Hieu qua giam dau eCia Efferalgan Codeine tai thdi di^m 0,5 gid ngay thU hai I I cao hon Mobie, su khae biet khdng ed y nghTa thdng ke (p>0,05).
Hieu q u i giam dau eua Efferalgan Codeine tai thdi diem 2 gid n g l y t h d hai la thap hon Mobic, su khIe biet ed y nghTa thdng ke (p<0,05).
Hieu q u i g i l m dau cua Efferalgan Codeine tai thdi diem 6 gid ngay thQ hai la thap han Mobic, sQ khac biet cd y nghTa thdng ke (p<0,001).
7
%"
S ^ S 4 E
^ 1 0
d1-0,5h dl-3h
"
~~7'^
d1-6h d2-0,5h d2-2h
— Nh6m 2
d2-6h Thdi cTiemdanh gia
Bieu do 1. Hieu qua giam dau danh gia theo thang ^ d m VAS qua eac thdi diem khac nhau trong 48 gid dau sau p h l u thuat
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N''7/2017
4. Ban luan
4.1. Ve dac ^em chung cda mSu nghien c^
Ve gidi: Nhin chung trong so ele trUdng hap den nhd rang khdn thi nQ nhieu hon nam. Do nU thudng cd su ehu y nhieu hon tdi sQc khde b i n t h i n , hay thudng dQpc t u v i n nhd rang sd 8 de phdng bien chQng trong q u i trinh mang thai, sinh nd han che tien hanh cle can thiep nha khoa va lien quan tdi vi^c sQ dung ele thudc khang sinh sau nhd rang ed the I n h hUdng den thai nhi v l tre bu me. 0 nghien eUu nay ty le nQ/nam - 6/4. SQ khae biet ve gidi 11 khong ed y nghla thdng ke. Ket q u i k h i tuong ddng vdi mdt sd nghien cQu nhQ nghien cUu cda Hassan (2010) [5].
Ve thdi gian p h l u t h u l t : Yeu t d nay anh hUdng
\dn den p h l n Qng dau sau phau thuat vi thdi gian phau t h u l t thQdng ty le vdi dp khd cua r i n g nho v l mQc dp tdn thQOng md quanh rang [6]. Trong de tai cCia chdng tdi, su khIe biet ve thdi gian phau t h u l t giQa hai nhdm nghien cQu khdng ed y nghTa thdng ke (p>0,05).
4.2. Danh gia hieu quS giSm dau cua hai nhom thudc ng^y thd nhat
& nhdm paracetamol + codeine, eUdng dp dau g i l m manh trong vdng 30 phdt dau tien. K h i nang g i l m dau nay duy tri tuang ddi tdt eho den 2 gid sau khi udng (dUdng bleu dien gan nhU di ngang).
NhUng tdi thdi diem 6 g d thl hieu qua g i l m dau ha xudng rat t h I p . TQc la tai thdi diem gid thU 6 sau lidu dau, eudng dp dau tang dan t r d lai. Dieu n l y ed the dupe giai thich bang dupc ddng hoc cCia thudc.
Paracetamol hap thu nhanh qua tieu hda ndn dat dinh t i e dung (ndng dp tdi da sau k h o i n g 30 phut).
Thdi gian ban t h l i 112 gid, nhUng tai thdi diem 2 gid hieu q u i g i l m dau hau nhu khdng g i l m di do ed su kdt hop vdi codeine. Codeine ed thdi gian b i n t h l i khoang 2,9 gid. Do dd paracetamol ddgc ket hpp vdi codeine n h I m dem lai t i e dung g i l m dau manh han, va thdi gian t i e dung cung dai hon. Tai thdi diem 6 gid, luc n l y thude g i l m dau da ddgc t h l i ra gan nhu h o l n toan khdi ea the, nen benh n h i n bat d i u dau trd lai. Bdi vay, khi ke paracetamol ndi
ehung hay paracetamol + codeine ndi rieng, thudng eho bdnh nhan udng vien tiep theo sau 4 - 6 gid,
d nhdm meloxieam, tai thdi diem 30 phOt sau dung thude, hieu q u i g i l m dau tuang ddi thIp, sau dd tang dan len tai thdi diem 2 gid v l tiep tue duy tri hieu qua eao eho den thdi diem 6 gid sau udng.Ve mat dQpc dpng hpe, dieu nay la cd the ly giai diroc do meloxieam can nhieu thdi gian hon de gin v6i protein huyet tQong, va dat dUpc ndng dp toi da trong m l u sau 2 g i d vdi hon djch v l 5 - 6 gid vol dang vien nen.
Tai thdi diem 0,5 gid paracetamol -I- codeine co hieu qua g i l m dau tdt hon meloxieam, sU khac biet nay cd y nghla thdng ke (p<0,05). Bdi tai thdi diem nay, paracetamol da dat dUOc ndng dp tdi da trong huyet tuang nen cd hieu qua g i l m dau eao, trong klii meloxieam thl van chua dat duoc den dinh tie dung.
Tai thdi diem 2 gid, meloxieam cd tac dung giam dau t o t han, nhung sQ khae biet khdng coy nghla thdng ke (p>0,05), do luc nay, paracetamol da bat dau dupc ehuyen hda d gan va t h l i dan mot phan qua than, cdn meloxieam van ehUa dat d^n dinh t i e dung tQc la chUa dat dUOc den ndng do to!
da trong huyet tUong.
Tai thdi diem 6 gid, meloxieam cd t i c dung giam dau t o t hon rd ret v l sU khIc biet nly eo j nghTa thong ke (p<0,05). Do tai thdi diem nay, meloxieam da dat duae ndng dp tdi da trong huyet tuang, cdn paracetamol + codeine da dupe chuyen hda v l t h l i gan het nen hieu qua g i l m dau chi con rat t h I p . Ket q u i nay cung k h i tuang dong v6i nghien cQu cda Le Ddc L l n h [7].
4.3. Hieu qui glim dau cOa hai nhdm thuoc ngay thd hai sau phau thuat
d nhdm I, cQdng dp dau tiep tuc g i l m manh sau 0,5 gid sQ dung thude. Hieu q u i g i l m dau tiep tuc duac duy tri d mUe dp eao trong vdng 2 gid diu sau phau t h u l t (dudng bleu dien gan n h U i ^ ngang), vi hieu q u i g i l m dau g i l m manh d thdi diem 6 gid.
d nhdm 11, hieu q u i g i l m dau la thap d thfli diem 0,5 g i d do thudc ehUa dat dupc ndng do cao trong huyet tUOng, nhUng la cao han so vdi ciing thdi diem d ngay thU n h l t . Tiep dd hieu q u i giS""
TAP CHlYDUOC LAM SANGIOi Tap 12-So 7/2017
dau tang eao d thdi diem 2 g i d va tiep tuc tang tai thdi diem 6 gid. Hieu q u i giam dau ndi ehung la eao hon so vdi cung thdi diem cda ngay thU nhat.
d thdi diem 0,5 gid, hieu qua g i l m dau eua paracetamol + codeine van eao hon meloxieam tuy nhien su khIe biet nay khdng ed •^ nghTa thdng ke (p>0,05). Nhung d thdi diem 2 gid sau sQ dung thude, meloxieam ed tac dung g i l m dau t d t han la paracetamol + codeine v l sU khac biet n l y 11 cd y nghla thdng kd, dieu nay khIe vdi d ngay t h d nhat khi paracemol + codeine cd t i c dung g i l m dau t d t han du khdng ed y nghTa thdng ke. Tai thdi diem 6 gid, t i e dung g i l m dau eua meloxieam eao han rd ret. Nhin tren bieu do ta cd the thay, t i e dung g i l m dau cda meloxieam ngay thQ hai cd sQ tang tien tai tat ca ele thdi diem, trong khi dUdng bleu dien hieu qui g i l m dau eua paracetamol + codeine gan nhu khdng thay ddi. G i l i thich eho sU thay ddi nay, dUa theo duoc d d n g hpe v l t i c d u n g dupe ly eua thudc. d ngay thQ hai, t h d i diem udng thudc g i l m dau meloxieam each lieu trUdc d d ~12 gid (do cleh ke don Mobie 7,5mg n g l y udng 2 l l n , moi lan 1 vien, sau an), t r o n g khi t h d i gian ban thai cua meloxieam ti/2 = 20 g i d , nen khi udng lieu tiep theo thi trong huyet tUong van cdn m d t luang meloxieam t r o n g huyet tUOng.
Ngoai ra, meloxieam cdn cd t i e dung ehdng viem manh khi Ue che proteoglycanase va collagenase eua md sun. Mdt trong nhQng yeu t d gly nen dau sau phau t h u l t nhd rang la do receptor nhan e l m giac dau bi kich thich bdi cae c h i t hda hpc cua md ton thQong tiet ra. Viee Qe ehd qua trinh vi^m cung la mpt eo ehe quan trpng lam g i l m dau ciia meloxieam.
5. Ket luan
5.7. Ue hieu qui glim dau c6a hai nhom thudc tai cac thdi diem
Thdi diem 0,5 gid ngay dau: Paracetamol + codeine ed t i e dung g i l m dau t d t hon meloxieam.
Thdi cfiem 6 gid n g l y dau: Meloxieam ed t i e dung g i l m dau tdt ban paracetamol + codeine rd ret.
Thdi diem 0,5 gid ngay thQ hai: Paracetamol + codeine cd t i c dung g i l m dau t o t han nhQng sQ khae biet nay khdng cd y nghTa thdng kd.
Thdi diem 2 gid va 6 gid ngay thU hai:
Meloxieam cd t i c dung g l i m dau tdt hOn paracetamol + codeine rd ret.
5.2. Cach sddung thudc
Meloxieam: Men dung trudc p h l u t h u l t tU 4 - 5 gid.
Paracetamol + codeine ed tac dung g i l m dau nhanh, nhUng hieu q u i g i l m dau va thdi gian t i e dung kem nen dung trong cac tieu phau thuat tU nhe den trung binh.
Tai lieu tham khdo
1. Bromley L, Brandner B et al (2010) Acute pain.
Oxford University Press: 46.
2. Royal Colleges of Surgeon and Anaesthetic et al (1990) Acute pain service. Britishpainsociety.org: 45.
3 Melzack, Ronald, Wall et al (1988) The challenge of pain.
4. Moore, Edwards AJ et al (2003) Bandolier's Little bookofpain. Oxford University Press.
5. All HH (2010) Pattern of third molar impaction In a Saudi population. Saudi Arabia.
6 Michael M, Ghali GE, Peter EL (2004) Peterson's Principles of Oral and Maxillofacial Surgery. 2"'' edition: 160.
7. Le DQc Lanh, Pham Thj PhUOng Loan (2007) Hiiu qud gidm dau cda meloxieam vd acetaminophen sau phdu thudt rdng khon hdm dudi lech. Tap chi Y HpcTPHdChi Minh 11,tr. 174-182.
