The Clinical Research Of Parecoxib Sodium In Preventing Post Anesthetic Hyperalgesia Induced By Remifentanil

Objeetive:Relatively large dose of remifentanil anesthesia with small doses of remifentanil-induced hyperalgesia extent;To investigate the influence before the end of surgery to prevent injection parecoxib sodium on hyperalgesia after anesthesia by remifentanil.Methods:Select eighty female patients(ASA I-II)undergoing elective surgery subtotal thyroidectomy under general anesthesia. Randomly divided into four groups (n = 20): Group A of small doses of remifentanil: remifentanil was continuous infusion 0.1μg/kg?min of during operation. Group B of large dose remifentanil group; remifentanil was continuous infusion 0.3μg/kg?min of during operation. Group C of small doses of remifentanil+ parecoxib sodium: 15 minutes before the end of surgery intravenous parecoxib sodium 40mg, remifentanil was continuous infusion 0.1μg/kg?min of during operation. Group D of large doses of remifentanil+ parecoxib sodium: 15 minutes before the end of surgery intravenous parecoxib sodium 40mg, remifentanil was continuous infusion 0.3μg/kg?min of during operation. After induction of anesthesia and endotracheal intubation, constant infusion of propofol and remifentanil to maintenance of anesthesia, Intermittent intravenous injection of cisatracurium muscle relaxation at the maintenance. Group C and Group D, respectively 15 minutes before the end of surgery intravenous parecoxib sodium 40 mg. Half an hour before the end of surgery to stop injection of muscle relaxants. Stop the infusion of propofol at 5 minutes before the end of skin closure. Remifentanil infusion was stopped at the end of skin closure. Extubation until patients after have indication extubation. Four groups patients were observed and recorded the general situation; Into the operating room(T1), extubation time(T2), 5 minutes after extubation (T3)and 10 minutes after extubation (T4) at each time point of the mean arterial pressure and heart rate; Intraoperative fentanyl, propofol dosage; Extubation in patients after surgery time and recovery time of consciousness; The oral pain score when extubation time (T2),at the time of 5 minutes and 10 minutes after extubation,1 hour (T5),2 hours (T6),3 hours (T7) and 6 hours (T8)after surgery of the point in time the pain visual analogue scale (VAS scores); After stopping the end of surgery to first postoperative analgesic tramadol time of application,within 6 hours after application of the total amount of tramadol and the postoperative complications of anesthesia.Results:Comparison of T1-T4 time point, MAP and HR, at the time point of T2 and T3 B group than the A, C, D groups, MAP and HR changed greatly, P <0.05; Comparison of tracheal extubation oral pain score, A group score higher than C group, P <0.05. B group score higher than A, C, D groups, P <0.05; Comparison of postoperative VAS scores, B group at the time point of T3,T4,T5,T6 and T7 VAS values were more than A, C, D groups, P <0.05. C group at the time point of T3,T4 and T5 VAS values were less than D group, P <0.05. A group at the time point T5 VAS values was higher than C group, P <0.05. Comparison of postoperative analgesic time of first were used, A group of time shorter than C group, P <0.05. B group was shorter than A, C, D groups, P <0.05. Time was significantly longer than the C group, D group, P <0.05. Compared after 6 hours the total amount of tramadol, the dosage B group more than the A, C, D groups, P <0.05. Four patients in the intraoperative use of fentanyl, propofol, and the total time after extubation, consciousness after anesthesia recovery time and complications were not statistically different.Conelusions : Perioperative large dose then less dose remifentanil administration might induce postoperative hyperalgesia; Selective COX-2 inhibitor parecoxib sodium to some extent could prevent hyperalgesia induced by remifentanil; Fifteen minutes before the end of surgery received intravenous parecoxib sodium has no effect on patients' recovery.