The Clinical Research Of Parecoxib In The Preemptive Analgesia For Spinal Surgery

OBJECTIVE:To investigate the effect of parecoxib in the preemptive analgesia on postoperative pain stress response for spinal surgery, so as to evaluate the clinical effect of parecoxib in the preemptive analgesia.METHODS:60 ASAⅠ-Ⅱpatients aged 20～60 years old undergoing selective lumbar fixation operation were randomly divided into 3 groups: Group A(experimental group), B (control group)and C(blank control group),20 cases in each group. They were all endotracheal intubated after the induction of anesthesia with midazolam(0.1mg/kg),fentanyl(6μg/kg) and vecuronium(0.1mg/kg). Anesthesia was maintained with propofol, remifentanil, cis-atracurium, and the total dosage of fentanyl is less than 10μg/kg. All cases in 3 groups keep a good hemodynamic stability. Group A were given 5ml saline and 40mg parecoxib before anesthesia; Group B were given 5ml saline and 40mg parecoxib at the end of the operation; Group C was given 5ml normal saline at the end of operation. Three groups took fentanyl PCIA after operation.Venous blood sample were taken at the time before anesthesia(TO), at the end of operation(T1),6 hours after operation(T3) and 24 hours after operation(T4) to evaluate the levels of blood glucose, CRP and IL-6 respectively; VAS scores were recorded at the time of 2h,4h,6h,12h,24h after operation; Total fentanyl were recorded 48 hours after the operation and side effects were also recorded 24 hours after the operation such as nausea and vomiting.RESULTS:1. Stress response:①The levels of blood sugar(BS)among three groups showed no obvious difference before operation. After operation, they all reached the peak level at T1 and descended to normal range in 24 hours after operation. Compared with Group B and Group C, Group A showed a shorter recovery time. There is no significant difference between TO and T2 in group A, but there is significant difference between TO and T2 in group B and group C. At T1 and T2, BS in Group A was the lowest and that in Group C, which showed that the fluctuation of BS in Group A was the least.②There was no significant difference among the concentrations of CRP in three groups at T0(P> 0.05). The concentrations of CRP in 3 groups descended at T1, and gradually went up at T2,T3. There was significant difference between the concentrations of CRP at T1,T2,T3 and the one at TO (P<0.05); At T1 and T2, CRP in group A were lower than that in group B(P<0.05)and CRP in group B were lower than that in group C(P<0.05).③There was no significant difference among the concentrations of IL-6 in three groups at T0(P> 0.05). The concentrations of IL-6 in 3 groups descended at T1, and gradually went up at T2,T3,.There was significant difference between the concentrations of IL-6 at T2,T3 and the one at T0 (P<0.05); At T1 and T2, CRP in group A were lower than that in group B(P<0.05)and CRP in group B were lower than that in group C(P<0.05).2. The VAS scores of each time point within 12 hours after operation in group C wree all higher than those in group A (P<0.05)and B(P<0.01). There was significant difference (P<0.01) in VAS scores between group A and B in 6 hours and 12 hours after operation. There was no significant difference in side effect after operation among three groups(P>0.05). It was showed that preemptive analgesia can evidently relieve pain after operation and get a better satisfaction of patients.CONCLUSIONS:1. Parecoxib applied before operation in the preemptive analgesia for spinal surgery can evidently relieve pain after operation and rise satisfacion of patients.2. Parecoxib applied before operation in the preemptive analgesia for spinal surgery can effectively reduce post-operation stress response.