The Effect Of Parecoxib Sodium And Tramadol Combined With Sufentanil- Pca On Acute/chronic Post-thoracotomy Pain

ObejectiveTo observe whether intravenous parecoxib sodium combined with tramadol can improve the effect of sufentanil- PCA after thoracotomy, and to investigate the chronic pain 3/6 month postoperatively.MethodsSixty patients(ASAⅠ-Ⅱ) were randomly divided into three groups: control group(group S, n=20), parecoxib sodium group(group P, n=20), parecoxib sodium combined with tramadol group(group C, n=20). Patients were chosen by the researcher who did not perform the post-operative follow-up visit randomly.Group P: parecoxib sodium 40 mg(diluted to 5 ml with saline) was intravenously administered just 0.5h before the operation. Group C: parecoxib sodium 40 mg was intravenously injected 0.5h before the operation, then intravenous tramadol 2mg·kg-1 was administrated 0.5h before the end of the operation. Group S: saline 5 ml was intravenously administered 0.5h before the operation. All the patients were taken the sufentanil-PCA immediately when they were awake, and the PCA would last for 48h.The resting and motion VAS of pain,the actual/effective number of PCA, the level of restlessness and the residence time in PACU at 0.5h,8h,12h,24h,48h postoperatively were evaluated and recorded, the side effects and the overall satisfaction to analgesic therapy were questioned at the 48h. The incidences of chronic pain, the VAS of pain, the characteristic of pain, the impact on the daily life and so on were investigated with telephone interview 3/6 month post-operatively. Results1. There were no significant differences among each group of age, weight, ratio of gender and the operation time(P>0.05);2. The resting and motion VAS of pain were significantly lower in group C and group P compared to those in group S at each time points postoperatively(P<0.05), the resting VAS of pain in group C and group P were separately recorded as (1.80±0.52) and (2.50±0.95) (P<0.05), and the motion VAS of pain were (2.85±0.76) and (3.30±1.38)(P<0.05); The effective number of PCA was significantly less in group C and group P than group S;3. The rates of restlessness were 10%,50% and 90% in group C,group P and group S (P<0.05). No significant differences among each group of the residence time at PACU were found (P>0.05);4. Each group had a SpO2 higher than 95% in 48h post-operatively, group C and P were more close to the 100%(P<0.05). There was no patient over conscious-sedation in each group, and the scores were similar (P>0.05);5. No significant differences of adverse effect among groups were found (P>0.05);6. The overall satisfaction to analgesic therapy of group C and group P were similar(P>0.05), and better than group S(P<0.05);7. The incidence of chronic pain were 11 %( 2), 17 %( 3) and 47 %( 8) separately in group C, P and S 3 month post-operatively(P<0.05), 6 %( 1),17 %( 3)及30 %( 5) separately in group C, P and S 6 month post-operatively (P>0.05);8. The incidence of allodyna were 11 %( 2),6 %( 1) and 24 %( 4) separately in group C, P and S (P>0.05);9. One patient in group P and two patients in group S had chronic pain affecting their routine life.ConclusionIntravenous parecoxib sodium combined with tramadol can improve the effect of sufentanil- PCA after thoracotomy, and restrain the development of chronic pain in a way.