Clinical Application Of Preemptive Analgesia With Parecoxib Sodium In The Closed Abdominal Injury

Objectives: To study the clinical applications of preemptive analgesia with parecoxib sodiumon the patients with abdominal closed injury.Methods:80emergent surgical cases with closed abdominal injury were chosen from thegeneral surgery department of Baoding No.1central hospital in Jul2013-Jan2014. Amongthem were49males and31females. They ranged in age from18to58and the average age is35±11. The clinic time after injury was30min to3h. Open surgery was adopted, including22cases with surgical repair of liver rupture,35cases with spleen rupture repair,15caseswith intestinal rupture repair,and8cases with resection of part of the bowel and intestinalanastomosis. The group cases strictly follow the inclusion and exclusion criterion.The80cases were divided into two groups according to the random number table: the experimentalgroup (parecoxib sodium) and the control group (normal saline). Each group was40cases.The patients of the experimental group were at one time injected intravenously40mg ofparecoxib sodium20minutes before operation and the control group cases were injectedintravenously4ml of normal saline. Venous blood samples from the upper limbs wererespectively drawn from the two groups at the different time points:10minutes beforeinjection(T1), the end of the operation(T2),6h after the operation (T3),12h after theoperation(T4), and24h after the operation(T5).Quantitative sandwich enzyme-linkedimmunosorbent kit was used to measure the concentration of plasma interleukin-6(IL-6) andTNF-a. HPLC(High Performance Liquid Chromatography) and electrochemical process wereused to measure plasma epinephrine（E） and chemical fluorescence immunity analysismethod was used to determine plasma cortisol levels. In24hours after the operation, videoanalog scale(VAS) was used to evaluate the analgesic effect at different time points--the veryend of the operation,2h,6h,12h and24h after the operation.Results:1. inflammatory cytokines: The IL-6plasma concentration of the two groups weresignificantly higher at the time point T3,T4and T5than pre-operation. There was statisticalmeaning(p<0.05). The IL-6plasma concentration of the experimental group at the time point T3,T4and T5was obviously lower than that of the control group.(p<0.05). The TNF-aplasma concentration of the two groups were significantly higher at the time point T4and T5than pre-operation (p<0.05). The TNF-a plasma concentration of the experimental group atthe time point T4and T5were obviously lower than that of the control group and there wasstatistical meaning (p<0.05).2. Stress hormone concentration: The plasma concentration of the two groups at the differenttime point were clearly higher than pre-operation and there was statistical meaning(p<0.05).The plasma cor concentration of the experimental group at the different time pointsT2,T3, T4and T5were obviously lower than that of the control group. The plasma Econcentration of the two groups at the time point T2were obviously higher thanpre-operation. The plasma E concentration of the experimental group at the time point T2were obviously lower than that of the control group and there was statisticalmeaning(p<0.05).3. The evaluation result of VAS: The VAS evaluation results of the experimental group atthe different time points---the very end of the operation,2h,6h,12h after the operation,were significantly lower than that of the control group and it has statistical meaning(p<0.05).Conclusions: Parecoxib sodium preemptive analgesia are in advance given to the emergentsurgical patients with abdominal closed wound before operation, which can achieve goodanalgesic effect and can greatly improve analgesic quality after operation. It can greatlyreduce the patients’ inflammatory cytokines, the sensitivity of the nervous system,the releaseof stress hormones and the stress response. Therefore, it is of great help to the patients’recovery from operation.