| Objective:To analyze the analgesia effects of pretreatment intravenous parecoxib combined with cryoanalgesia after thoracic surgery.Method:Ninety patients(ASA Ⅱ-Ⅲ)undergoing selective thoracic surgery were divided into three groups:parecoxib group(group T),cryoanalgesia group(group L)and parecoxib combined with cryoanalgesia group(group F),each group had 30 patients.Cases in group T were intravenously injected parecoxib 10 minutes before the operation.Cases in group L were isolated the intercostals nerves around the surgical incision and the region of the thoracic drainage by the surgeons at the end of the surgery,and the intercostal nerve cryotherapy was performed with the CO2 cryogenic probe before closing thoracic cavity.Referring to the methods of group T and group L,intravenous parecoxib combined with cryoanalgesia were applied in all the cases in group F.During the operation of all the cases in three groups,effective anesthesia depth and intraoperative hemodynamic stability were maintained,no drug allergy,intraoperative bleeding and other accidents happened.Recorded the observations respectively:(1)Recording the mean arterial pressure,heart rate,SPO2 and SPCO2 when the patients entered the operation room.(2)Recorded the changes of PaO2 and PaCO2 before and after operations.(3)Recorded the VAS pain scores at 1h,2h,6h,12h,24h and 48h after extubation.(4)Recorded Ramsay sedation score to estimate the agitation situation at the time of extubation and 30mins after operation.(5)Recorded the using dosage of oxycodone hydrochloride controlled-release tablets within 48h after the operations.(6)Recorded the adverse events after operations,such as respiratory depression,cardiac arrhythmias,nausea and vomiting,lethargy,pruritus and fever.Results:(1)The patients’ postoperative pain in all three groups was reduced in varying degrees,and no adverse reactions such as respiratory depression,nausea,vomiting and itching were recorded.(2)The postoperative values of PaO2 and PaCO2 in three groups were statistically significant,group F was better than group T and group L.Combined analgesia can improve the limiting ventilation barrier caused by pain effectively,increase the oxygen partial pressure and reduce the accumulation of CO2.(3)The VAS score of group T was higher than group F within 48h after the operation,which was statistically significant(p<0.01);The VAS score of group L was higher than group F within 24h after the operation,which was statistically significant(p<0.05),and the VAS score was not statistically significant(p>0.05)after 24h after the operation.(4)Patients with good Ramsay score(2-4 point)in group F were more than group T and group L,patients in group F has a better cooperation in opening eyes,handshake and suction,and the postoperative agitation was mitigatory.(5)The dosage of analgesics used in group F was smaller than group L and group T,which was statistically significant(p<0.05).Conclusion:Parecoxib combined with cryoanalgesia has a good effect on postoperation analgesia in thoracotomy patients,which is better than using parecoxib and cryoanalgesia along,can reduce the dosage of postoperative analgesic used in patients.Parecoxib combined with cryoanalgesia has no side effects such as respiratory depression and so on,reduce the protective breathing due to pain,promote patients cough,expectoration and pulmonary function recovery,it is suitable for postoperative analgesia in thoracotomy. |
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