Effect Of Parecoxib Combined With Thoracic Epidural Analgesia On Pain And Stress Response After Thoracic Surgery

Objective:To study the analgesia effects of intravenous parecoxib combined with thoracic epidural analgesia (TEA) as well as its effect on stress response after thoracic surgery, and to investigate the residual pain1month postoperatively.Methods:Fifty-six ASA class I or Ⅱ patients undergoing thoracic surgery were included in this prospective, randomized, double-blind, placebo-controlled study. General anesthesia was standardized. Patient-controlled epidural analgesia (T7-T8) was used until chest tubes were removed. All patients were randomly divided into two groups:placebo group (group C, n=28) or parecoxib sodium group (group P, n=28). Patients in two groups were allocated to receive parecoxib or placebo (normal saline) intravenously just0.5h before the operation and every12h after operation for3days. The intensity of pain was measured by using a VAS (0=no pain,10=worst pain) and recorded at2,4,8,24,48,72h after operation. The actual/effective number of PC A, the side effects, the overall satisfaction to analgesic therapy in72h and the days fit for discharge were recorded. Venous blood samples were taken before operation, the1st and3rd day after operation for detecting cortisol, ACTH, interleukin-6and tumor necrosis factor-a level. The incidences of residual pain, the VAS of pain, the characteristic of pain, the impact on the daily life were questioned with telephone interview1month after surgery.Results:(1) Postoperative pain scores at rest and during coughing were lower in the parecoxib group compared to those in placebo group at2,4,8,24,48,72h postoperatively (P<0.01). The effective number of PCA was significantly less and patient satisfaction was greater in the parecoxib group than placebo group (P<0.01). Adverse effect and the days fit for discharge were comparable between two groups.(2) There were no significant differences in cortisol level between T1and TO in parecoxib group (P>0.05), while cortisol levels were significantly increased in placebo group (P<0.01) at T1. The cortisol levels in placebo group were higher than parecoxib group at T2. The level of ACTH both decreased in two groups after operation but it was significantly lower in parecoxib group than that in placebo group. (3) There were no changes in plasma IL-6and TNF-a levels before and after analgesia at T1and T2(P>0.05).(4) The incidence of residual pain were24%and53.8%separately in group P and C1month postoperatively (P<0.05). Parecoxib group had a lower pain score than placebo group (P<0.05). The incidence of allodyna were4%and15.4%separately in group P and S (P<0.05). Three patient in group P and10patients in group C had chronic pain affecting their daily life.Conclusions:Parecoxib in multimodal analgesia improves postoperative analgesia provided by TEA, relieves stress response after thoracic surgery, and may restrain the development of chronic pain.