| Fifty to seventy percent of surgical patients suffer middle-intensity or above pains after surgical procedures, and which not only causes the patients' physiological and psychological problems, but also affects the patients' living quality. Therefore postoperative pain and its mechanism have been important aspects in medical research for last ten years. There are many ways for postoperative analgesia in clinic. Opioid agents are commonly used analgesics for postoperative pain relief, but they are associated with a number of adverse effects, such as respiratory depression, alteration in mental status, ileus, constipation, nausea and vomiting, which severely impact its analgesic quality. Multimodal pain therapy that combines opioid with other analgesics has been recommended in postoperative surgical patients to reduce the need for opioids and improve overall analgesic management. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to reduce pain for above one hundred years, but they were used for postoperative analgesia only after some new types of drugs were developed. They cause fewer side effects, and have effects of local anti-inflammatory and analgesia. But they also have side effects, including gastrointestinal ulceration and bleeding, kidney toxicity and decreased platelet aggregation. Lornoxicam, a new kind of xicam NSAIDs, not only decreases the production of prostaglandins (PGs), but also improves analgesic effect by increasing the release of endogenous morphine. And it can be used intravenously for postoperative pain management. Rofecoxib, a kind of coxibNSAIDs, is a special cyclooxygenase-2(COX-2) inhibitor, which causes fewer side effects than traditional NSAIDs, and its analgesic effect lasts for about 24 hours. If two drugs are proved safe and efficacious for postoperative analgesia, it will change the traditional analgesic mode which depends mainly on opioids. The present study was designed to aim at: CD To investigate analgesic efficacy and tolerability of lornoxicam for postoperative analgesia in patients undergoing gynecological surgery and find out safer and more efficacious analgesic method. (2) To study effects of patient-controlled analgesia (PCA) with lornoxicam for postoperative analgesia on IL-6 and function of platelets. (3) To evaluate analgesic and stress-attenuating effects of rofecoxib combined with local bupivacaine.Experiment 1Objective: To investigate analgesic efficacy and tolerability of lornoxicam for postoperative analgesia in patients undergoing gynecological surgery and to find out safer and more efficacious analgesic method. Methods: 110 patients undergoing elective hysterectomy were randomly divided into five groups (n=22 each): Groups C, F, L, M and ML. Group C received 5ml normal saline epidurally, group F received postoperative patient-controlled intravenous analgesia (PCIA) with fentanyl, group L received PCIA with lornoxicam, group M received 2mg morphine epidurally and group ML received Img morphine epidurally combined with PCIA with lornoxicam. The efficacy of analgesia was assessed by Visual Analogue Scale (VAS) at 8, 16, 24, 36 and 48 hours after surgery respectively. Results: the VAS of groups F, L and ML was significantly less than that of group C at all time points after surgery (p<0.01). The VAS of group ML was less than that of group F at 24,36 and 48 hours after surgery respectively (P<0.01) . The VAS of groups ML and M was less than that of groups L and C respectively at 8, 16 and 24 hours after surgery (p<0.05). The total dose of lornoxicam used for postoperative analgesia was 27.6 4.4 mg in group L and 19.2 3.6mg in group ML respectively. There weresignificant differences in the doses of lornoxicam between groups L and ML (p<0.01). Lornoxicam caused fewer side effects than fentanyl did; the rate of vomiting was 13.6%, 4.6%, 9.1% and 31.8% in groups L, M, ML and F respectively. Conclusions: the analgesic efficacy by PCIA with lornoxicam was inadequate during the early postoperative time, but lornoxicam PCIA combined with epidu...
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