Effects Of Parecoxib Pre-emptive Analgesia After Surgeries In Patients With Complicated Rentinal Detachment

OBJECTIVETo evaluate the influences of preoperative intravenous different doses of parecoxib on postoperative pain, coagulation function, renal function and perioperative changes of plasma prostaglandin E2 (PGE2),serum cortisol (Cor) and interleukin -6 (IL-6) in complicated rentinal detachment patients.METHODSNinety ASAⅠ-Ⅱpatients under elective complicated rentinal detachment were randomly ,double-blindly divided into three groups(n=30):parecoxib 40mg (Pi), parecoxib 20mg (P2),0.9% saline 2ml(C). Patients received intravenous injection of at 30min before surgery respectively. PGE2 in plasma and Cor,IL-6 in serum in each group were measured by radioimmunoassay 30min before surgery (T1) and the end of operation(T2),2h (T3),6 h (T4)and 24h (T5) after operation. All patients were monitored on coagulation function and renal function. Postoperative analgesia efficacy was assessed by VAS at T2, T3, T4,T5·Adverse effects such as nausea, vomiting, itch, headache, Bradycardia and satisfaction with postoperative analgesia were recorded after surgery.RESULTS1) plasma PGE2 concentration:The concentration of plasma PGE2 in P2 group and C group at T2～T4 were significantly increased compared to at T1 (P<0.05). The concentration of plasma PGE2 in P1 group at T2～T5 was slightly increased compared to at T1 but There was no significant diference (P>0.05). The concentration of P2 group at T2～T4 decreased compared with it of C group (P<0.05). The concentration of P1 group at T2～T4 were significantly decreased compared with it of C group (P<0.01)2) serum Cortisol concentration:The concentration of serum Cortisol at T2～T5 in P2 group and C group were significantly increased compared to at T1 (P<0.05), The concentration of P2 group at T2～T4 decreased compared with it of C group (P<0.05) The concentration of P1 group at T2～T4 were significantly decreased compared with it of C group (P<0.01)3) serum IL-6 concentration:The concentration of serum IL-6 in P2 group and C group at T2～T4 were significantly increased compared to at T1 (P<0.05).The concentration of serum IL-6 in P1 group at T2～T5 was slightly increased compared to at T1 but There was no significant diference (P>0.05).. The concentration of P2 group at T2～T4 decreased compared with it of C (P<0.05). The concentration of P1 group at T2～T4 were significantly decreased compared with it of C group (P<0.01)4) VAS pain scores:The VAS pain scores of P2 group at T2～T3 were decreased compared with those in C group (P<0.05). The VAS pain scores of P1 group at T2-T4were significantly decreased compared with those in C group (P<0.01). The VAS pain scores of P1 group at T4 was decreased compared with those in P2 group (P<0.05)5) The ratio of satisfaction with postoperative analgesia:The ratio of satisfaction with postoperative analgesia in P2 at T4 and T5 were increased with those in C(P<0.05). Those in P1 at T4 and T5 were significantly increased with those in C (P<0.01)6) renal function, coagulation function:There was no significant diference in renal function, coagulation function (P>0.05)7)adverse effects:There was no significant diference (P>0.05)CONCLUSION1) Preoperative intraxenous parecoxib can inhibit the production of mediators of inflammation PGE2 and proinflammatory factor IL-6 and analgesia effects were related with the dose of parecoxib.2) It can gradually enhance pre-emptive analgesia effects through relieving central and peripheral sensitization in patients undergoing complicated rentinal detachment3) It can effectively prevent stress response and relieve postoperative immunosuppression through inhibiting the production of Cor in patients undergoing complicated rentinal detachment.4) Parecoxib pre-emptive analgesia was safe and effective in patients undergoing complicated rentinal detachment.