Clinical Efficacy And Renal Safety Of Preincisional Parecoxib Sodium On Postoperative Fentanyl Analygesia In Patients Undergoing Nephrectomy

Objective:To observe the preemptive analgesic efficacy of parecoxib on prevention of agitation in the recovery period after remifentanil-based general anesthesia and postsurgical pain management and to evaluate the effect of single dose of parecoxib 40mg on renal function following nephrectomy.Methods:In this study,60 patients aged 26～75 undergoing nephrectomy under general anesthesia were randomly allocated to 2 groups (n=30): Parecoxib group received intravenous parecoxib 40mg 20 minutes before incision, while control group received equivalent dose of 0.9%NaCl as placebo. General anesthesia was maintained with propofol, remifentanil and atracuromium. All patients accepted patient-controlled intravenous analgesic (PCIA) pump with fentanyl (1.01mg/ml) immediately after extubation. MAP, HR and SpO2 were monitored at 4 different time points: pre-induction(T1),10min before extubation(T2), immediately after extubation(T3) and 10min after extubation(T4). Agitation levels were observed at T2,T3,T4 in two groups during recovery. The intensity of pain was measured by static and dynamic visual analogue scale (VAS) at 2,6,12 and 24 hours postoperatively. The fentanyl consumption, the number of delivered doses, the patient's pain relief(PR) and the patients' global evaluation of study medication(PGESM) at 12 and 24 hours after operation, also the incidence of opioid-type side effects were recorded and compared between the two groups. Renal safety evaluation included 24h urinary volume and clinical lab results including BUN, CREA,β2-M and RPB, which were recorded preoperatively and on the first and third day after operation.Main Results:The two groups were comparable with respect to gender, age, body weight, operation time, the consumption of fentanyl and remifentanil during the general anesthesia. MAP, HR and agitation levels in the parecoxib group were all lower than the control group at T2,T3,T4 (P<0.05). The static VAS scores in the parecoxib group were significantly lower than that in the control group within the first 6 hours postoperatively (P<0.01), as well as the dynamic VAS scores within the first 12 hours (P<0.05). The PGESM demonstrated a greater level of satisfaction among patients taking parecoxib than those taking placebo (P<0.05). The fentanyl consumption at 12 and 24h after operation was significantly less than that in control group and was reduced by 26.9% and 21.4% respectively. However, a reduction in opioid-type side effects was not demonstrated in the parecoxib group. In addition, patients in parecoxib group reported less fever than placebo group. No serious renal dysfunctional events were observed in either group.Conclusion:This study shows that the preincisional administration of parecoxib sodium with PCIA after nephrectomy resulted in significant prevention of agitation emergence, improvement of postoperative analgesic management and reduction of opioid requirement. However, except fever, the incidence of opioid-related adverse events had no obvious change regardless of preoperational parecoxib treatment. Parecoxib was well tolerated in patients after nephrectomy and preserved normal renal function status.