| Background and ObjectiveThoracic surgeries cause serious trauma and severe pain. A series of pathophysiologic changes caused by pain not only cause suffering to the patients,but also affect the body circulatory, respiratory, digestive, endocrine and immune system function. These changes of the body can cause the occurrence of postoperative complications and are not conducive to patients recovered. So postoperative pain is one of the most important issues to doctors in perioperative. The traditional mode of postoperative analgesia can not meet the clinical needs.Preemptive analgesia as a new model is getting more and more clinical applications.Preemptive analgesia of NSAIDs is the most popular in current clinical studies. Parecoxib sodium is a kind of NSAIDs and is selective cyclooxygenase-2 inhibitor.It inhibits peripheral and central COX-2 expression and prostaglandin synthesis. It can increased pain threshold and play a role in double analgesia.Many clinical studies in general surgery, orthopedics surgery and gynecology surgery have confirmed that parecoxib sodium is safe and effective for postoperative analgesia.This study focused on the effectiveness and safety application of preemptive analgesia of parecoxib sodium in thoracic surgery.Materials and Methods90 patients(age from 30 to 65 years old, weight from 50 to 80kg, ASAâ… ï½žâ…¡) undergoing thoracic suegery under general anesthesia were randomly divided into three groups:Group A received 40mg parecoxib sodium 20 minutes befor the surgery; Group B received 40mg parecoxib sodium when skin was sutured; Group C was control group. All of the surgeries were completed by the same group of thoracic doctors. All surgeries were performed under balanced anesthesia with routine monitoring.At the completion of surgery, sufentanil 2μg/kg and normal saline to a total amount 100ml were used for intravenous analgesia pump(loading dose 10ml+ continuous background infusion 2ml/h+PCA volume 0.5ml/times, lockout time 15min). We should observe the following index:(1) the incidence of emergence agitation and agitation score in all three groups during recovery. (2) VAS score, BCS score at times of 3h,6h,12h,24h,48h and the patients'global evaluation of the 24h postoperation analgesia were recorded after the surgery. (3) sufentanil consumption within 12h and 24h was also recorded after the surgery. (4) the incidence of side effects, the change of renal function and blood clotting in all three groups after the surgery.Statistical analysis was performed with SPSS 13.0 software. All data were expressed as mean±SD. T test was used to test the difference between groups. One-way analysis of variance was used to test the difference for continuous variables within group. A P-value less than 0.05 was considered significant.Results1. No significant differences were noted with regard to age, gender, weight, height and body mass index (P>0.05) 2. No significant differences were noted with regard to operative duration, infusion volume, bleeding volume and urine output (P>0.05)3. The incidence of emergence agitation and agitation score in group A and group B were lower than group C and the difference was significant (P<0.05).Though the incidence of emergence agitation in group A was lower than group B, there was no significant difference (P>0.05)4. VAS scores were lower and BCS scores were higher in group A and group B than group C at 3h,6h and 12h, the difference was significant (P<0.05). VAS scores and BCS scores were no significant difference at 24h and 48h in three groups (P>0.05) There was no significant difference in group A and group B (P>0.05).The patients' global evaluation of the 24h postoperation analgesia in group B and group C were worse than group A, the difference was significant (P<0.05)5. Sufentanil consumption in group A and group B were less than group C at 12h and 24h, the difference was significant (P< 0.05). There was no significant difference in group A and group B (P>0.05)6. The renal function and blood clotting in all three groups were no significant difference (P>0.05).The incidence of side effects in group A and group B were less than group C and the difference was significant (P<0.05). There was no significant difference in group A and group B (P>0.05)Conclusions1. Pre-emptive analgesia of parecoxib sodium in thoracic surgery can reduce the incidence of emergence agitation during recovery, enhance postoperative analgesia, reduce postoperative PCA sufentanil consumption and decrease the incidence of side effects.2. Administration parecoxib sodium at the start of the surgery or at the end of the surgery is no significant difference influence on emergence agitation and postoperative analgesia.3. Pre-emptive analgesia of parecoxib sodium have no obvious adverse effects in renal function and blood clotting of patients. |
