Effects Of Parecoxib Preemptive Analgesia On Plasma Stress Hormone Levels And PCA In Elderly Patients Undergoing Total Hip Replacement

Objective:To observe the effects of parecoxib preemptive analgesia on plasma stress hormone levels and safty of PCA in elderly patients undergoing total hip replacement.Method:Sixty ASAⅠ～Ⅱelderly patients undergoing total hip replacement under spinal combined epidural anesthesia were randomly divided into three groups: Control group (Group A),parecoxib preemptive analgesiaⅠ(group B) and parecoxib preemptive analgesiaⅡ(group C) each group had 20 cases. Group A:Received intravenous normal sal in 2 ml 30 min before anesthesia.Group B:Received intravenous parecoxib 40 mg 30 min before anesthesia. Group C:Received intravenous parecoxib 40 mg 30 min before anesthesia and immediately after surgery. The patients in each group received PCIA immediately after surgery. The vital signs such as SpO2, blood pressure and pulse rate were observed during operation and PCA. Serum cortisol, epinephrine, blood sugar and norepinephrine levels were measured at T1 (before operation),T2 (12 h after the end of operation),T3(24h after the end of operation). Pain intensity was meassured by visual analog scale (VAS) score at 4,8,12,24 and 48 h after operation. The total consumption of sufentanil. the total number and the valid number of pressing PCA pump were recorded at 48 h after operation. Meanwhile, the score of MMSE sedation scale and the adverse effects such as nausea and vomiting, pruritus and respiratory depression were observed after operationResults:Serum cortisol and epinephrine at T2,T3 in each group were significantly higher than T1(P<0.05). At the same time Serum cortisol and epinephrine at T2,T3 in group A were significantly higher than those in group B and group C(P<0.01). Parecoxib preemptive analgesia can restrain the plasma stress hormone levels. The valid number of pressing PCIA pump and adverse effects at T2,T3 in group A were significantly higher than those in group B and group C(P<0.01). Parecoxib combined PCIA can reduce the acute opiod consumption and have less side reactions than control group.Conclusions:Parecoxib administered preemptively can improve the quality of postoperative analgesia and reduce consumption of opioid analgesics postoperatively in elder patients undergoing total hip replacement.