Comparing Effects Of Preoperative Parenteral Parecoxib And Flurbiprofen Axetil In Relieving Acute Postoperative Pain Following Laparoscopic Cholecystectomy

Objective Compared with open cystic resection, laparoscopic cholecystectomy becamesmore popular as less invasion and rapaider recovery. Although its incision pain is less seriousthan laparotomy, the postoperative pain still exists. Quite a number of patients complained ofpain on both hypochondrium and shoulder. And sometimes its pain is quite obvious, even morethan incision pain,which is called“Laparoscopic postoperative pain syndrome”. The aim of thesubject is to evaluate the analgesic effect of preoperative parenteral parecoxib in laparoscopiccholecystectomy, which is compared with flurbiprofen axetil by means of observing andrecording the VAS scores during rest and movement, the consumption of pethidine, side effectand patient satisfaction, providing reference for clinical practice.Methods One hundred patients （ASAⅠ～Ⅱ, age from 18 to 60 years old ） scheduled forlaparoscopic cholecystectomy under general anesthesia were randomly divided into 5 groups：group C，P₁，P₂，F₁and F₂, 20 cases in each group.They were all endotracheal intubated after theinduction of anesthesia with midazolam（0.03mg/kg）,etomidate （0.4mg/kg）,cisatracuriumbesylate （0.15mg/kg） and remifentanil（1.5ug/kg）. Anesthesia was maintained by continuousinfusioning propofol (5-7mg/kg^-1·h^-1) and remifentanil(8-15ug/kg^-1·h^-1), meanwhile intermittentlyinject cisatracurium . They were received single intravenous saline 2 ml，parecoxib 40 mg，parecoxib 80 mg，flurbiprofen axetil 50 mg or flurbiprofen axetil 100 mg 15 min before surgeryrespectively. VAS scores during rest and the time when cough，rolling over or sit up wererecorded at 1（T₁），2（T₂），6（T₃），12（T₄）and 24（T₅）hour after operation. The consumptionof pethidine，side effect and patient satisfaction were also writen down in 24 h after operation.Results1)VAS score: The resting VAS scores of group P₁，P₂，F₂were significantly decreasedcompared with group C（P <0.05）, but no significant differences were found between thegroups P₁，P₂and F₂（P﹥0.05）.The moving VAS scores of group P₁，P₂，F₁，F₂weresignificantly decreased compared with group C（P <0.05）, and the scores of group F₂were significantly lower than those in groups P₁，P₂，F₁（P <0.05）.2)The situation of useing pethidine: The number of using pethidine in groug P₁，P₂，F₂was obviously reduced compared with group C （P <0.05）. 3)Adverse reaction: The incidence and severity of nausea and vomiting in group P₂weresignificantly reduced compared with group C, （P <0.05）；but no significant differenceswere found between the groups F₂and C（P﹥0.05）；the incidence and severity ofvomiting in groups P₁,F₁were significantly reduced compared with group C （P <0.05）.4)Patient satisfaction: The patient satisfaction in group P₁，P₂，F₁，F₂were improvedobviously（P <0.01），and that the patient satisfaction in group P₂，F₂were greater thanthose in group P₁，F₁（P <0.05）.Conclusion Preoperative parenteral parecoxib can effectively relieve postoperative pain，reduce the number of using pethidine，decrease the incidence of nausea and vomiting andimprove the patient satisfaction. And parecoxib 80mg is more comfortable and safe than 40mg.Compared with flurbiprofen axetil, the analgesic effect of parecoxib 40mg is better thanflurbiprofen axetil 50mg. The analgesic effect of parecoxib 80mg is no better than flurbiprofenaxetil 100mg, but it has better gastrointestinal tract security.