Evaluation Of Parecoxib Sodium Combined With PCIA And Ultrasound Guided Paravertebral Nerve Block For Postthoracotomy Pain Management

Background Postoperative pain after non cardiac thoracic surgery can besevere unless adequately treated. Patient-controlled intravenous analgesia(PCIA) with morphine, parecoxib sodium and ultrasound guidedparavertebral nerve blocks were used to improve pain control alone. Inthis study, we evaluated the efficacy of parecoxib sodium combined withPCIA and paravertebral nerve block and opioid-related side effects.Methods This is a prospective, randomized, double-blind study in China.We enrolled120patients with American Society of Anesthesiologists(ASA) physical status I–II undergoing non cardiac thoracic surgery. Thenthese patients were randomly divided into4groups: group A (30patientswho received PCIA); group B (30patients who received parecoxibsodium and PCIA) group C (30patients who received PCIA andultrasound guided paravertebral nerve block); group D (30patients whoreceived parecoxib sodium, PCIA and ultrasound guided paravertebralnerve block). Efficacy was evaluated by pain scores at rest and in motionand total dose of opioid analgesics used among the4groups. Side effectsrelated to opioids (nausea, vomiting, respiratory depression, sweating,dizziness, pruritus, urinary retention) were recorded as well. Finally,patient satisfaction was assessed.Results Parecoxib sodium, nerve block and combination of parecoxibsodium and nerve block reduced the total amount of opioid analgesicsrequired over8h by13.1%,16.0%and36.6%; over16h by9.2%,8.6%and24.6%; over24h by5.7%,6.3%and18.1%(P<0.05). Patientsreceiving parecoxib sodium, PCIA and ultrasound guided nerve blocksexperienced the greatest maximum pain relief and highest patientsatisfaction compared to those in other groups. In addition, patientsreceiving parecoxib sodium were the ones with the lowest incidence rate of emergence agitation.Conclusion Combination of parecoxib sodium, ultrasound guidedparavertebral nerve blocks and PCIA with opioid analgesics resulted insignificantly improved postoperative analgesic management as defined byreduction in opioid requirement, lower pain scores and higher patientsatisfaction.