Clinical Observations On The Effect Of Preemptive Analgesia With Parecoxib On Postoperative Pain In Patients With Lumbar Disc Herniation

Objective:1. To explore the antalgic effect of parecoxib in LDH patients after microendoscopy discectomy and nerve root canal enlargement.2. To study the effect of parecoxib on the level of inflammatory mediators in LDH patients after microendoscopy discectomy and nerve root canal enlargement.3. To study the safety of parecoxib in LDH patients after microendoscopy discectomy and nerve root canal enlargement.Method:LDH patients who were prepared to receive microendoscopy discectomy and nerve root canal enlargement were screened for study. A total of120patients were randomly assigned to control group (n=60) and preemptive group (n=60), patients in control group were treated with Tramadol and preemptive group were treated with preemptive parecoxib plus Tramadol. Parecoxib was administered during surgery. Patients were studied at0,1,4and7days postoperatively for visual analogue scale (VAS) and side effects. Venous blood samples were obtained at different time point, ELISA was applied to test the concentration of IL-6, IL-10and PGE2, Wei Shi method was used to test the level of ESR, and Particle-enhanced immunoturbidimetric assay was apllied to test hs-CRP concentration.Result:1. Comparation of inflammatory mediators level between two groups:IL-6concentrations at1day,4day and7day postoperatively in preemptive parecoxib group were significantly lower than that in control group (p<0.01). Compared with control group, IL-6concentrations evaluated significantly at3time points after operation in preemptive group (p<0.01). PGE2concentrations at1day,4day and7day postoperatively in preemptive group were lower than that in control group, significant difference was only observed at7day between two groups (p <0.05). Furthermore, ESR level and hs-CRP concentration increased during0and4days after operation in both groups, but the level decreased significantly from4days after operation, which was more obvious in preemptive group (p<0.05).2. Comparation of VAS score between two groups:compared to the control group, the VAS score was lower in preemptive group at1day postoperatively (p<0.01). The number of patients who experienced worse pain at4day postoperatively was3and4in preemptive group and control group, respectively (P>0.05). Furthermore, the number of patients who experienced rebound tenderness at7day postoperatively was4and7, respectively (P>0.05).3. No stastical significance was observed in the incidence of adverse reaction between two groups (P>0.05). Conclusion:1. Preemptive analgesia with parecoxib40mg during microendoscopy discectomy and nerve root canal enlargement produced better analgesia effect in the term of VAS score.2. Preemptive analgesia with parecoxib40mg during microendoscopy discectomy and nerve root canal enlargement regulate inflammatory response by reducing the production of cytokines and promote anti-inflammatory cytokine.3. Preemptive analgesia with parecoxib40mg during microendoscopy discectomy and nerve root canal enlargement was safe.