Clinical Research About Preemptive Analgesia Of Celecoxib After Joint Replacement

Objective:To explore further the selection of analgesic time and dose, to make clear the better way of celecoxib for preemptive analgesia. At the same time, observing the analgesic effect and security of taking orally celecoxib combined with patient-controlled intravenous analgesia(PCIA) in treatment of the pain after artificial joint replacement, to provide the basis for formulating the standardization and individualization analgesia plan later.Methods:60 patients for selective total knee arthroplasty(TKA) or total hip arthroplasty(THA)was selected, randomly divided into A, B, C three groups, each group 20 cases. The patients began to take 200 mg orally celecoxib two times per day from preoperative 3 days in group A; 400 mg celecoxib with 5ml water from preoperative 4 ~ 5 hours in group B;did not taking any painkillers before operation in group C. All patients used the postoperative intravenous analgesia pump(combined with 100μg sufentanil,100 mg flurbiprofen axetil, 15 mg tropisetron,100 ml normal saline dilution) for postoperative 48 h,began to take orally celecoxib 200 mg postoperative 6h, 200 mg/times, 2 times/day from the first postoperative day to 5-8 days after the operations(determined by the patients’ pain degree). Parecoxib or flurbiprofen axetil was injected in vein whose pain was unbearable.The observation items mainly includes: 1. visual analogue scores(VAS) at preoperative 2h,postoperative 4 h, 8 h, 12 h, 24 h, 48 h, 72 h of every patient; 2. the adverse effects rates in every group,for example the incidence of delayed wound healing, nausea, vomiting,abdominal pain, diarrhea, headache, dizziness and so on; 3. the additional relief aid casesin each group; 4. total blood loss of every patient during and after the operation(postoperative blood loss mainly refers to the daily wound flow).Results:The preoperative VAS scores were not significantly different in every group. The postoperative VAS scores each time in group A were significantly lower than that in group C(P < 0.05),but there were no intergroup significant difference between group A and group B,group B and group C at the first 3 days after operation(P > 0.05).The rate of postoperative medical assistance,adverse reaction and the total blood loss were not significantly different(P>0.05).Conclusions:The celecoxib combined with PCIA has definite analgesic effect on the pain afer TKA and THA during the perioperation, starting medication preoperative 3 days could get better,without obvious increase of adverse reactions and bleeding volume.