Clinical Evaluation Of Parecoxib Sodium In Lung Cancer Patients Underwent Thoracioscopic Loboectomy

Objective: To evaluate the perioperational use of parecoxib in lung cancer patients underwent thoracioscopic loboectomy. Method: 60 lung cancer patients of both sexes, underwent routine thoracioscopic loboectomy(age ranged from 40-65 years, BMI ranged from 20-25, ASA physical status I-II) were divided and randomly assigned into control group and parecoxib group with random number table method(N=30 in each group). Both control and parecoxib group patients received sufentanyl for routine pain management. Additionally, patients in parecoxib group received parecoxib sodium 40 mg diluted with 2 ml saline, administered intravenously 20 min prior to anesthesia induction. Four time points(prior to anesthesia induction, two hour post operation, 24 hour post operation and 48 hour post operation) were selected as T1, T2, T3 and T4, respectively. At every time point, 4-5 ml venous blood samples were collected, and then flow cytometry was utilized to investigate the perioperational T lymphocyte subpopulation status(CD3+, CD4+,CD8+levels and the ratio of CD4+/CD8+) as well as NK cell levels. Additionally, enzymatic methods were used to detect the serum SOD activity and MDA levels for the perioperational oxidative stress status. The analgesic effects were assessed with VAS grading and BCS grading at 6, 12, 24 and 48 hour post operation. The operation duration, one lung ventilation duration and bleeding amount were recorded. Additionally, the drainage volume in 48 hour post operation and GI complication incidence were recorded; the blood routine, bleeding time, clotting time, hepatic function and renal function were also assessed before and after treatment for safety evaluation. Statistics were performed with SPSS 19.0.Results: Preoperational parameters: Prior to anesthesia induction, the parameters of the two groups of patients, including the general condition, the immune function, SOD activity and MDA levels did not differ significantly from each other, confirming the plausibility of the randomized grouping.Immune function and oxidative status: At time points T2 and T3, significantly lower CD3+, CD4+,CD8+levels and the ratio of CD4+/CD8+ as well as NK cell levels were observed in patients from both groups comparing to corresponding parameters in T1(P<0.05), while all immune function endpoints recovered to T1 level at T4(P<0.05),suggesting transient, reversible immune suppressive effects in patients underwent minimal access surgery. Meanwhile, parecoxib pretreatment resulted in remarkably less immune suppression relative to control group(P<0.05), demonstrating the preventive effect of parecoxib pretreatment against surgery induced immune suppression. At 12 hour post operation, patients in both groups exhibited significantly decreased serum SOD activity and increased serum MDA level(P<0.05), indicating oxidative stress. Such changes were reverted to preoperational levels 48 hour after operation(P<0.05). Furthermore, the decrease in SOD activity and increase in MDA level were time-dependent and the parecoxib group patients exhibited obvious less oxidative stress comparing to those in control group(P<0.05). Our data indicated the decrease in oxidative stress over time after the operation, and the parecoxib pretreatment could decrease the excess oxidative stress.Analgesic effects evaluation and other clinical parameters: After the operation, the VAS grading in both group of patients significantly decreased time-dependently, while BCS grading was positively correlated with post operational time. In both grading, parecoxib group exhibited better grading relative to control group(P<0.05), indicating remarkable decrease in pain and improved comfort following parecoxib pretreatment. No statistical difference in one lung ventilation duration, bleeding amount and operation duration were observed between the two groups(P>0.05), indicating no remarkable influence in clinical parameters following parecoxib pretreatment.Safety evaluation: The drainage volume post operation, GI complication incidence, hepatic function, renal function, blood routine, bleeding time and clotting time in patients from both groups stayed in the clinical normal range. No statistical difference were observed between the two groups(P>0.05).Conclusions: 1. Pretreatment with parecoxib 40 mg, i.v. in lung cancer patients underwent thoracioscopic loboectomy resulted in effective analgesic effect, decreased perioperational oxidative stress and improved patient immune function.2. Parecoxib pretreatment has a good safety profile.