The Recovery Impact Of Perioperative Use Of Parecoxib In ERAS Strategy For Patients Undergoing Curative Gastric Cancer

?Background?Gastric cancer is very common in China,especially for advanced gastric cancer.Surgery is one of the major treatments;however,surgery causes great trauma leading to delayed recovery,organ dysfunctions,and even death.ERAS aims to decrease surgical trauma and risk of complications,promote recovery after surgery.Severe postoperative pain after surgery causes delayed out-of-bed activity and recovery of bowel function,prolongs hospitalization and increases medical cost.Parecoxib belongs to NSAIDs and inhibit the activity of COX-2 enzyme.Parecoxib is clinically widely used for reliving postoperative pain.However,whether it is safe to use parecoxib in patients undergoing gastrectomy under assessment,as high activity of COX-2 enzyme is critical for gastric injury healing.?Objective?The aim of this study is to investigate the recovery effect of perioperative use of parecoxib in ERAS strategy for patients undergoing curative resection for gastric cancer.?Methods?Sixty patients newly diagnosed as gastric cancer,aged between 18⁶5 years and falling in ASA I^III,were enrolled between June 2016 to May 2017.The patients were randomly allocated to experimental group?group P,n=30?or control group?group S,n=30?.Patients in group P received parecoxib 40 mg iv.in 30 minutes before surgery and every 12 hours after surgery for 3 days.Patients in group S received 5ml saline instead of parecoxib before and after surgery.All patients received ERAS program and PCIA postoperatively.Preoperation pain?T₀?,postoperative pain at 12h?T₁?,24h?T₂?and 48h?T₃?,recovery,complication,inflammatory markers and serum CEA level at day 2 and day 5 were observed.?Results?Comparing to patients in group S,the pain intensity at rest and cough was significantly lower for patients in group P at T₁ and T₂?P<0.05?.In addition,the serum concentrations of IL-1?,TNF-?and CRP were significantly lower in group P than group S at postoperative day 2?P<0.05?.The number of neutrophiles,serum concentrations of IL-1?,TNF-?,PGE₂ and CEA were lower in group P than group S at postoperative day 5,the number of neutrophils and levels of PGE₂ and CEA were lower in group P at postoperative day 5?P<0.05?.The times of first flatus and postoperative hospital stay were shorter in P group than group S?P<0.05?.The postoperative complication rate was comparable between two groups.?Conclusions?Perioperative use of parecoxib after gastric surgery in ERAS program reduced postoperative pain and inflammatory reaction,enhanced gastrointestinal function recovery,shortened postoperative hospital stay.Additionally,perioperative use of parecoxib did not increase the risk of postoperative complication.