| ObjectiveWe developed a novel multimodal analgesia strategy using the combination of celecoxib and gabapentin to evaluate its clinical effect in patients undergoing lumbar decompression surgery,and then we introduced the temperature measuring about the lumbar incision to evaluate the feasibility of incision skin temperature in predicting the inflammatory response of incision after lumbar surgery.The purpose of this study was to explore a novel perioperative analgesia strategy based on the concept of enhanced recovery after surgery and to indicate the trend and influencing factors of incision inflammatory response to promote rapid postoperative recovery after lumbar decompression surgery.Methods67 patients with lumbar degeneration diseases who underwent lumbar decompression surgery were selected from the Orthopedic Center of Zhujiang Hospital.Inclusion and exclusion criteria were established before patient enrollment in this clinical trial.Patients were randomized into either the treatment group with the the multimodal analgesia strategy or the control group.The 32 patients in the treatment group were given celecoxib(200mg)and gabapentin(300mg)6 hour before anesthesia induction,and continued postoperatively twice daily.While the 35 patients in control group received tramadol hydrochloride when needed.Patients were treated with a standard Intravenous compound inhalation general anesthesia,and used a unified configuration of venous PCA analgesia pump postoperative routinely.The background infusion rate of PCA is set at 2 mL/hour,and 0.5ml was added with an extra press.The postoperative VAS scores were recorded in the time 4h,8h,12h,16h,1～7d after the surgery,then we measure the surgical incision and peripheral skin temperature preoperative and 1,3,5,7 days postoperative,serum indices were determined at the same time.While the age,operative segment,operation time,intraoperative blood loss,the drainage volume and postoperative complications were also recorded.When the VAS score>4 or the patient require analgesics,additional analgesic measures were taken:a.the extra press of PCA analgesic pump;b.Oral or Intramuscular injection of tramadol hydrochloride,no more than 400mg per day.Consumption of both press times and tramadol were strictly recorded.All statistical analyses were conducted using SPSS20.0(SPSS Inc.,Chicago,IL,USA).P values<0.05 was considered statistically significant.Results1.The postoperative VAS scores and the additional analgesic consumption were lower than those in the control group.Postoperative adverse effects such as nausea,vomiting,dizziness were lower than the control group,while the proportion of the postoperative very satisfied ratio was significantly higher than the control group(P<0.05).2.The incision skin temperature and the temperature difference increasing following the surgery,and much lower in the treatment group(P<0.05).The WBC,CRP and intraoperative blood loss showed positive correlations with incision skin temperature and the temperature difference,while the HGB,multimodal analgesic and operative time showed inverse correlations.What’s more,the days after surgery showed inverse correlation with incision skin temperature,and ESR showed positive correlation with the temperature difference.Conclusions1、Perioperative use of celecoxib and gabapentin can better reduce postoperative pain and the central analgesic drugs requirements.Reducing postoperative adverse effects,improving patient satisfaction rate and promoting rapid recovery of patients.2、The skin temperature,especially the temperature difference between the incision and peripheral have potential to be a new index to monitor the inflammatory response.In combination with WBC,ESR and CRP,it is better to early monitoring the local inflammatory response about the incision after lumbar decompression surgery.3、Perioperative use of celecoxib and gabapentin can reduce the level of local inflammatory reaction in lumbar postoperative incision,so as to promote rapid healing of incision. |
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