| Thoracic surgeries cause serious trauma and severe pain and inhibit respiration, cough and expectoration function which could increase postoperative complication incidence. As a result, adequate post operative analgesia is required. Clinical studies have shown that these complications could be completely avoidable if good analgesia was given. Traditionally, analgesics are injected with single dosage when pain is complained of which turns out to be unsatisfactory due to patients'central sensitization to analgesics. Current development trend of analgesia modes are multi-modal analgesia and pre-emptive analgesia. Multiple applications of different analgesics provide with synergic analgesic effect and avoid overlapping side effects and also inhibit noxious stimulation transmission through multiple mechanisms. Parecoxib sodium is a kind of selective NSAIDs with anti-inflammatory, analgesic and antipyretic effects. It could inhibit peripheral COX-2 expression and peripheral prostaglandin synthesis to exert its effects in analgesia and anti-inflammation; it can also inhibit central COX-2 expression and central prostaglandin synthesis to suppress pain hypersensitivity to play a role in peripheral-central double analgesia. Compared with other non-selective COX-2 inhibitors, the incidence of gastrointestinal reaction is significantly lower, and platelet aggregation and clotting time are not influenced. In this study, we combined parecoxib sodium pre-emptive analgesia with patient-controlled intravenous analgesia to investigate whether sodium parecoxib could alleviate agitation and could play a role in pre-emptive analgesia.Objective: To observe analgesic effect and agitation condition of the recovery period with parecoxib sodium administered at different times in pulmonary lobectomy.Method: 60 ASAⅡ~Ⅲpatients undergoing elective pulmonary lobectomy under general anesthesia, ages from 20 to 65 years old, were randomly divided into three groups: group A(parecoxib sodium 40mg administrated 20 minutes before the surgery); group B(parecoxib sodium 40mg administrated when skin was sutured); group C(control group). All surgeries were performed under combined intravenous-inhalational general anesthesia with routine monitoring and open vein access, and penehyclidine 1mg was administrated intravenously 15mins before the operation. Anesthesia induction: midazolam 0.05mg/kg, propofol 1~2mg/kg, vecuronium 0.1mg/kg, sufentanil 0.5μg/kg, preoxygenation 3mins with positive pressure ventilation via face mask then endotracheal intubation. Maintenance of anesthesia: inhalation of 2%-3% sevoflurane, on-demand intravenous propofol, vecuronium, and no sufentanil within 30mins before skin closure. Total amount of sufentanil was less than 0.8ug/kg. Sevoflurane inhalation was stopped when the end of surgery. Neostigmine 1mg and atropine 0.5mg were administrated as muscle relaxant antagonists when spontaneous breathing resumed. When spontaneous breathing tidal volume was over than 5ml/kg with oxygen saturation over 95% when air was breathed and swallowing reflex resumed, we extubated the patient. All patients were connected to Aipeng ZZB automatic computer injection pump with sufentanil 2ug/kg, ramosetron 0.6mg and saline to a total amount 100ml for postoperative analgesia. Loading dose(10ml) + continuous background infusion(2ml/h) + PCA volume (0.5ml/times), lockout time 15min. Blood pressure, heart rate and agitation level were observed in all three groups during recovery. VAS score, BCS score, PCA press frequency and effective press frequency were recorded at times of 2hs, 4hs, 8hs, and 24hs after the surgery. Sufentanil consumption within 24hs was also recorded as well as side effects.Results: Blood pressure and heart rate in group A and B were lower than group C and the difference was significant(P<0.05),and agitation level in group A and B were lower than group C and the difference was significant(P<0.01). And there was no significant difference between group A and B(P>0.05). VAS scores were lower in group A and B at 2hs, 4hs, and 8hs than group C with statistical significance and agitation level in group A and B were lower than group C and the difference was significant(P<0.05). There was no significant difference at 24 hours after the surgery(P>0.05). BCS ratings were higher in group A and B at 2hs, 4hs, 8hs than in group C with significant differences(P<0.05) and no significance at 24hs(P>0.05). VAS score was lower in group A within than group B after 2hs with significant difference(P<0.05) and no significant difference at other times between group A and B(P>0.05). PCA press frequency was more in group A than group B and the difference was significant(P<0.05). There was no significant difference in PCA press frequency between the two groups(P>0.05). PCA press frequency, sufentanil consumption and side effects were less than group C in group A and B after 24hs and there were significant differences(P<0.05).Conclusion: Parecoxib sodium can be effective in preventing agitation occurrence and playing the role in pre-emptive analgesia in thoracic surgery anesthesia. Administration at the start of the surgery is better than at the end of it. Parecoxib sodium in combination with postoperative analgesia can significantly enhance postoperative analgesia, reduce postoperative PCA press frequency and sufentanil consumption and can also decrease the incidence of adverse reactions rate. |
PDF Full Text Request