| Objective:Parecoxib (parecoxib sodium) is an injectable prodrug of valdecoxib, which is a potent and selective inhibitor of cyclo-oxygenase-2. Parecoxib combined with opioid analgesics is often recommended for relieving acute postoperative pain. Efficacy and safety of intravenous parecoxib sodium in the short term does not increase short-term adverse effects. However, there is little research about intravenous injection of parecoxib at the different time combined with sufentanil, whether it is effective and safe for postoperative analgesia in elderly patients. Therefore, the study is to evaluate the effects of parecoxib sodium on analgesic efficacy of postoperative patient-controlled analgesia with sufentanil in elderly patients undergoing tumor surgery. To investigate the role of preemptive analgesia and the sufentanil-sparing effect and side effects of intravenous parecoxib sodium.Methods:Sixty patients undergoing digestive tract tumor surgery were equally randomized assigned into three groups, ASAⅡ-Ⅲ, patients aged 60-80 years, weight 50-80 kg. The patients in group A were injected intravenously parecoxib sodium 40 mg before induction of anesthesia, which was given before the end of surgery in group B. The patients in group C received normal saline as the controls. All patients were given a standardized general anaesthetic comprising i.v. midazolam 0.05 mg kg-1, fentanyl 3μg kg-1, propofol 2 mg kg-1, and cisatracurium besylate injention 0.15 mg kg-1. Their lungs were ventilated after endotracheal intubation. Anesthesia was maintained with continuous infusion remifentanil and propofol, sevoflurane inhalation, intermittent intravenous fentanyl and cisatracurium besylate injention. PCIA pump configuration:sufentanil 100μg+ramosetron 0.6mg+ normal saline diluted to 100ml, background infusion of 1.5ml h-1, additional dose 1ml, lockout time 15 min. The patients in three groups received PCIA with sufentanil. The patients were connected and started PCIA pump after extubation. The intensity of pain was measured using VAS score (0-10,0=no pain,10=worst pain), recorded at 1 h,4 h,8 h,12 h and 24 h after operation. Meanwhile, the score of Ramsay sedation scale and Bruggrmann comfort scale and the valid number of pressing PCIA pump were observed after operation. The total consumption of sufentanil and were recored at 12 h and 24 h after operation. The number of the patients'global ebaluation of the postoperative analgesia and the adverse effects such as nausea and vomiting were recorded. Results:Compared with group C, groups of A and B VAS points were significantly lower at 1 h,4 h,8 h,12 h after operation (P＜0.05 or P＜0.01). The VAS poits of group A was significantly lower at 4 h,8 h,12 h than that of groups of B after operation (P＜0.05 or P<0.01). Compared with group C, groups of A and B BCS points were significantly higher at 1 h,4 h,8 h,12 h after operation (P＜0.05 or P＜0.01). The BCS poits of group A was significantly higher at 4 h,8 h than that of groups of B after operation (P＜0.05 or P＜0.01). Compared with group C, groups of A and B the valid number of pressing PCIA pump were significantly less at 1 h,4 h,8 h,12 h after operation (P＜0.05 or P＜0.01), which was less in group A than that in group B (P＜0.05 or P＜0.01).12 h and 24 h sufentanil consumption in groups of A and B was significantly less than that in group C (P＜0.01), which was less in group A than that in group B (P＜0.01). The percentage of the patients who considered the postoperative analgesia'satisfantory'in groups of A and B was significantly higher than that in group C (P=0.04, P<0.05). There was no significant difference in the score of Ramsay sedation scale and the incidence of adverse effects among three groups during analgesia.Conclusion:Preoperative injection of parecoxib sodium may improve the outcomes of PCIA with sufentanil in elderly patients undergoing tumor surgery. At the same time, additional injection of parecoxib sodium 40 mg, especially given before induction of anesthesia, provides better analgesic effects and reduces sufentanil consumption and doesn't increase adverse effects. |
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