| PART 1 TIMING OF INTRAVENOUS PARECOXIB ANALGESIA IN ABDOMINAL HYSTERECTOMYObjective: The aim of this study was to determine the analgesic effect of parecoxib when administered either before or at the end of surgery in patients undergoing abdominal hysterectomy.Methods: We randomly assigned sixty ASA gradeâ… -â…¡patients scheduled for abdominal hysterectomy to the following three groups: the PR group received intravenous parecoxib 40mg before induction, the PO group received intravenous parecoxib 40mg at wound closure, and the CO group received normal saline at both time points. The intensity of pain was measured using a visual analog scale and recorded at 2h, 4h, 8h, 12h, 24h, and 48h after operation, and also tramadol consumption, the number of unsatisfied demand, rescue medication and adverse events.Results: Postoperative pain scores were decreased in the PR and PO group than that in the CO group. Tramadol consumption at 8h, 12h, 24h, and 48h after operation were similar in the PR and PO group, both were significantly less than that in the CO group. There were fewer unsatisfied demands in the PR group. 24h global evaluations of postoperative analgesia were greatly improved in the PR and PO group than that in the CO group. There were no significant differences of VAS score, tramadol consumption, and 24h global analgesic evaluation between the PR and PO group. Adverse effects included nausea, vomiting and there were no differences in frequency among the three groups. No serious adverse event was reported.Conclusions: Parecoxib administration at the end of surgery is as effective as at the beginning of surgery with regard to analgesic effect and tramadol-saving effect. There were not any evidences suggesting a preemptive analgesia efficacy from preincision. PART 2 EFFECTS OF INTRAVENOUS PARECOXIB ON POSTOPERATIVE ANALGESIA AND COAGULATION FUNCTION IN ELDER AFTER ORTHOPEDIC SURGERYObjective: The aim of this study was to determine the effect of parecoxib when administered either before or at the end of surgery on postoperative analgesia and coagulation function in the aged after orthopedic surgery.Methods: Forty-five ASAâ… -â…¡patients aged 65-85 years undergoing total hip arthroplasty (THA) were randomized to three groups of 15. The PR group received intravenous parecoxib 40mg before induction, The PO group received intravenous parecoxib 40mg 30 min before skin closure, The CO group received normal saline at both time points. VAS score and Ramsay score were recorded at 2h, 4h, 8h, 12h, 24h, and 48h after operation, as well as the number of unsatisfied demand, tramadol consumption and the rescue medication. The patients'global evaluation of postoperative analgesia was made 24h after operation. Safety was assessed by vital signs, adverse events and coagulation function. Coagulation function parameters included PT,APTT,TT,FIB and PLT count were tested on day 1 and day 2 after operation.Results: Compared with CO group, tramadol consumption of PR and PO groups at 8h, 12h, 24h, and 48h after operation were decreased. Not only the VAS score of PR group at 8h, 12h, 24h, 48h after operation were lower, but also the VAS score of PO group at 8h, 48h. The global satisfactions of postoperative analgesia in both groups were improved. The numbers of unsatisfied demand at 24h, 48h after operation were higher in CO group. Adverse events such as nausea, vomiting were reported, but there was no severe complication related to the use of parecoxib. Postoperative HR, MAP, and SpO2 were stable. Coagulation function parameters and PLT count were in the normal range and there were no significant differences among the three groups.Conclusions: The present study demonstrated that the perioperative administration (either before or at the end of the surgery) of parecoxib after THA in the aged resulted in significantly improved postoperative analgesia. It could reduce tramadol requirement, lower pain score, and heighten patients'subjective rating of the medication. Perioperative intravenous parecoxib had little interference on coagulation function.
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