帕瑞昔布钠在腹腔镜结肠癌根治术中的超前镇痛作用

Preemptive analgesic effect of parecoxib sodium in patients undergoing laparoscopic colorectal surgery

目的观察帕瑞昔布钠对腹腔镜结肠癌根治术的超前镇痛作用。方法 40例30～64岁,ASAI～II级择期行腹腔镜结肠癌根治术病人,随机分为两组,在麻醉诱导时(A组)或手术结束前30min(B组)静脉推注帕瑞昔布钠40mg,术后均予布托啡诺病人自控镇痛(PCA)。比较两组病人术后VAS评分,PCA按压总次数和有效按压次数及布托啡诺用量,镇痛的补救措施,不良反应和病人对镇痛的满意度。结果 A组VAS评分在术后2,4,6,8,12,24h均低于B组(P<0.05),术后24h满意度明显提高,A组术后12h和24hPCA总次数和PCA有效次数及布托啡诺用量均显著低于B组(P<0.05),术后24h内两组病人均未使用补救镇痛药,而有关不良反应发生率的差异两组间无统计学意义(P>0.05)。结论对腹腔镜结肠癌根治术病人,于麻醉诱导时静脉注射帕瑞昔布钠40mg的镇痛效果优于手术结束前给药,存在超前镇痛效应,是多模式镇痛的一种很好的药物选择。

Objective To investigate the preemptive analgesic efficiency of parecoxib in patients undergoing laparoscopic colorectal surgery.Methods Forty ASA I-II patients aged 30 to 64 years undergoing laparoscopic colorectal surgery were randomized to receive either intravenous parecoxib sodium（40 mg） at anesthesia induction（group A） or intravenous parecoxib sodium（40 mg） 30 min before the completion of surgery（group B）.Butorphanol was administered by patient-controlled analgesia for postoperative analgesia.The intensity of pain measured by VAS score was recorded at 2,4,6,8,12,and 24 h after the operation.The number of unsatisfied demand and the number of successfully delivered doses,butorphanol consumption at 12 h and 24 h after the operation,the patients＇ global evaluation of the postoperative analgesia and the number of the patients receiving rescue medication and adverse effects related to analgesia were recorded and compared between the two groups.Results The VAS scores at different time points were significantly lower in group A than in group B（P〈0.05）.The number of unsatisfied demand and the number of successfully delivered doses were significantly higher and butorphanol consumption at 12 h and 24 h after the operation was significantly less in group A（P〈0.05）.The incidence of adverse events was similar between the two groups.Conclusion Administration of 40 mg parecoxib sodium at anesthesia induction in the patients undergoing laparoscopic colorectal surgery can result in significant preemptive analgesia.