切口浸润麻醉复合帕瑞昔布静注用于腹腔镜胆囊切除术后镇痛

The analgesic effect of parecoxib on postoperative visceral pain relief after laparoscopic cholecystectomy

目的探讨切口浸润麻醉复合帕瑞昔布对腹腔镜胆囊切除术(LC)后内脏痛的镇痛效果。方法 60例择期行LC患者随机均分为帕瑞昔布组(P组)、腹腔内局麻组(B组)和对照组(C组)。P组于手术结束前约30 min静脉注射帕瑞昔布40 mg;B组于胆囊切除后在腹腔内喷洒0.25%布比卡因30 ml;C组于手术结束前约30 min静脉注射生理盐水。采用VAS评分记录患者术后1、4和24 h时内脏痛以及镇痛药的用量。结果术后1、4 h时,P组的内脏痛VAS评分显著小于C组(P<0.01)。P组和B组术后24 h内需要追加芬太尼镇痛的患者例数显著少于C组(10%vs.15%vs.60%,P<0.01)。结论手术结束前约30 min静脉注射帕瑞昔布40 mg可以显著减轻LC术后内脏痛并且减少镇痛药的需求。

Objective To explore the analgesic effect of parecoxib on postoperative visceral pain relief after laparoscopic cholecystectomy. Methods Sixty patients scheduled for elective laparoscopic cholecystectomy were randomized into three groups （n=20 each） .. P group, B group and C group. 40 mg of parecoxib or normal saline was infused intravenously 30 rain before the end of surgery in P group and C group respectively, and 30 ml of intraperitoneal 0.25% bupivacaine was given intraperitoneally after the removal of the gallbladder in B group. The degree of the postoperative visceral pain was assessed at 1, 4 and 24 h after surgery, using a visual analog scale. The consumption of analgesics was also recorded. Results The VAS scores of P group at 1 h and 4 h after surgery were significantly lower than those of C group （P〈0.01）. The percentage of patients who required supernumerary fentanyl within the first 24 h postoperatively was also significantly less in P and B group than in C group （10% vs. 15% vs. 60%, P〈0.01）. Conclusion Intravenously administration of 40 mg parecoxib 30 min before the end of surgery could significantly reduce postoperative visceral pain and opioid consumption after laparoscopic eholecystectomy.