帕瑞昔布结合切口局麻用于腹股沟疝无张力修补术术后的镇痛效果评价

The evaluation of postoperative analgesic effect of parecoxib following free- tension inguinal hemioplasty combined with incision infiltration by local anesthetics

目的观察帕瑞昔布结合切口局麻用于腹股沟疝无张力修补术术后的镇痛效果。方法选择腰硬联合麻醉下行腹股沟疝无张力修补术的患者200例,将患者分为4组,每组50例。在手术结束前10 min,A组静注生理盐水4 m L及切口予生理盐水浸润(对照组),B组静注帕瑞昔布钠40 mg及切口予生理盐水浸润(帕瑞昔布组),C组静注生理盐水4 m L及切口予0.75%罗哌卡因局部浸润麻醉(罗哌卡因),D组静注帕瑞昔布钠40 mg及切口予0.75%罗哌卡因局部浸润麻醉(帕瑞昔布+罗哌卡因)。术后观察6小时(T1)、24小时(T2)2个时间点安静时的VAS值,并记录患者术后24小时内是否要求给予药物镇痛、对整体镇痛质量的满意度。结果在T1时间点,对照组与帕瑞昔布组评分无显著性差异;罗哌卡因组评分亦显著低于对照和帕瑞昔布组(P<0.05);帕瑞昔布+罗哌卡因组评分显著低于另外3组(P<0.05)。在T2时间点,帕瑞昔布+罗哌卡组评分显著低于另外3组(P<0.05),而其它3组间评分无显著性差异。帕瑞昔布+罗哌卡因组只有3例(6%)患者要求额外镇痛药物治疗,对整体镇痛质量满意度达86%,与另外三组比较,P<0.05,而另外3组间无明显差异。结论帕瑞昔布钠结合切口局麻可以为腹股沟疝无张力修补术术后早期提供良好的镇痛效果。

Objective To investigate the postoperative analgesic effect of parecoxib following free- tension inguinal hemioplasty when local anesthetics was infiltrated at incision site. Methods Two hundred patients undergoing free-tension inguinal hemioplasty under spinal anesthesia were assigned to four groups,each group of 50 cases. The patients in the group A received intravenous 4 ml saline and incision infiltration with saline in ten minutes before the end of operation. The patients in group B received intravenous parecoxib 40 mg and incision infiltration with saline. Those in group C received intravenous 4ml saline and incision infiltration with 0.75% ropivacaine. And those in group D received intravenous parecoxib 40 mg and incision infiltration with 0.75% ropivacaine. The observation time points included T1（6 hours after operation）,T2（24 hours after operation）. VAS values,additional requirement of opioids analgesia 24 hours after the operation,the rate of satisfactory with analgesia quality were compared between four groups. Results There was no significant difference between group A and group B of the VAS scores at time point T1,while the VAS values of group D was significantly lower than other three groups（all P values〈0.05）. Group C was also significantly lower than group A and group B（all P values〈0.05）. There was no significant difference among the three groups（group A,B and C）of the VAS values at time point T2（P〉0.05）,while the VAS values of group D was significantly lower than others（P〈0.05）.Three patients（6%）received additional analgesics in the group D and significantly lower than other three groups（all P values 0.05）,while there was no significant difference among the other three groups. The rate of satisfactory with analgesia in group D（86%）was significantly higher than other three groups（P〈0.05）,while there was no significant difference among the other three groups. Conclusion Paricoxib combined with local anesthetics infiltration can significantly relieve the pain of early stage after operation in the patients receiving free-tension inguinal hemioplasty.