不同时间点帕瑞昔布钠超前镇痛对肩关节镜肩袖修复术后镇痛及麻醉药量的影响

Effects of Parecoxib Sodium advanced analgesia at different time points on analgesia and narcotic dosage after shoulder arthroscopic rotator cuff repair

目的探讨不同时间点帕瑞昔布钠超前镇痛对肩关节镜肩袖修复术后镇痛及麻醉药量的影响。方法选取2021年4月至12月浙江省宁波市医疗中心李惠利医院收治的177例拟行肩关节镜肩袖修复术治疗的患者,采用随机数字表法分为A组(麻醉诱导前10 min给予帕瑞昔布钠40 mg,手术结束前10 min给予生理盐水,59例)、B组(麻醉诱导前10 min及手术结束前10 min给予帕瑞昔布40 mg,59例)、C组(麻醉诱导前10 min给予生理盐水,手术结束前10 min给予生理盐水,59例)。比较三组瑞芬太尼使用情况;比较三组术前1 h,术后3、6 h视觉模拟法(VAS)评分;比较三组术后24 h患者自控镇痛按压次数及术后芬太尼用量;记录三组不良反应发生情况。结果A组瑞芬太尼用量均低于B、C组,差异有统计学意义(P<0.05)。A、B组组内不同时间点VAS评分两两比较,差异有统计学意义(P<0.05)。术后3、6 h,A组VAS评分低于B、C组;B组VAS评分低于C组,差异有统计学意义(P<0.05)。A、B组术后24 h患者自控镇痛按压次数及术后芬太尼用量低于C组;A组术后24 h患者自控镇痛按压次数及术后芬太尼用量低于B组,差异有统计学意义(P<0.05)。三组术后不良反应总发生率比较,差异无统计学意义(P>0.05)。结论麻醉诱导前采用帕瑞昔布钠超前镇痛可缓解患者术后疼痛,减少术后24 h患者自控镇痛按压次数及术后芬太尼用量,且安全可靠。

Objective To investigate the effects of Parecoxib Sodium on advanced analgesia at different time points on analgesia and narcotic dosage after shoulder arthroscopic rotator cuff repair.Methods A total of 177 patients with shoulder arthroscopic rotator cuff repair who were admitted to Li Huili Hospital,Ningbo Medical Center,Zhejiang Province from April to December 2021 were selected,they were divided into group A(40 mg of Parecoxib Sodium was given 10 min before anesthesia induction,and normal saline was given 10 min before the end of surgery,59 cases),group B(normal saline was given 10 min before anesthesia induction,and 40 mg of Parecoxib Sodium was given 10 min before the end of surgery,59 cases),and group C(normal saline was given 10 minutes before anesthesia induction and 10 minutes before the end of surgery,59 cases).The use of Remifentanil was compared among three groups;visual analogue scale(VAS)scores of three groups were compared 1 h before surgery,and 3 and 6 h after surgery;the number of self-controlled analgesia compressions 24 h after surgery and the amount of Fentanyl were compared among the three groups,and the occurrence of adverse reactions in three groups was recorded.Results The dosage of Remifentanil in group A was lower than that in groups B and C,and the differences were statistically significant(P<0.05).The pairwise comparison of VAS scores at different time points in group A and B showed statistically significant differences(P<0.05).The VAS score of group A was lower than that of group B and C at 3 and 6 h after surgery;VAS score of group B was lower than that of group C,and the differences were statistically significant(P<0.05).The number of self-controlled analgesia compressions and the amount of Fentanyl in group A and B were lower than those in group C 24 h after surgery;the number of self-controlled analgesia compressions 24 h after surgery and the amount of Fentanyl in group A were lower than those in group B,and the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of postoperative adverse reactions among three groups(P>0.05).Conclusion Preanalgesia with Parecoxib Sodium before anesthesia induction can relieve postoperative pain,reduce the number of patient-controlled analgesia compressions 24 h after surgery and the amount of Fentanyl after surgery,and it is safe and reliable.