Objective To systematically evaluate the efficacy and safety of injected cyclooxygenase-2 inhibitor for acute postoperative pain. Methods We electronically searched PubMed, EBSCO, Springer, Ovid and CNKI databases from 1999 through Jan. 2009 to identify randomized controlled trials (RCTs) about cyclooxygenase-2 inhibitor or parecoxib sodium for acute postoperative pain. The methodological quality of included RCTs were assessed, and the data was extracted by two reviewers independently according to the Cochrane Handbook. The homogeneous RCTs were pooled using RevMan software, and the non-homogeneous studies evaluted using descriptive qualitative analysis. Results Seven RCTs involving 1939 patients met the inclusion criteria. The results of meta-analyses showed that: ① Efficacy: The comparison of PCA combined parecoxib sodium (successively injected less than 3 days) i.v. with PCA alone: after 24, 48, and 72 hours of the initial dose of parecoxib 40 mg i.v., the percentage of the patients’ global evaluation of study medication (PGESM) described effective (excellent and good) was higher than that of the control group [RR (95%CI) were 1.41 (1.13, 1.75), 1.25 (1.15, 1.35), and 1.30 (1.21, 1.40) respectively]; the percentage of the PGESM described ineffective (fair and poor) was lower than that of the control group [RR (95%CI) were 0.43 (0.26, 0.72), 0.44 (0.34, 0.57), and 0.33 (0.23, 0.48) respectively]. ② Safety: Combination of PCA with parecoxib sodium could lessen the incidence of postoperative fever (RR=0.34, 95%CI 0.22 to 0.53) and nausea and vomiting (RR=0.69, 95%CI 0.57 to 0.83), but not statistically decrease of respiratory depression (RR=0.84, 95%CI 0.38 to 1.83), pruritus (RR=0.91, 95%CI 0.54 to 1.52), and headache (RR=0.77, 95%CI 0.47 to 1.28). Conclusion The combination of PCA with parecoxib sodium successively injected less than 3 days can significantly increase the scores of PGESM, and does not increase the incidence of adverse effects or postoperative complications, and also has the advantage of decreasing postoperative fever, nausea and vomiting.
目的 观察帕瑞昔布钠与舒芬太尼用于无痛胃镜麻醉的安全性和有效性及对患者满意度的影响，为提高临床无痛胃镜麻醉的安全性和舒适性提供依据。 方法 采取前瞻性随机双盲对照方法，纳入2011年8月－12月拟行无痛胃镜检查的患者120例，随机分为3组。患者于胃镜检查开始前口服利多卡因胶浆，静脉注射舒芬太尼、帕瑞昔布钠或生理盐水10 mL。检查时静脉注射异丙酚。记录患者检查过程中生命体征、异丙酚使用量、诱导时间、检查时间、苏醒时间、医师以及患者满意度、舒适度等数据。 结果 舒芬太尼组检查中各时间点平均动脉压明显低于帕瑞昔布组（P=0.029），血管活性药物用量明显高于帕瑞昔布组（P=0.036）。医师以及患者满意度舒芬太尼组和帕瑞昔布组相当，且均高于对照组（P＜0.05）。除呛咳外，帕瑞昔布组其他不良反应的发生率明显低于舒芬太尼组（P＜0.05）。 结论 实施无痛胃镜检查前15 min静脉注射帕瑞昔布钠0.6 mg/kg或舒芬太尼0.10 μg/kg均可以获得满意的麻醉效果，麻醉医师和患者及家属的满意度明显增高，且帕瑞昔布对呼吸和循环的影响更小，安全性更高。
目的 通过Narcotrend指导丙泊酚的靶控浓度来研究帕瑞昔布钠超前镇痛对宫腔手术患者术中和术后镇痛效果的影响。 方法 2012年1月－6月，60例实施宫腔手术的患者随机分为A、B两组，每组30例，A组为术前20 min静脉注射帕瑞昔布钠组，B组为术前20 min静脉注射等量生理盐水组。记录Narcotrend值D1，患者心率稳定时两组的靶控浓度、血压、心率、血氧饱和度（SpO2）及患者术苏醒后10 min镇痛效果视觉模拟评分（VAS）、Riker镇静、躁动评分（SAS）。 结果 A组患者的瑞芬太尼目标靶控浓度小于B组（P＜0.05），两组的丙泊酚靶控浓度差异无统计学意义（P＞0.05）。两组患者血压、心率均小于术前（P＜0.05），SpO2与术前比较差异无统计学意义（P＞0.05）。术后患者VAS评分A组低于B组（P＜0.05），SAS评分B组高于A组（P＜0.05）。 结论 帕瑞昔布钠对Narcotrend值无影响，帕瑞昔布钠能减少宫腔手术患者术中、术后的疼痛及术后的躁动。
目的 观察帕瑞昔布钠超前镇痛在痔上黏膜环切术中对丙泊酚半数有效效应室靶浓度和对术后视觉模拟评分法（VAS） 的影响。 方法 2010年3月－2011年10月择期手术患者60例，随机分为帕瑞昔布组（试验组）和生理盐水组（对照组），每组各30例，分别于术前10 min静脉注射帕瑞昔布钠40 mg或生理盐水2 mL。痔上黏膜环切时靶控输注丙泊酚，其靶控浓度按序贯法确定，相邻靶浓度之间对数差为0.05。观察两组丙泊酚的有效浓度及术后2、4、8、24 h的VAS评分。 结果 试验组的半数有效效应室靶控浓度（4.30 μg/mL）低于对照组（4.95 μg/mL），差异有统计学意义（P＜0.05）。术后4、8、24 h试验组VAS评分明显低于对照组，差异有统计学意义（P＜0.05）。 结论 帕瑞昔布钠可以减少术中丙泊酚的用量，并可得到满意的术后镇痛效果。
【摘要】 目的 观察帕瑞昔布钠超前镇痛在小儿上肢骨折手术的镇痛效果及不良反应发生情况。 方法 选择2009年6月－2010年12月气管插管全身麻醉下择期行单侧上肢骨折切开复位内固定手术患儿90例，随机分为帕瑞昔布钠组（P组）、曲马多组（T组）及对照组（C组），每组各30例患儿；于麻醉前分别静脉注射帕瑞昔布钠1 mg/kg、曲马多2 mg/kg、等容量生理盐水。3组患儿年龄、性别、体重、手术时间等一般情况差异无统计学意义（Pgt;0.05）。各组均于术后2、4、6、8 h各时间点观察患儿疼痛评分、镇静评分；观察拔除患儿气管导管后5 min躁动评分；记录患儿术中芬太尼总用量及术后镇痛药物用量；随访术后24 h内不良反应的发生情况。 结果 术后各个时间点P组疼痛评分明显低于T、C组（Plt;0.01）；T组镇静评分于术后2、4、6 h明显高于P、C组（Plt;0.01），镇静评分在P、C组之间比较差异无统计学意义（Pgt;0.05）；P组术后躁动评分明显低于T、C组（Plt;0.01）；P组患儿围手术期芬太尼用量明显少于T、C组（Plt;0.01）；T组术后恶心呕吐发生率明显高于P、C组（Plt;0.05）。P组无呼吸抑制、伤口异常出血等严重不良反应。 结论 帕瑞昔布钠超前镇痛用于小儿上肢骨折手术可产生明显镇痛作用，并可有效预防苏醒期躁动发生，明显减少围手术期芬太尼用量，恶心呕吐等不良反应发生率明显低于曲马多。【Abstract】 Objective To study the efficacy and safety of preemptive analgesia with parecoxib sodium in children undergoing upper limb orthopedic surgery. Methods Ninety children from June 2009 to December 2010 scheduled for elective upper limb orthopedic surgery under general anesthesia were selected and randomly divided into three groups with 30 children in each. For the children in group P (parecoxib sodium), group T (tramadol) and group C (control), preemptive analgesia was induced by an intravenous injection of parecoxib sodium at 1 mg/kg, tramadol at 2 mg/kg, and normal saline respectively before anesthesia. Pain intensity score and sedation score were recorded 2, 4, 6, and 8 hours respectively after operation. The agitation score was measured 5 minutes after extubation. The perioperative fentanyl consumption and postoperative analgesic medicine consumption were recorded. The adverse effects were observed within 24 hours after operation. Results The demographic data such as age, gender, weight, and operation time did not differ statistically among the three groups of children (Pgt;0.05). Compared with groups T and C, the pain score in group P was significantly lower at all time points after operation (Plt;0.01). The sedation score in group T was significantly higher than those in group P and C 2, 4, and 6 hours after operation (Plt;0.01), but the sedation score did not differ significantly between groups P and C (Pgt;0.05). The agitation score after trachea extubation in group P was significantly lower than the other two groups (Plt;0.01). The quantity of fentanyl used in group P was significantly lower than in groups T and C (Plt;0.01). The incidence of postoperative nausea or vomiting in group T was higher than those in groups P and C (Plt;0.05). There was no depression of breath or abnormal hemorrhage in group P. Conclusion Parecoxib sodium has a better analgesic effect in children undergoing upper limb orthopedic surgery. The agitation score and the incidence of postoperative nausea or vomiting are significantly lower, and the use of parecoxib sodium can also significantly reduce the perioperative fentanyl consumption.
ObjectiveTo evaluate the preemptive analgesic efficiency of parecoxib on patients undergoing inguinal hernia repair. MethodsOne hundred and twenty patients scheduled for surgery between May and August 2013 were randomized into group A (n=60) and group B (n=60). Patients in group A received intravenous parecoxib sodium (40 mg) for 45 minutes before surgery while group B received equivalent normal saline. All patients underwent tension-free hernia repair under local anesthesia with simplex lidocaine. Visual analogy scores (VAS) after surgery and the maximum VAS were recorded. The number of patients requiring rescue analgesic (tramadol injection) or with adverse effects related to analgesia were observed and recorded. Postoperative hospital stay and patient satisfaction score with analgesic effect were compared between the two groups. Concentrations of plasma prostaglandin E2(PGE2) before surgery and 24 hours after surgery were measured in both groups. ResultsVAS scores were significantly lower in group A at 2, 4, 8 and 12 hours after surgery than group B, while no significant difference was seen after 24 hours of the surgery. The number of patients requiring tramadol (3/60) or with adverse effects (2/60) in group A were significantly lower than that in group B (11/60 and 8/60 respectively). Postoperative hospital stay was shorter while patient satisfaction score with analgesic effect was higher in group A than in group B. There were no significant differences in concentration of plasma PGE2 between the two groups before surgery and after 24 hours of the surgery (P>0.05). ConclusionPreemptive administration of parecoxib for hernia repair can result in significant analgesic effect with fewer adverse effects, higher patient satisfaction and faster recovery.
ObjectiveTo investigate whether parecoxib sodium preemptive analgesia reduces inflammatory cytokines and stress hormones production in elderly patients after total hip replacement. MethodSixty patients with American Society of Anesthesiologists Classification Ⅰ-Ⅱ undergoing total hip replacement for femoral neck fracture or aseptic necrosis of the femoral head, aged between 60 and 90 years with a body weight more than 50 kg, were randomly divided into preemptive analgesia group (group P, n=30) and control group (group C, n=30). The patients in group P received parecoxib sodium 40 mg intravenously 30 min before skin incision, and another 20 mg 8 hours after the first administration. All the patients in the two groups received the administration of patient-controlled analgesia sufentanyl. We recorded blood levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), cortisol (COR), adrenaline (AD) and noradrenaline (NAD) 30 min before skin incision, and 1 hour, 6 hours, 12 hours and 24 hours postoperatively. ResultsThe blood levels of IL-6, TNF-α, COR, AD and NAD in group P at 1 hour, 6 hours, 12 hours or 24 hours postoperatively were significantly lower than those in group C (P<0.05). ConclusionsParecoxib sodium preemptive analgesia reduces postoperative inflammatory cytokines and stress hormones production in elderly patients undergoing total hip replacement.
ObjectiveTo explore the effect of dexmedetomidine-parecoxib sodium on early postoperative cognitive function in elderly patients undergoing general anesthesia. MethodsFrom August 2013 to October 2014, 120 elderly patients underwent hip replacement surgical procedures. The patients were randomly divided into four groups (with 30 patients in each group):dexmedetomidine-parecoxib sodium group (group C), dexmedetomidine group (group D), parecoxib sodium group (group P), and saline group (group S). Cognitive function was assessed preoperatively, on the first, 3rd and 7th postoperative day by using mini-mental state examination (MMSE) scale. ResultsCompared with the MMSE scores before the surgery, the scores in the four groups on the first postoperative day decreased obviously (P<0.05); the scores in group D, P, and S on the 3rd postoperative day were obviously lower than those before the surgery (P<0.05); the scores in group C on the 3rd postoperative day didn't differ much from that before the surgery (P>0.05); and the scores in group C on the first and 3rd operative day were obviously higher than those in the other 3 groups (P<0.05). The differences in MMSE scores on the 7th operative day among the 4 groups were not significant (P>0.05). After the surgery, the incidence of cognitive dysfunction in group C was significantly lower than those in the other three groups (P<0.05); the incidences of cognitive dysfunction in group D and P were obviously lower than that in group S (P<0.05) while the difference between group D and P was not significant (P>0.05). ConclusionDexmedetomidine-parecoxib sodium can decrease the incidence of early cognitive dysfunction in elderly patients undergoing hip replacement surgery, whose therapeutic effect is better than using dexmedetomidine or parecoxib sodium alone.
Objective To clearly define and describe the difference of analgesic actions and side effects between dezocine and parecoxib sodium in video-assisted thoracic surgery (VATS) lobectomy. Methods Ninety patients underwent thoracotomy (lobectomy) and were hospitalized in the Department of Thoracic Surgery, West China Hospital, Sichuan University between August 2015 and January 2016. Patients were randomly divided into two groups including a parecoxib sodium group (a PG group, 43 patients) and a dezocine group (a DG group, 47 patients). We analyzed the occurrence of side effects in the two groups, as well as other outcomes including visual analogous scores and location of the pain et al. Results The occurrences of nausea, vomit and abdominal distention in the PG group (9.30%, 2.33%, 13.95%) were significantly lower than those of the DG group (25.53%, 17.02%, 40.43% , P=0.046, P=0.032, P=0.009) in the early period after operation. Pain scores at the postoperative 12 h, 24 h, 48 h and 72 h in the PG group (2.56±0.96, 2.47±0.96, 1.93±0.99, 0.98±1.24) were better than those of the DG group (4.00±1.60, 3.62±1.48, 3.36±1.55, 2.47±1.78,P=0.000, P=0.000, P=0.000, P=0.002). And the same results were found in the postoperative coughing VAS assessment. The mostly reported pain location was the chest drainage, incision site and chest wall in turn. Postoperative pain properties, in turn, were swelling, stabbing pain and numbness. Conclusion Postoperative pain after VATS lobectomy may be adequately controlled using parecoxib sodium. The low pain scores and decreased adverse effects are achieved.