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OBJECTIVE To compare the efficacy and safety of parecoxib and ketorolac tromethamine for perioperative analgesia， and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed， Embase， the Cochrane Library， CNKI， VIP， Wanfang Data， Baidu and Google， randomized controlled trials （RCT） about parecoxib （trial group） versus ketorolac tromethamine （control group） for perioperative analgesia were collected from the inception to Jun. 17th， 2022. After screening the literature and extracting the data， the quality of the included literature was evaluated using the bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0. Meta-analysis， sensitivity analysis and publication bias analysis were performed with RevMan 5.4 software. RESULTS A total of 12 RCTs were included， with 1 118 patients. Meta- analysis results showed that at the time of administration before anesthesia induction， there was no statistically significant difference between the 2 groups in visual analogue scale （VAS） [MD＝－0.16， 95%CI （－0.41， 0.09）， P＝0.20]， numerical rating scale （NRS） [MD＝0.01， 95%CI （－0.36， 0.38）， P＝0.97]， postoperative bleeding [MD＝0.15， 95%CI （－0.63， 0.93）， P＝0.71]， and consumption of opioid analgesics [MD＝0.12， 95%CI （－0.77， 1.01）， P＝0.79]. At the time of postoperative administration， VAS and bleeding volume at 48 h after operation of trial group were significantly lower than control group （P＜0.05）. The results of subgroup analysis by different com assessment time points showed that the VAS of patients in trial group at 0 h after operation were significantly lower than control group at the time of administration before anesthesia induction； at the time of postoperative administration， VAS of patients in the trial group at 12 h and 48 h after operation were significantly lower than control group （P＜0.05）. There was no statistical significance in the incidence of ADR between 2 groups [RR＝0.93，95%CI （0.78，1.11），P＝0.43]. The results of subgroup analysis according to different types of adverse reactions showed that the incidence of nausea and vomiting of trial group was significantly lower than control group， and the incidence of other adverse reactions was significantly higher than control group （P＜0.05）. Results of sensitivity analysis showed that study results were stable and reliable. Results of publication bias analysis showed that there was great possibility of publication bias in this study. CONCLUSIONS The efficacy of parecoxib is equivalent to that of ketorolac tromethamine for perioperative analgesia before operation； at the time of administration after operation， parecoxib has better analgesic effect and less postoperative bleeding； the incidence of nausea and vomiting caused by parecoxib is lower at any time of administration.
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OBJECTIVE To systematically evaluate the effectiveness and s afety of parecoxib sodium for gynecological surgery postoperative analgesia ，and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed ， Embase，the Cochrane Library ，CNKI，VIP，Wanfang data and SinoMed during the inception to Feb. 16th，2021，randomized controlled trials （RCT） about parecoxib sodium （trial group ） versus 0.9％ sodium chloride injection （control group ） for gynecological surgery and postoperative analgesia were collected. After screening literatures ，extracting data and evaluating the quality of literatures with modified Jadad scale ，Meta-analysis，sensitivity analysis and publication bias analysis were performed by using RevMan 5.3 software. RESULTS A total of 14 RCT were included ，involving 1 120 patients. The results of Meta-analysis showed that visual analogue scale （VAS）score at 4 h after operation [MD ＝－1.65，95％CI（－2.48，－0.82），P＝0.000 1]，VAS score at 6 h after operation [MD ＝－1.03，95％CI（－1.60，－0.45），P＝0.000 5]，VAS score at 12 h after operation [MD ＝－0.98， 95％CI（－1.38， －0.59），P＜0.000 01]，the proportion of postoperative analgesia requirements [OR ＝0.14，95％CI（0.04， 0.50），P＝0.003] and the dosage of morphine [MD ＝ －17.75， com 95％CI（－20.93，－14.56），P＜0.000 01] in trial group were significantly lower than control group. There was no statistical significance in the incidence of nausea between 2 groups [OR＝ 0.68，95％CI（0.43，1.08），P＝0.10]. The results of sensitivity analysis showed that the above results were basically stable. The results of publication bias analysis showed that there was little possibility of publication bias in this study. CONCLUSIONS Parecoxib sodium is effective and safe for gynecological surgery and posto perative analgesia.
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Objective @# To compare the analgesic effect and safety of bilateral inferior alveolar nerve block combined with parecoxib sodium analgesia and simple intravenous analgesia pump in analgesia after orthognathic surgery.@*Methods @#Forty patients with simple ascending sagittal split osteotomy and ankle plasty were randomly divided into the experimental group and the control group, with 20 patients in each group. The experimental group received 2 mL 1% ropivacaine by inferior alveolar nerve block anesthesia on both sides. Immediately after surgery, parecoxib sodium 40 mg was intravenously administered. The control group was given an intravenous analgesia pump for analgesia. Pain intensity (VAS pain score) and Ramsay sedation score were recorded at 2 h, 4 h, 8 h, 24 h, 48 h after operation, and the incidence of postoperative adverse reactions was observed.@*Results@#There was no significant difference in pain intensity and Ramsay sedation score between the two groups at each time point (P>0.05). During the analgesic treatment, the incidence of nausea and vomiting in the experimental group was significantly lower than that in the control group (P<0.05).@*Conclusion@# Bilateral inferior alveolar nerve block combined with parecoxib sodium analgesia and simple intravenous analgesia pump are effective for analgesia after mandibular orthognathic surgery, but the former has a lower incidence of adverse reactions, more suitable for analgesia after mandibular orthognathic surgery.
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OBJECTIVE@#To observe and evaluate the clinical effect of intra-articular injection of parecoxib in patients with early knee osteoarthritis.@*METHODS@#From September 2016 to August 2017, 107 patients with early knee osteoarthritis were treated, including 50 males and 57 females, aged 45 to 64 (51.9±4.2) years. They were divided into basic therapy+oral glucosamine group(group A) 36 cases, oral celecoxib+basic therapy+oral glucosamine group(group B) 36 cases, intra-articular injection of parecoxib+basic therapy+oral glucosamine group(group C) 35 cases. There was no significant difference in gender, age, BMI and clinical stage(Kellgren-Lawrence classification) between the three groups before treatment. VAS score, HSS score and patient satisfaction were compared before and after treatment in the three groups. The levels of inflammatory cytokines in synovial fluid were measured before and after treatment in the three groups.@*RESULTS@#All cases were followed up for(15.2±2.6) months on average. The VAS score and HSS score of each group were improved after treatment(<0.001). There were significant differences in VAS and HSS scores among the three groups after treatment(<0.001). The clinical efficacy of group C was better than that of group A and B(<0.001), group B was better than that of group A(<0.001), and group C had the highest satisfaction(<0.001). After treatment, the concentration of proinflammatory factor TNF-α and IL-6 in the synovial fluid of each group decreased(<0.001) and the concentration of anti-inflammatory factor IL-10 increased(<0.001). After treatment, the concentrations of TNF-α, IL-6 and IL-10 in the synovial fluid of the three groups were significantly different(<0.001).@*CONCLUSIONS@#For patients with early knee osteoarthritis, intra-articular injection of parecoxib can significantly improve clinical symptoms and avoid adverse reactions of long-term oral NSAIDs, which is an effective treatment.
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Adult , Aged , Female , Humans , Male , Middle Aged , Injections, Intra-Articular , Isoxazoles , Therapeutic Uses , Osteoarthritis, Knee , Drug TherapyABSTRACT
OBJECTIVE@#To explore the effect of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative pain management in patients undergoing pancreaticoduodenectomy.@*METHODS@#This randomized controlled trial was conducted among 98 patients undergoing pancreaticoduodenectomy in the Department of Biliary Surgery of West China Hospital between March, 2017 and August, 2018. The patients were randomized to receive perioperative analgesia with local infiltration anesthesia with ropivacaine combined with multimodal analgesia with parecoxib (experimental group, =50) or postoperative analgesia with dizosin (control group, =48). The regimens for intraoperative anesthesia and postoperative pain relief were identical in the two groups. The differences in NRS pain score, use of pain relief agents, the incidences of adverse reactions to analgesia and wound infection, and the time to first ambulation and first flatus passage after the operation were compared between the two groups.@*RESULTS@#At 12, 24 h, 48 h, 72 h and 7 days after the operation, the patients in the experimental group had significantly lower NRS scores ( < 0.05) than those in the control group. The rate of use of rescue analgesics was significantly lower in the experimental group than in the control group (32% 66.67%, < 0.05); the rate of tramadol hydrochloride use was also significantly lower in the experimental group ( < 0.05). Compared with those in the control group, the patients in the experimental group showed a significantly lower total incidence of adverse reactions (22% 54.17%, < 0.05) as well as a lower incidence of nausea and vomiting ( < 0.05), an earlier time of first ambulation and first flatus passage after the operation ( < 0.05), and a shorter postoperative hospital stay ( < 0.05).@*CONCLUSIONS@#In patients undergoing pancreaticoduodenectomy, local infiltration of ropivacaine combined with multimodal analgesia with ropivacaine can effectively relieve perioperative pain, reduce the use of relief analgesics, lower the incidence of adverse reactions, and promote the recovery after the surgery.
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Humans , Analgesia, Patient-Controlled , Analgesics, Opioid , Anesthetics, Local , China , Double-Blind Method , Isoxazoles , Pain Management , Pain Measurement , Pain, Postoperative , Pancreaticoduodenectomy , RopivacaineABSTRACT
<p><b>OBJECTIVE</b>To observe the analgesic and sedative effects of acupuncture combined with local anesthesia for percutaneous vertebroplasty (PVP).</p><p><b>METHODS</b>Sixty patients of single segmental osteoporotic vertebral compression fractures who were prepared to receive PVP were randomly divided into an observation group, a control 1 group, a control 2 group, 20 cases in each group. The patients in the observation group were treated with electroacupuncture (EA) at Hegu (LI 4), Neiguan (PC 6) and Zusanli (ST 36) 20 min before operation; during operation, EA was given combined with regular anesthesia. The patients in the control 1 group were treated with intramuscular injection of parecoxib sodium (40 mg), combined with regular anesthesia. The patients in the control 2 group were treated with intravenous injection of dezocine (5 mg), combined with regular anesthesia. Visual analogue scale (VAS) and Ramesy sedation score were compared among the three groups.</p><p><b>RESULTS</b>In the observation group and control 2 group, the VAS during puncture and bone cement placement was higher than that before acupuncture (all <0.01); the VAS during bone cement placement was higher than that before puncture (<0.05, <0.01); the VAS after operation was lower than that during puncture and bone cement placement (<0.05, <0.01). In the control 1 group, the VAS during puncture and bone cement placement and after operation was higher than that before acupuncture (<0.01, <0.05), the VAS after operation was lower than that during puncture and bone cement placement (<0.05, <0.01). There was no significant difference in VAS and Ramesy score among three groups at all time points (all >0.05).</p><p><b>CONCLUSION</b>Compared with local anesthesia and analgesics, acupuncture combined with local anesthesia has similar analgesic and sedative effect for PVP, which could be considered a better method for PVP anesthesia.</p>
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Objective To investigate the effects of perioperative parecoxib sodium on serum surfactant protein A and inflammatory response in elderly patients undergoing video-assisted thoracoscopic pneumonectomy,Methods Sixty-two ASA Ⅰ or Ⅱ elderly patients,aged 65-78 years,weighing 51-79 kg,scheduled for elective video-assisted thoracoscopic pneumonectomy under general anesthesia,were randomly divided into 3 groups:0.3 mg/kg parecoxib sodium group (group P1,n=21),0.6 mg/kg parecoxib sodium group (group P2,n =21) and control group (group C,n =20).The patients were given intravenous parecoxib sodium of 0.3 mg/kg immediately before induction of anesthesia and at 12 h after operation in group P1,and also parecoxib sodium of 0.6mg/kg immediately before induction of anesthesia and at 12 h after operation in group P2,while the equal volume of normal saline was given in group C.Blood samples were taken from the central vein before the induction of anesthesia(T0),after operation(T1),12 h after operation(T2) and 24 h after operation(T3).The concentration of serum surfactant protein A (SP-A),TNF-α,IL-6 and IL-8 were determined by ELASA.The incidence of pulmonary complications at 72 h after operation were also recorded.Results Compared with T0,the concentration of serum SP-A,TNF-α,IL-6 and IL-8 increased significantly in all groups at T1-T3 (P＜0.05).Compared with C group,the concentration of serum SP-A,TNF-α,IL-6 and IL-8 in groups P1 and P2 decreased significantly at T1-T3 (P＜0.05),there were no significant differences between groups P1 and P2.The incidence of postoperative pulmonary complications had no statistically significant differences between the three groups.Conclusion Parecoxib sodium can significantly reduce the concentration of serum SP-A and alleviate the inflammatory response in elderly patients undergoing video-assisted thoracoscopic pneumonectomy.
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Objective To investigate the postoperative analgesic effect of parecoxib following laparoscopic inguinal hernia repair when local anesthetics was infiltrated at incision site.Methods 160 patients were divided into four groups (40 in each group).Group A received intravenous 4 ml saline and incision infiltration with saline in ten minutes before thc end of operation.Group B received intravenous parecoxib 40 mg and incision infiltration with saline.Group C received intravenous 4 ml saline and incision infiltration with 0.75％ ropivacaine.Group D received intravenous parecoxib 40 mg and incision infiltration with 0.75％ ropivacaine.Results There was no significant difference between group A and group C of the VAS scores at 6 hours,while the VAS values in group D was significantly lower than group A,B and C (P ＜ 0.05).There was no significant difference among group A,B and C in VAS at 24 hours (P ＞ 0.05),while VAS in group D was significantly lower than others (P ＜ 0.05).The satisfactory rate with analgesia in group D (95％) was significantly higher than other three groups (P ＜ 0.05).Conclusions Paricoxib combined with local anesthetics infiltration can significantly relieve the pain at postoperative early stage in patients receiving laparoscopic inguinal hernia repair.
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Objective@#To investigate the effect of preoperative use of paracetin sodium on epidural pain and coagulation in patients with epidural hematoma.@*Methods@#80 brain trauma patients with epidural hematoma underwent surgery were selected, and they were randomly divided into two groups according to the digital table, 40cases in each group.30min before surgery, the observation group was given parecoxib sodium, and the control group was treated with the same volume of 0.9% saline.Then, the changes of the visual analogue scale (VAS score) and PCIA compression times were compared between the two groups at 6h, 12h, 24h and 48h after operation.The coagulation changes were observed.@*Results@#6h, 12h, 24h and 48h after operation, the VAS scores of the pain in the observation group were (4.1±0.3)points, (4.0±0.2)points, (3.0±0.3)points and (2.3±0.3)points, respectively, which were lower than those in the control group(t=17.541, 3.508, 7.589 and 28.284, all P<0.05).6h, 12h, 24h and 48h after operation, the PCIA times in the observation group were (1.9±0.4)times, (1.8±0.3)times, (1.1±0.2)times and (0.7±0.1)times, respectively, which were lower than those in the control group (t=4.939, 3.795, 12.279 and 16.000, all P<0.05). The PT, TT, APTT and Fib between the two groups had no statistically significant differences (t=0.407, 0.000, 1.491 and 0.331, all P>0.05).@*Conclusion@#Preoperative use of parecoxib sodium can effectively reduce the perioperative pain in patients with epidural hematoma, and it has no effect on coagulation function with high safety.
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Objective To investigate the preemptive analgesic effect and safety of paracoxib sodium in patients under-going endoscopic submucosal dissection(ESD). Methods A total of 80 ASA I or II patients aged 35-65 years undergoing ESD under general anesthesia were randomized into two groups(n=40 each):parecoxib sodium group(group B) was received intrave-nous parecoxib sodium 40 mg (in 5 mL 0.9% sodium chloride solution) 10 min before anesthesia induction and control group (group A)was received 0.9% sodium chloride solution 5 mL instead of parecoxib sodium.At the end of operation,patients in both groups were received 5 mg of dezocine.Blood samples were analyzed for PT,TT,APTT,Fib,PLT and PAgT before induction of an-esthesia,at 30 min and 120 min after operation.Patients'Visual analogue scale(VAS),Numeric sedation scale(NSS),and ad-verse reactions were recorded at the end of the operation,2,4 and 6 h after operation. Results Compared with those before parecoxib sodium administration,the fibrinogen concentration and PAgT were significantly higher in group B at 30 min after the intravenous injection of parecoxib sodium(P<0.05),while there was no significant difference in PT,TT,APTT and platelet count between group B and group A(P>0.05).VAS at the end of operation,2,4 and 6 h after operation were lower in group B(P<0.05),and the patients were more satisfied in group B(P<0.05). Conclusion Parecoxib could temporarily enhance blood co-agulation in patients undergoing ESD and could offer safe and effective analgesia.
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Objective To investigate the effect of intrathecal parecoxib sodium in bone tumor pain of rats. Methods Bone tumor pain was induced by injection of MRMT-1 tumor cells (1 × 104/L) into the tibia of female SD rats under sevoflurane anesthesia. The development of bone tumor was monitored by radiological study, and histological sections stained with hematoxylin and eosin. At 3 d after MRMT-1 tumor cell injection, a PE-10 catheter was inserted into the intrathecal space for drug administration. At 10 d after MRMT-1 tumor cell injection, rats were randomly divided into 5 equal groups, control group, parecoxib sodium 0.1, 0.3, 1.0 and 3.0 g/L group. For pain assessment, a withdrawal threshold was measured using von Frey filament being applied to the tumor cell inoculation site. The effects of intrathecal saline or parecoxib sodium were investigated. Results Intra-tibial injection of MRMT-1 tumor cells produced a bone tumor in radiologic and pathologic findings.Also, the paw withdrawal threshold was significantly decreased(mechanical allodynia).Percentage of the maximal possible effect (% MPE) of control group and parecoxib sodium 0.1, 0.3, 1.0 and 3.0 g/L group was (13.89 ± 4.17)%,(7.54 ± 3.91)%,(57.47 ± 11.47)%,(85.72 ± 9.42)% and(100.00 ± 0.00)%,compared with control group, intrathecal parecoxib sodium dose-dependently increased the withdrawal threshold (P<0.05).Conclusions Intrathecal parecoxib sodium reduces bone tumor-related pain behavior.
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Objective To explore the effect and safety of dexmedetomidine and parecoxib sodium alone or in double combinations in improving restlessness in recovery period in patients undergoing thoracic surgery.Methods One hundred and twenty eight patients who underwent thoracic surgery in the Central Hospital of Xinyang from September 2014 to September 2016 were selected and randomly divided into control group,dexmedetomidine group,parecoxib sodium group and combined group,with 32 cases in each group.Patients in the dexmedetomidine group were given 10 mL of saline at 0.5 h before surgery,and were given a slow injection of 0.5 μg · kg-1 of dexmedetomidine by intravenous injection at 10 minutes before the end of the operation.Patients in the parecoxib group were given 40 mg (10 mL) of parecoxib sodium 0.5 h by intravenous injection before surgery.Patients in the combined group were given 40 mg (10 mL) of parecoxib sodium 0.5 h by intravenous injection before surgery,and were given a slow injection of 0.5 μg · kg-1 of dexmedetomidine intravenously at 10 minutes before the end of the operation.Patients in the control group received intravenous injections of equal saline at 0.5 h before surgery and 10 minutes before the end of the operation.The operation time,peroperative bleeding,peroperative infusion volume,and anesthesia time were observed.Plasma tumor necrosis factor-α (TNF-t),C reactive protein (CRP) and interleukin-10 (IL-10) levels and TNF-α/IL-10 of all patients at the time of 10 min before induction of anesthesia (T0),15 min before extubation (T1),tracheal extubation time (T2),15 min after extubation (T3) were detected.At the same time,restlessness in stage of analepsia and sedation of all patients were evaluated.The adverse reactions of the four groups in the recovery stage were statistically analyzed.Results There was no significant difference in the operation time,peroperative bleeding,peroperative infusion volume and anesthesia time among the four groups(P ＞ 0.05).The levels of TNF-α,CRP and IL-10 at T1,T2 and T3 in the four groups were significantly higher than those at T0 (P ＜ 0.05).The levels of TNF-α,CRP,IL-10 at T2 and T3 were higher than those at T1 (P ＜0.05),but the levels of them at T3 were lower than those at T2 in the four groups(P ＜0.05).The TNF-α/IL-10 at T1,T2 and T3 in the control group was significantly higher than that at T0 (P ＜ 0.05),and TNF-α/IL-10 at T1,T2 and T3 in the other three groups was significantly lower than that at T0 (P ＜ 0.05).The level of TNF-α/IL-10 at T2 and T3 was higher than that at T1,at T3 it was higher than that at T2 in the control group(P ＜ 0.05) . But there was no significant difference among the time point of T1,T2 and T3 in the other three groups(P ＞ 0.05).Compared with the control group,TNF-α,CRP and TNF-α/IL-10 levels at T1,T2 and T3 in the other three groups were significantly lower(P ＜ 0.05),and IL-10 levels were significantly higher(P ＜0.05).The levels of TNF-α,CRP and TNF-α/IL-10 at T1,T2 and T3 in the combined group were significantly lower than those in dexmedetomidine group and parecoxib sodium group(P ＜ 0.05),while the IL-10 levels were significantly higher(P ＜ 0.05).The restlessness rate in the dexmedetomidine group,parecoxib sodium group and combined group were significantly lower than that in the control group (P ＜ 0.05),while the ramsay sedation was significantly higher (P ＜ 0.05).The restlessness rate in combined group was significantly lower than that in dexmedetomidine group and parecoxib sodium group (P ＜ 0.05).All the patients had no tachycardia,nausea,vomiting,respiratory depression and other adverse reactions.Conclusion Dexmedetomidine combined with parecoxib can reduce the restlessness rate significantly,and can produce some inhibition to the inflammatory reaction.The clinical effect of dexmedetomidine combined with parecoxib is better than dexmedetomidine and parecoxib sodium alone.
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Objective To investigate the analgesic effect of perioperatively intravenous Parecoxib for pain management after laparoscopic surgery of colorectal cancer,and whether it can reduce opioid requirements and opioid-related adverse effects.Methods 116 patients ungergoing laparoscopic colorectal resection were randomized to receive either intravenous parecoxib at a dose of 40 mg 15 minutes before induction of anesthesia followed by 40 mg every 12 hous for 72 hours (Parecoxib Group,n =59) or without the use of Parecoxib (control group,n =57).All patients had access to patient controlled analgesia (PCA) with Sufentanil within 48 hours after the operation.Patients were assessed with respect to Visual Analog Scale (VAS) from 0-10,and supplementary opiates were provided when VAS was above 4.Results Compared with control group,Parecoxib group had lower VAS scores at rest,while coughing and mobilization at each time point after the operation (P ＜ 0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).The postoperative hospital stay was less in Parecoxib group (P ＜0.05),and Parecoxib group consumed less opium on post-op day 1 [0 mg(0,7.5) vs.10 mg(7.5,15),Z=2 364,P =0.000],and less total opium consumption in 5 days after surgery [20 mg (10,25) vs.42.5 mg (37.5,45),Z =1 770,P =0.000].Conclusions The use of Parecoxib with PCA Sufentanil in postoperative analgesia resulted in comprehensive enhancement of the analgesic efficacy,reducing the opioid requirement,promoting postoperative recovery and shortening hospital stay.
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Objective:To compare the preventive effects of dezocine or parecoxib used alone or combination on emergence pain and agitation in the patients undergoing radical hysterectomy. Methods: Sixty ASA Ⅰ~Ⅱ patients undergoing radical hysterectomy were randomly divided into three groups. At the time of sewing incision, the dezocine group (group D, n=20) received dezocine in-travenous injection at the dosage of 0. 1 mg·kg-1, the parecoxib group (group P, n=20) received parecoxib intravenous injection at the dosage of 0.8 mg·kg-1, and the combination group (group DP, n=20) received 0.1 mg·kg-1dezocine and 0.8 mg·kg-1 parecoxib. When the operation was finished, the patients were transferred to the recovery room with endotracheal tubes, and recovered and extubated without the administration of reversal agents. Visual analogue scale ( VAS) for pain and Aono' s four-point scale for e-mergence agitation ( EA) were measured. The recovery time, extubation time, VAS, degree of EA and side effects such as nausea, vomiting, respiratory depression and hypersomnia during the emergence were also evaluated and recorded. Results:There were no sig-nificant differences in recovery time and extubation time among the three groups (P >0. 05). The VAS score and degree of EA in group DP were lower than that in group D (4. 65 ± 1. 69) and group P (5. 95 ± 1. 82) (P0. 05), and no side effects such as nausea, vomiting, respiratory depression and hypersomnia were detected during the emergence. Conclusion:Intravenous injection of 0. 1 mg·kg-1 dezocine combined with 0. 8 mg·kg-1 parecoxib at the time of sewing incision shows effective analgesia and emergence agitation reduction without obvious complications in the patients undergoing radical hysterecto-my.
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OBJECTIVE:To observe the effects of parecoxib preemptive analgesia combined with postoperative epidural analgesia on hip replacement and immune function. METHODS:Totally 86 patients undergoing unilateral hip replacement selected from Xining Third People's Hospital during Jan. 2014-Jun. 2016 were divided into observation group and control group according to random num-ber table,with 43 cases in each group. Two groups underwent unilateral hip replacement under spinal epidural anesthesia. Observation group was given Parecoxib sodium for injection 40 mg intravenously 30 min before the end of surgery. Control group was given con-stant volume of normal saline intravenously. Both groups were given epidural analgesia pump(Ropivacaine hydrochloride injection 150 mg+Ondansetron hydrochloride injection 16 mg+Dezocine injection 10 mg,added into normal saline to 100 mL)after surgery with dripping speed of 2 mL/h and patient-controlled time of 15 min. The hemodynamic indexes,analgesic effect,T lymphocyte subsets and NK cells levels were compared between 2 groups at different time points as well as the occurrence of ADR after surgery. RE-SULTS:Two patients of observation group and one patient of control group withdrew from the study. Before surgery,there was no sta-tistical significance in MAP and HR between 2 groups(P>0.05);12,24 h after surgery,MAP and HR of control group were signifi-cantly increased and higher than observation group,with statistical significance(P0.05). There was no statistical significance in VAS score between 2 groups immediately after surgery(P>0.05);6,12,24,48 h after surgery,VAS scores of observation group were signifi-cantly lower than those of control group,with statistical significance(P0.05). CD3+,CD4+and NK cells levels of 2 groups immediately after surgery,CD3+,CD4+,CD4+/CD8+ and NK cells levels of 2 groups at 12,24 h after surgery,CD3+and CD4+of control group at 48 h after surgery all changed significantly;CD3+,CD4+,CD4+/CD8+and NK cells levels of observation group at 12,24 h after sur-gery were significantly higher than those of control group,with statistical significantly(P0.05). CONCLUSIONS:The parecoxib preemptive analgesia combined with postopera-tive epidural analgesia shows good analgesic effect for hip replacement patients,keeps their hemodynamics stable and protects immune function to certain extent with good safety.
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Objective To investigate the effects of ulinastatin with parecoxib sodium on early cellular immunology function and cognitive function in elderly patients undergoing total hip replacement.Methods One hundred patients (aged 65-80 years,ASA grade Ⅱ) undergoing elective total hip replacement were randomly assigned into 4 groups: group W(n=25),group P(n=25),group WP(n=25) and group C(n=25).The patients in group W received intravenous injection of ulinastatin with a dose of 5 000 U/kg before skin incision and at the moment of the end of operation.Patients in group P accepted intravenous injection of parecoxib sodium of 40 mg before anesthesia and at a 12 h intervals for six times.Patients in group WP accepted intravenous injection of ulinastatin with a dose of 5 000 U/kg before skin incision and at the moment of the end of operation,and accepted intravenous injection of parecoxib sodium with a dose of 40 mg before anesthesia and at a 12 h interval for six times.Patients in group C were given normal saline at the same time as placebo.The operation time,the volume of bleeding and autologous blood receiving and the intraoperative fentanyl consumption were recorded in four groups.Blood samples were obtained before induction (T0),at the end of operation (T1),on 6 h (T2),24 h (T3),72 h (T4) after operation for determination of plasma concentration of S100β protein,neuron-specific enolase(NSE),IL-6,TNF-α.The percentages of T lymphocyte subsets (CD3+,CD4+,CD8+) and CD4+/CD8+ ratio were detected with flow cytometry.The Mini-Mental State Examination (MMSE) was used to test the cognitive function of the patients at T0,T4 and 7 d after operation (T5).Results Compared with T0,the percentages of CD3+,CD4+ cells and CD4+/CD8+ in groups C,W and P were significantly decreased,the plasma concentrations of IL-6 and TNF-α significantly increased at T1-T4,concentration of NSE and S100 protein were significantly increased at T2 and T3 (P<0.05).the percentages of CD3+,CD4+T lymphocyte and CD4+/CD8+ ratio in groups W and P at T2,T3 and group WP at T1-T4 was significantly higher than that of group C,the concentration of IL-6,TNF-α,NSE and S100β protein content was significantly lower than in group C (P<0.05);the percentages of CD3+,CD4+T lymphocyte and CD4+/CD8+ ratio in group WP was significantly higher than those of groups W and P,the concentrations of TNF-α,IL-6,NSE and S100β protein content was significantly lower than those of group W and P at T2,T3 (P<0.05).Compared with T0,MMSE score in group C was significantly lower at T4,T5 (P<0.05).MMSE score of groups W,P and WP was significantly higher than that of group C at T4 (P<0.05).MMSE score of group WP was significantly higher than those of groups W and P at T4 (P<0.05).Conclusion Ulinastatin combined with parecoxib sodium ameliorates early cellular immunology function and cognitive function in elderly patients undergoing total hip replacement,and it is more effective than using ulinastatin or parecoxib sodium alone.
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Objective To investigate effects of preoperative application of parecoxib on postoperative analgesia and coagulation function in neurosurgical patients.Methods A total of 90 patients (38 males and 52 females,ASA physical status Ⅰ or Ⅱ) undergoing crainotomy were randomly divided into two groups(n=45): parecoxib group (group P) and control group (group C).At 30 min before operation,group P received intravenous injection of parecoxib 40 mg (5 ml),group C intravenous injection of saline 5 ml.Postoperative patient-controlled intravenous analgesia (PCIA) was performed in all patients.PCIA formula of sufentanil 2 μg/kg+tropisetron 0.2 mg/kg,were diluted with normal saline to 120 ml.The visual analogue scale (VAS),the total and effective PCIA pump compressions,Ramsay sedation scale of 2,4,16,24,48 h after operation were recorded.Coagulation function was measured before and 2 h,48 h after parecoxib administration.Meanwhile,adverse reactions were recorded.Results Comparion of VAS between the two groups was made within 48 h after surgery,the total and effective PCIA pump compressions,were much more in group C than in group P (P<0.05).Ramsay sedation scale of group C was higher than that in group P at 2 h after operation.There were no significant differences in coagulation function.And the percentage of patients′ adverse effects in group P was lower than that in group C (P<0.05).Conclusion Parecoxib,as an analgesic,can enhance analgesic effect of sufentanil PCIA.Not only does it reduce the amount of sufentanil and incidence of adverse reactions,but also it has no significant effect on blood coagulation function.
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Objective To investigate the application effect of psychological intervention combined with parecoxib in rehabilitation of patients with bile duct carcinoma after the operation. Methods According to the different intervention models from January 2015 to March 2017 in the first people's hospital of Yongkang city surgical treatment of bile duct carcinoma,40 cases of patients groups: control group with routine nursing plus saline intervention, observation group with psychological nursing + Tenai (parecoxib sodium) mode of intervention; on the psychological state of the two groups before and after intervention to improve patients the cognitive function, to improve the situation, changes in pain scores were recorded, and the related data for comparative analysis. Results The psychological nursing + Tenai (parecoxib sodium) model (observation group) intervention in the treatment of patients with bile duct cancer surgery clinical effect is better than that of routine nursing mode + normal saline (control group) the clinical effect of intervention, the psychological state of patients to improve the situation, improve cognitive function, pain score changes were better than the control group, there was statistical significant differences (P<0.05). Conclusion The surgical treatment of patients with cholangiocarcinoma patients psychological nursing + Tenai (parecoxib sodium) intervention effect significantly, can effectively improve the patients psychological status, cognitive function, and can reduce postoperative pain fully, has an excellent role in promoting the rehabilitation of patients after surgery, worthy of clinical application.
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Objective:To observe the effect of parecoxib on neutrophil-to-lymphocyte ratio (NLR)after the modified radical mastectomy,and to explore its potential mechanisms for inhibition ofperioperative inflammation.Methods:A total of 40 breast cancer patients undergone the modified radical mastectomy were randomly divided into a parecoxib group (n=20) and a control group (n=20).The parecoxib group received intravenous parecoxib (40 mg,5 mL) during general anesthesia induction,post-operative day 1 and day 2;the control group received intravenous normal saline (5 mL) at the corresponding time points.Their peripheral bloods were collected for routine test in the morning of the surgery day (T1),and Day 1 (T2),Day 3 (T3) and Day7 (T4) after the surgery, and NLRwas calculated.Results:Compared with T1,NLR in the control group at T2 and T3 was significantly increased (P＜0.05),but not at T4 (P＞0.05);NLR in the parecoxib group was sharply increased at T2 (P＜0.01),and returned to preoperative levels at T3 and T4 (P＞0.05).NLR in the parecoxib group was significantly lower than that in the control group at T2 (P＜0.05),but there were no significant difference between the two groups at other time points (P＞0.05).Conclusion:Parecoxib can restrain the inflammatory responses and improve immune function of the breast cancer patients by suppressing the elevation of NLR after the modified radical mastectomy,which is expected to improve the prognosis of the breast cancer patients.
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Objective To observe the effect of parecoxib on intestinal barrier function of septic mice.Methods Sepsis was induced by cecal ligation and puncture (CLP) model.Twenty-one male C57BL/6 mice were randomly divided into three groups (n =7 in each group):group Sham,group CLP,group P (parecoxib 2 mg/kg was administered via gastric tube 2 h after CLP).In vivo intestinal permeability was measured using an in vivo ligated loop model 24 h after surgery.Twenty-one male C57BL/6 mice were randomly divided into three groups as before.The small intestine tissue sample was harvested 24 h after surgery.The intestinal pathological changes were observed under light microscope.The expression of tight junction proteins ZO-1,Occludin,and Claudin-1 in the ileum were measured by Western blot.IL-6 and PGE2 level in the ileum were measured by ELISA.Results Compared with group Sham,the intestinal permeability was significantly increased and there was a significant intestinal pathological injury in group CLP.IL-6 and PGE2 level in the ileum was sig nificantly increased and the expression of tight junction protein ZO-1,Occludin,and Claudin-1 in the ileum were reduced in the group CLP (P＜0.05).Compared with the group CLP,intestinal permeability and pathological injury was significantly reduced in the group P.The levels of IL-6 and PGE2 were significantly decreased (P＜0.05),the expression of ZO-1,Occludin,and Claudin 1 were upregulated in group P (P＜0.05).Conclusion Parecoxib can decrease the levels of proinflammatory factors and up-regulate the expression of tight junction to reverse intestinal barrier dysfunction caused by sepsis in mice.