Effects of parecoxib and morphine on remifentanil-induced postoperative hyperalgesia in patients undergoing orthopedic operation / 中华麻醉学杂志

ABSTRACT

Objective To investigate the effects of parecoxib and morphine on remifentanil-induced postoperative hyperalgesia in patients undergoing orthopedic operation. Methods Sixty ASA Ⅰ or Ⅱ patients,aged 20-62 yr, weighing 45-100 kg, undergoing orthopedic surgery, were randomly divided into 3 groups ( n = 20 each). Anesthesia was induced with midazolam, propofol, remifentanil and rocuronium. The patients were mechanically ventilated after tracheal intubation. Group Ⅰ received iv injection of morphine 0.15 mg/kg, group Ⅱ received iv injection of parecoxib 20 mg and morphine 0.075 mg/kg and group Ⅲ received iv injection of parecoxib 40 mg and morphine 0.075 mg/kg. Anesthesia was maintained with infusion of propofol and remifentanil and intermittent iv boluses of vecuronium. The emergence time, consciousness recovery time, extubation time,incidence of agitation and shivering, and VRS score at 5 min after recovery of consciousness were recorded. Pain at rest and at movement was evaluated using VAS score at 1,2, 4, 8, 12 and 24 h (T1-6) after surgery and MAP andHR were recorded simultaneously. The incidence of nausea and vomiting during 24 h after surgery was also recorded. Blood samples were taken before induction of anesthesia, at the end of operation and 24 h after operation for determination of plasma concentrations of PGE2 and TNF-α. Results There was no significant difference in emergence time, consciousness recovery time, extubation time, VRS scores, MAP, HR, incidence of agitation,shivering, nausea and vomiting among the 3 groups. Compared with group Ⅰ , VAS scores at rest at T1-2 and at movement at T1-6 were significantly increased in group Ⅱ , while VAS scores at rest and at movement decreased at T1-5 in group Ⅲ (P＜0.05). VAS scores at rest at T1-6 and at movement at T1-5 were significantly lower in group Ⅲ than in group Ⅱ (P＜ 0.05). There was no significant difference in the plasma concentrations of PGE2 and TNF-α at different time points between group Ⅰ and Ⅱ (P＞0.05). The plasma concentrations of PGE2 and TNF-α were significantly lower at the end of surgery in group Ⅲ than in group Ⅰ and Ⅱ (P＜0.05). Conclusion Preoperative iv parecoxib 40 mg and morphine 0.075 mg/kg can reduce remifentanil-induced postoperative hyperalgesia in patients undergoing orthopedic operation, and the efficacy is better than that of morphine alone.