Department of Anesthesiology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
J Surg Res. 2013 Aug;183(2):821-6. doi: 10.1016/j.jss.2013.02.059. Epub 2013 Mar 30.
The analgesic efficacy of parecoxib in postsurgical pain management has been confirmed in minimally invasive surgery. However, little is known about its effects used in combination with opioids and about its potential for opioid-sparing effects in complex operations. This study was performed to investigate the influence of parecoxib on morphine analgesia after gynecological tumor surgery.
Eighty patients undergoing gynecological tumor resection were randomized to receive either intravenous parecoxib at a dose of 40 mg (Group P, n = 40) followed by 40 mg every 12 h for 48 h or saline as a control (Group C, n = 40) 30 min before induction of anesthesia, followed by saline at the same time points after the operation. All patients had access to patient-controlled analgesia with intravenous morphine. Patients were assessed with respect to pain score (visual analog scale from 0-10), cumulative morphine requirement, satisfaction score, and side effects at 2, 6, 12, 24, and 48 h after surgery.
A total of 79 patients were evaluated. The cumulative dose of morphine administered at each time point was lower in Group P than in Group C (P < 0.05), at 2 h (3.81 ± 0.35 versus 4.13 ± 0.45; P = 0.01), 6 h (16.20 ± 1.49 versus 19.60 ± 0.35; P < 0.001), 12 h (26.29 ± 2.75 versus 32.49 ± 2.42; P < 0.001), 24 h (41.72 ± 2.70 versus 49.97 ± 4.53; P < 0.001), and 48 h (60.06 ± 4.00 versus 65.68 ± 3.23; P < 0.001). Compared with Group C, Group P had significantly lower visual analog scale scores at rest and with movement, respectively, at 2 h (4.2, P < 0.001 and 5.0, P < 0.001), 6 h (3.6, P < 0.001 and 4.5, P < 0.001), 12 h (3.0, P = 0.017 and 4.0, P < 0.001), 24 h (2.1, P < 0.001 and 3.4, P < 0.001), and 48 h (1.8, P < 0.001 and 2.6, P < 0.001). The satisfaction score was higher in Group P than in Group C (8.6 ± 0.3 versus 6.8 ± 0.7, P < 0.001). There were no significant differences in side effects between the two groups (P > 0.05).
The use of parecoxib with patient-controlled analgesic morphine in postoperative analgesia resulted in comprehensive enhancement of the analgesic efficacy, reducing the opioid requirement and increasing patient satisfaction after gynecological tumor surgery.
帕瑞昔布在微创手术后的疼痛管理中已被证实具有镇痛效果。然而，关于其与阿片类药物联合使用的效果以及在复杂手术中是否具有节省阿片类药物的潜力，目前知之甚少。本研究旨在探讨帕瑞昔布对妇科肿瘤手术后吗啡镇痛的影响。
80 例行妇科肿瘤切除术的患者随机分为两组：静脉注射帕瑞昔布 40mg（P 组，n=40），麻醉诱导前 30 分钟给予帕瑞昔布，然后每 12 小时给予 40mg，持续 48 小时；或生理盐水作为对照（C 组，n=40），麻醉诱导前 30 分钟给予生理盐水，然后在术后相同时间点给予生理盐水。所有患者均接受静脉注射吗啡自控镇痛。术后 2、6、12、24 和 48 小时，评估患者的疼痛评分（视觉模拟评分 0-10 分）、累积吗啡用量、满意度评分和不良反应。
共 79 例患者接受评估。与 C 组相比，P 组各时间点的吗啡累积剂量均较低（P<0.05），2 小时时（3.81±0.35 与 4.13±0.45；P=0.01）、6 小时时（16.20±1.49 与 19.60±0.35；P<0.001）、12 小时时（26.29±2.75 与 32.49±2.42；P<0.001）、24 小时时（41.72±2.70 与 49.97±4.53；P<0.001）和 48 小时时（60.06±4.00 与 65.68±3.23；P<0.001）。与 C 组相比，P 组在静息和运动时的视觉模拟评分分别在 2 小时（4.2，P<0.001 和 5.0，P<0.001）、6 小时（3.6，P<0.001 和 4.5，P<0.001）、12 小时（3.0，P=0.017 和 4.0，P<0.001）、24 小时（2.1，P<0.001 和 3.4，P<0.001）和 48 小时（1.8，P<0.001 和 2.6，P<0.001）时显著降低。P 组的满意度评分高于 C 组（8.6±0.3 与 6.8±0.7，P<0.001）。两组不良反应发生率无显著差异（P>0.05）。
帕瑞昔布联合术后自控镇痛吗啡用于妇科肿瘤手术后镇痛可全面增强镇痛效果，减少阿片类药物需求，提高患者满意度。
