Zhu Yang-Zi, Yao Rui, Zhang Zhe, Xu Hui, Wang Li-Wei
Department of Anesthesiology, Xuzhou Central Hospital Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University Department of neurology, Xuzhou Central Hospital, Xuzhou, PR China.
Medicine (Baltimore). 2016 Jul;95(28):e4082. doi: 10.1097/MD.0000000000004082.
Trial design neuroinflammation and postoperative pain after surgery are increasingly reported in association with postoperative cognitive dysfunction (POCD). Parecoxib, a selective cyclooxygenase (COX)-2 inhibitor, is used for postoperative analgesia for its potent anti-inflammatory and analgesic effects. This study aimed to evaluate parecoxib's effects on POCD in elderly patients undergoing total knee arthroplasty.
Around 134 elderly patients undergoing total knee arthroplasty were randomly divided into parecoxib (group P) and control (group C) groups, and treated with parecoxib sodium and saline, respectively, shortly after induction of general anesthesia and 12-h postsurgery, respectively. Perioperative plasma IL-1β, IL-6, TNF-α, and C-reactive protein (CRP) 1evels were measured. Postoperative pain was assessed following surgery. Neuropsychological tests were performed before surgery, and 1 week and 3 months postoperation.
POCD incidence in group P was significantly lower compared with that of group C at 1 week after surgery (16.7% vs 33.9%; P < 0.05); no significant difference was found between groups C and P at 3-month follow-up (9.7% vs 6.7%). Compared with group C values, visual analog pain scale (VAS) scores at 3, 6, and 12 hours after surgery were significantly lower in group P(P < 0.05). Plasma IL-1β, IL-6, and TNF-α levels were lower in group P than in group C after the operation (P < 0.05). No significant difference in the plasma CRP level was found between groups P and C.
Parecoxib sodium decreases POCD incidence after total knee arthroplasty in elderly patients and may explain how this drug suppresses inflammation and acute postoperative pain caused by surgical trauma.
越来越多的研究报道，术后认知功能障碍（POCD）与手术引起的神经炎症和术后疼痛有关。帕瑞昔布是一种选择性环氧化酶（COX）-2抑制剂，因其强大的抗炎和镇痛作用而用于术后镇痛。本研究旨在评估帕瑞昔布对接受全膝关节置换术的老年患者POCD的影响。
约134例接受全膝关节置换术的老年患者被随机分为帕瑞昔布组（P组）和对照组（C组），分别在全身麻醉诱导后不久和术后12小时给予帕瑞昔布钠和生理盐水治疗。测定围手术期血浆白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）和C反应蛋白（CRP）水平。术后评估术后疼痛情况。在手术前、术后1周和3个月进行神经心理学测试。
术后1周，P组的POCD发生率显著低于C组（16.7%对33.9%；P<0.05）；在3个月的随访中，C组和P组之间未发现显著差异（分别为9.7%和6.7%）。与C组相比，P组术后3、6和12小时的视觉模拟疼痛量表（VAS）评分显著更低（P<0.05）。术后P组血浆IL-1β、IL-6和TNF-α水平低于C组（P<0.05）。P组和C组之间血浆CRP水平无显著差异。
帕瑞昔布钠可降低老年患者全膝关节置换术后的POCD发生率，并可能解释该药物如何抑制手术创伤引起的炎症和急性术后疼痛。
