不同时间点给予帕瑞昔布在肩关节镜术后的镇痛作用*

The analgesic effect of Parecoxib given in different time-point after shoulder arthroscopy*

摘要:

研究不同时间点给予帕瑞昔布在肩关节镜围术期的镇痛效果。方法 回顾性分析60例在肩关节镜下行肩袖修补术的患者，分为3组，A组分别在麻醉诱导期及其麻醉后12 h肌注帕瑞昔布40 mg，B组分别在手术结束时及术后12 h肌注帕瑞昔布40 mg，C组（对照组）在围手术期未注射帕瑞昔布，所有患者术后静脉注射吗啡作为补救镇痛，术后24 h内行视觉模拟评分（VAS），记录吗啡消耗量、术后首次需要镇痛时间、术后24 h肩关节被动前屈、外展活动度及并发症。结果 对照组术后24 h吗啡消耗量为（41.2±8.0）mg，A组消耗（18.2±5.8）mg，B组消耗（24.1±5.6）mg，A组和B组较对照组吗啡消耗量明显减少（P =0.000），A组较B组术后24 h吗啡消耗量也明显减少（P <0.01）；对照组首次补救镇痛时间为（19.9±7.7）min，A组为（45.8±15.6）min，B组为（31.2±10.4）min，A组和B组较对照组补救镇痛时间明显延长（P <0.01），且A组较B组也明显延长（P =0.000）；A组和B组各时间点VAS评分较对照组明显降低（P =0.000）；A组和B组各时间段吗啡消耗量较对照组明显减少（P <0.05）；A组和B组被动肩关节活动度均较对照组明显增加（P <0.05）；3组间术后并发症发生率比较，差异无统计学意义（P >0.05）。结论 帕瑞昔布在肩关节术后应用，可以明显改善疼痛、促进早期康复，术前给予帕瑞昔布具有超前镇痛作用。

Abstract:

To study the analgesic effect of Parecoxib given in different time-point during shoulder arthroscopic surgery for repairing rotator cuff. Methods 60 patients were retrospectively analyzed and assigned to three groups, patients in group A were intramuscular injection of 40 mg Parecoxib during anesthesia induction and 12 hours later respectively, patients in group B were given 40 mg Parecoxib at the end of the operation and at 12 hours after operation respectively, patients in group C (the control group) did not receive Parecoxib during perioperative time. Morphine was used as rescue analgesic for all the patients. The pain level was assessed on regular time using VAS at 24 hours postoperatively. The amount of Morphine consumption, the first time for analgesia, passive range of motion of shoulder at 24 h postoperatively and complications were recorded. Results Total consumptions of Morphine at 24 hours postoperatively were (41.2 ± 8.0) mg in control group, (18.2 ± 5.8) mg in group A, and (24.1 ± 5.6) mg in the group B. The amount of Morphine consumed in the group B and group C were significantly less than that in the control group (P = 0.000), meanwhile, group A consumed significantly less than that of group B (P < 0.01). The first time for rescue analgesic was (19.9 ± 7.7) minutes in the control group, (45.8 ± 15.6) minutes in group A, (31.2 ± 10.4) minutes in group B. The time in group A and group B were significantly delayed than that in the control group (P < 0.01), and group A was significant delayed than that in group B (P = 0.000). VAS score was significantly lower in group A and group B at each interval 24 hours postoperatively, as compared with control group (P < 0.05). Significantly less Morphine was consumed in group A and group B than that in the control group at each time interval and at 24 hours postoperatively (P = 0.000). Passive range of motions of shoulder in group A and group B were significantly wider than that in control group (P < 0.05). There was no statistically difference in complications in three groups. Conclusion Parecoxib used in perioperative period could significantly improve pain and promote rehabination. Parecoxib given preoperatively has the effect of preemptive analgesia.