联合应用塞来昔布在膝前交叉韧带重建术后的镇痛疗效分析

目的观察塞来昔布（celecoxib）对膝前交叉韧带术的术后镇痛效果和安全性。方法选择2001至2006年住院患者，共100例，随机分为塞来昔布组和对照组，两组术前1-2h分别给予对乙酰氨基酚（paracetamol）1000mg、塞来昔布400mg或安慰剂。所有患者的手术关节均接受关节内镇痛和外部冷敷。出院后前14d内，指导患者每6h服用对乙酰氨基酚1000mg、每12h服用塞来昔布200mg或相应的安慰剂。结果恢复室内塞来昔布组患者疼痛较轻者较多于对照组（41／50例比23／50例，P〈0．05），并且术后镇痛的芬太尼需要量少于对照组（0．454±0．15）mg比（0．854±0．22）mg，（P〈0．05），患者术后恶心呕吐的发生率低于对照组（17／50例比38／50例，P〈0．05）。术后14d的疼痛评分塞来昔布组低于对照组（P〈0．05）。结论围术期使用塞来昔布能够减少围手术期术后疼痛、阿片类药用量、术后恶心呕吐及恢复室停留时间。塞来昔布可应用于前交叉韧带手术预防性镇痛．

Evaluating the analgesic efficacy of celecoxib after anterior cruciate ligament reconstruction surgery

Objective To observe the analgesic efficacy of celecoxib after anterior cruciate liga-ment （ACL） surgery. Methods One-hundred consecutive patients were randomized to receive acetamino-phen 1000 mg and either celecoxib 400 mg or placebo 1-2 h before ACL surgery. All patients received intraarticular analgesics （bupivacaine, clonidine and morphine） and had an external cooling system applied to the operated knee. After discharge, patients were instructed to take acetaminophen 1000 mg every 6 h and either celecoxib 200 mg every 12 h or placebo for the first 14 days postoperatively. Results Patients in the celecoxib group were more likely to experience less pain in the recovery room than that of the control group （41/50 cases vs. 23/50 cases,P〈0.01） and require less opioids than that of the control group （0.45±0.15 mg vs. 0.85±0.22 mg,P 〈0.05） for postoperative analgesia. These patients reported a lower incidence of postoperative nausea and vomiting than those of the control group （17/50 cases vs.38/50 cases,P〈0.05）. Conclusions The postoperative pain,opioid dosage used,postoperative nausea and vomiting,and the time of staying in recovery room may be decreased by the perioperative administration of cele-coxib. Celecoxib can be used as the analgesic drug for ACL surgery.