帕瑞昔布钠对脊柱融合术后镇痛效果及肾功能的影响

目的观察帕瑞昔布钠对脊柱融合术患者术后镇痛效果及肾功能的影响。方法择期行脊柱融合手术患者60例，ASA Ⅰ ～Ⅱ级，采用随机数字法分为3组，每组20例：A组麻醉诱导时静脉注射帕瑞昔布钠40 mg;B组手术结束前10 min静脉注射帕瑞昔布钠40 mg;对照组C组同时点给予等容量生理盐水静脉注射。术中采用丙泊酚、瑞芬太尼...

Effects of parecoxib sodium on postoperative analgesia and renal function after spinal fusion surgery

Objective To observe the effects of parecoxib sodium on the post-operative pain relief and renal function after spinal fusion surgery. Methods Sixty ASA Ⅰ -Ⅱ patients undergoing elective decompressive lumbar laminectomy with posterior spinal fusion were randomly divided into group A, B and control group C following intravenous administration of dosing schedule: In group A, parecoxib 40 mg was injected during anesthesia induction; in group B, parecoxib 40 mg was injected 10 min before the completion of surgery; in control group C, the isochoric 0.9％ physiological saline was given either at anesthesia induction or 10 min before the completion of surgery. Anesthesia was maintained by propofol and remifentanil. All patients received the patient-controlled intravenous analgesia with morphine after surgery. The scores of visual analog scale (VAS) at rest and during coughing at 5 minutes post-extubation and 2, 4, 6, 12, 24 h and 48 h postoperatively. The total morphine consumption of each time point and the opioid-related symptom distress associated with opioid therapy after surgery were recorded. The red cell loss rate of intraoperative and the renal function in perioperative were measured, respectively. Results The VAS scores of resting and coughing in group A(4.4±1.8,2.3±1.1, 2.8±1.1)were significantly less than the group B(6.5±1.8, 2.8±1.0, 3.3±0.9) and C(7.1±1.9, 3.0±1.1, 3.6±0.9) at 5 min post-extubation and 2 h after surgery(P＜0.05 ). There was no statistically significance of the VAS scores among three groups from 24 h to 48 h after surgery. The total morphine consumption at 2, 4, 6, 12 h were significantly reduced in A[(36±27), (60±44), (68±51), (83±57) μg/kg] and B[(41±18), (83±47), (97±52), (120±69) μg/kg] groups compared with the control group[(69±36),(131 ±61), (158 ±79), (184 ±84) μg/kg] (P＜0.05). Summary the morphine consumption at 24 h and 48 h in group A was significantly less than those in groups B and C (P＜0.05). The opioid-related symptom distresses associated with opioid therapy were less in groups A and B than those in group C within 48 h after surgery. There were no significant differences in the red cell loss rate of intraoperative and the renal function in perioperative among the three groups. Conclusion Intravenous administration of the parecoxib sodium 40 mg either at the onset of anesthesia induction or 10 min before the end of surgery significantly decreased morphine consumption and side effects associated with opioid therapy, and did not affect the renal function. Administration of the parecoxib sodium at the beginning of anesthesia induction showed more beneficial therapeutic effects on the patients with spinal fusion surgery.