塞来昔布在全膝关节置换术后镇痛效果的评估

目的评估术前和术后联合使用塞来昔布（选择性环氧合酶2抑制剂），对人工全膝关节置换术后疼痛的影响，以观察其安全性和对减少术后阿片类药物用量的有效性。方法30例因关节炎需行双膝关节置换手术患者，随机分为塞来昔布加硬膜外镇痛组（CE组）和硬膜外镇痛组（E组），每组15例。CE组在术晨口服塞来昔布200mg，其余同E组。术毕连接患者自控镇痛泵（1．2mg／ml布比卡因加0．1mg／ml吗啡加0．02mg／ml氟哌利多）镇痛72h。术后24、48、72h各进行疼痛评分，记录比较每日盐酸哌替啶用量、镇痛满意度、镇痛期间不良反应。结果复合塞来昔布可明显降低术后24h静息、48h静息和活动时疼痛评分。CE组提高术后24h镇痛满意度为100％，高于E组的60％（χ2=6．71，P〈0．01）。两组患者在不良反应上无明显差别。结论口服塞来昔布可明显改善双膝置换术后疼痛，增加镇痛满意度。

Evaluation of analgesia of celecoxib in total knee arthroplasty

Objective To evaluate the effect of preoperative and postoperative use of celecoxib, a kind of selective cyclooxygenase 2 （ COX 2） inhibitor, on postoperative pain after artificial total knee replacement（TKA）, and observe its safety and effectiveness in decreasing the postoperative use of opiate drugs. Methods Thirty patients undergwent selective knee replacement were randomly given oral celecoxib 200 mg（ group CE, n = 15 ） or placebo （ group E, n = 15 ） 1 hour prior to surgery. All patient - controlled epidural analgesia after surgery for 72 h （0.1 mg/ml morphine ＋ 1.2 mg/ml bupivacaine ＋ 0.02 mg/ml droperidol）. Modified verbal rate scale was used to evaluate postoperative pain intensity, the outcomes included pain scores during rest and analgesia satisfaction. Daily morphine consumption was recorded. Results The pain scores were significantly less in the group CE than in group E during rest and knee joints movement on the first and second postoperative day. Analgesic satisfaction increased in group CE after-24 h（100% ）, above 60% of group E（χ2 =6.71, P 〈0.01）, two groups of patients was no significant difference in adverse reactions. Conclusions Celecoxib increases analgesia satisfaction, reduces pethidine hydrochloride and pain after TKA.