帕瑞昔布钠联合利多卡因在腰椎开放性手术围手术期镇痛中的疗效观察

目的 基于多模式镇痛和超前镇痛的理念,在腰椎开放性手术围手术期联合应用帕瑞昔布钠、利多卡因及静脉镇痛泵,从疼痛、炎症应激反应、安全性等角度全面评估该镇痛方法的有效性及安全性。 方法 进行前瞻性临床研究实验,采用随机数字表将2015年1月-2016年1月行腰椎开放性手术的136例患者随机分为实验组及对照组(各68例)。实验组在术前30 min,术后当晚及术后24 h分别给予注射用帕瑞昔布钠40 mg。对照组在相同时间段给予生理盐水。实验组在切口皮下组织缝合前沿皮缘给予利多卡因局部浸润注射。2组患者术后均给予以镇痛泵。记录和比较2组患者在术后3、12、24及48 h的疼痛评分及镇痛使用情况;术后围手术期患者的白细胞、C反应蛋白、血糖及体温情况。 结果 实验组在术后各时间段的VAS疼痛评分均显著小于对照组(P<0.05);镇痛泵使用总量显著少于对照组(P<0.05);实验组患者在术后第1、3天的白细胞、C反应蛋白、血糖及体温等指标均显著低于对照组(P<0.05)。2组患者在切口愈合率、引流量、输血率、并发症等指标差异无统计学意义(P>0.05)。 结论 采用帕瑞昔布钠联合利多卡因合并镇痛泵的方法在治疗腰椎开放性手术的镇痛效果中要显著优于单独使用镇痛泵者,能够有效地减少镇痛泵的使用,减轻术后的炎症反应,并具有良好的安全性。在临床工作中可以进一步的使用和推广。 

Observation on the Clinical Analgesic efficacy of parecoxib sodium and lidocaine in the perioperative period of Lumbar Open Surgery

Objective Basing on the concept of multimodal analgesia and preemptive analgesia,we evaluated the effect of parecoxib sodium preemptive analgesia and lidocaine combined with patient-controlled intravenous analgesia (PCIA) on postoperative pain,analgesic use,function recovery,inflammatory and stress response and perioperative safety after TKA and THA. Methods One hundred and thirty-six patients who were admitted and had the open operation in our hospital from January,2015 to January,2016 were randomly divided into 2 groups.The study group received a single 40 mg dose of parecoxib sodium 30 minutes before incision,the night on the operation day and 24 hours after the operation along with PCIA morphine,who has the injection of lidocaine on the subcutaneous tissue of incision before the end of the operation.The control group received only saline and PCIA morphine for postoperative pain management.Clinical outcomes were evaluated by visual analogue scale (VAS)(3,12,24,48 h after the operation) and the index like body temperature,leukocyte count,hypersensitive C reactive protein (hs-CRP),and blood glucose. Results VAS were improved significantly in the study group compared with the control group at all the observation points in the 48 h after surgery (P<0.05).The body temperature,leukocyte,hs-CRP and the blood glucose were also significantly decreased in the study group.There was no difference between the two groups in the incision healing rate,volume of drainage,blood transfusion rate and complications. Conclusion The multimodal analgesia regime combining parecoxib sodium,lidocaine and PCIA significantly can improve postoperative VAS,reduce morphine consumption and decrease inflammatory response without increasing the risks of bleeding and other adverse events,which should be further application and promotion in clinic.