塞来昔布在骨科术后多模式镇痛的临床应用

目的：对比研究骨关节手术后应用塞来昔布联合患者自控镇痛(PCA)多模式镇痛和传统术后镇痛的效果。方法：60例择期行骨关节手术患者，随机分成2组：多模式镇痛组术后使用经静脉用镇痛泵(芬太尼0.02 mg/h)，术后当天至第5天每天口服塞来昔布400 mg，第6天起改为200 mg/d连续8 d； PCA组术后仅使用镇痛泵另予以安慰剂。分别记录患者术后疼痛评分、阿片类药物用量、生命体征、芬太尼和塞来昔布的副作用情况(恶心呕吐、尿潴留等)、睡眠评分、出血量、术前及术后血常规、凝血全套、出院时患者满意度和出院后1月时电话随访患者确定慢性疼痛发生率。 结果：术后除0~4 h和4~8 h外，多模式镇痛组术后疼痛评分明显低于PCA组(P<0.05)。术后8~12 h,12~16 h,16~20 h时间段芬太尼用量及术后0~12 h, 0~24 h, 0~36 h芬太尼阶段性使用总量均明显少于PCA组(P<0.05)。患者的睡眠评分明显优于PCA组(P<0.05)，满意度评分和出院1月后慢性疼痛发生率均明显好于PCA组(P<0.05)。多模式镇痛组与PCA组在阿片类药物和塞来昔布的副作用事件发生率比较上无明显差异(P>0.05)。 结论：骨关节手术后塞来昔布结合PCA多模式镇痛明显优于术后单纯PCA镇痛。多模式镇痛能够提高术后镇痛效果，减少术后阿片类药物的用量，改善患者睡眠，提高其住院满意度及降低出院慢性疼痛发生率，不影响其血小板和凝血功能。

Multimodal effect of celecoxib on the perioperative analgesia in orthopaedic surgery

Objective To determine the multimodal postoperative analgesia effect of celecoxib combined with patient-controlled analgesia (PCA) and its clinical efficacy and related adverse events in orthopaedic procedures.MethodsSixty patients undergoing orthopaedic surgery were randomly divided into 2 groups. The observation group received 400 mg of celecoxib from POD0 to POD5 and 200 mg until POD14 plus IV PCA (fentanyl 1.0 mg/100 mL) postoperatively. The control group only took IV PCA postoperatively plus placebo. Visual analogue scale(VAS) scores and cumulative volumes of the opioid were assessd every 4 hours postoperatively until 48 hours. Sleep disturbance, vital signs and side effects including nausea, emesis, et al. were observed for 2 days. Blood-R and coagulation function were tested preoperatively and postoperatively. Blood loss, satisfied score, and chronic pain situation at 1 month were also measured.ResultsVAS scores, sleep disturbance, PCA cumulative volumes of the fentany were significantly better in the multimodal groups compared with the simple analgesia group(P<0.05), the opioid and celecoxib related adverse effects were not statistically lower in the multimodal groups(P>0.05). The observation group was more satisfied with analgesia treatment and experienced less pain 1 month after discharge(P<0.05).ConclusionThe multimodal use of the specific COX-2 inhibitor celecoxib in the postoperative period of orthopaedic procedures clearly improves postoperative pain, reduces the opioid consumption, releases the sleep disturbance, demonstrates more satisfaction in patients and lower chronic pain rate after discharge, without affecting the platelet and coagulation function.