Objective To evaluate the efficacy and safety of COX inhibitor flurbiprofen axetil in relieving propofol injection pain and preemptive analgesia after general anesthesia. Methods Databases such as PubMed, CBM, Springer, Ovid, CNKI and ISI were searched to identify randomized controlled trials (RCTs) about flurbiprofen axetil in relieving propofol injection pain and preemptive analgesia after general anesthesia published from 2000 to 2010. The methodological quality of the included RCTs was assessed and the data were extracted according to the Cochrane Handbook 5.0.1. Meta-analysis was performed by using RevMan 4.2.10 software. Results A total of 15 RCTs involving 1 425 patients were included. The results of meta-analyses showed that: a) Relieving propofol injection pain: Compared with the placebo group, flurbiprofen axetil could prevent the propofol injection pain (RR=3.13, 95%CI 1.08 to 9.11, P=0.04), and relieve the moderate and severe pain in injecting propofol (RR=0.57, 95%CI 0.40 to 0.81, P=0.002; RR=0.14, 95%CI 0.05 to 0.34, Plt;0.000 1, respectively), but there were no significant differences in relieving mild pain between the two groups; b) Preemptive analgesia: the visual analog scale (VAS) of post-operation at 2-hour (WMD= –2.25, 95%CI –4.20 to –0.29, P=0.02), 4-hour (WMD= –1.99, 95%CI –3.19 to –0.79, P=0.001), 8-hour (WMD= –1.39, 95%CI –1.86 to –0.93, Plt;0.000 01) and 12-hour (WMD= –2.70, 95%CI –4.73 to –0.68, P=0.009) was decreased when flurbiprofen axetil was injected before the operation, but there were no significant differences in VAS of post-operation at 48-hour between the two groups. When flurbiprofen axetil was injected at the end of the operation, VAS of post-operation at 12-hour (WMD= –0.94, 95%CI –1.73 to –0.16, P=0.02) was decreased, but there were no significant differences in VAS of post-operation at 24-hour between the two groups; flurbiprofen axetil could lessen the need for opioid analgesics (RR=0.47, 95%CI 0.27 to 0.82, P=0.008); and c) Safety: there were no significant differences in postoperative nausea, vomit and somnolence between the two groups. Conclusion Flurbiprofen axetil can significantly prevent or relieve the propofol injection pain; flurbiprofen axetil injected before operation can relieve post-operative pain at 2-, 4-, 8- and 12-hour; flurbiprofen axetil injected at the end of the operation can relieve post-operative pain at 12-hour. Yet more RCTs are required to discuss its effects on nausea, vomit and somnolence.
目的 观察帕瑞昔布钠超前镇痛在痔上黏膜环切术中对丙泊酚半数有效效应室靶浓度和对术后视觉模拟评分法（VAS） 的影响。 方法 2010年3月－2011年10月择期手术患者60例，随机分为帕瑞昔布组（试验组）和生理盐水组（对照组），每组各30例，分别于术前10 min静脉注射帕瑞昔布钠40 mg或生理盐水2 mL。痔上黏膜环切时靶控输注丙泊酚，其靶控浓度按序贯法确定，相邻靶浓度之间对数差为0.05。观察两组丙泊酚的有效浓度及术后2、4、8、24 h的VAS评分。 结果 试验组的半数有效效应室靶控浓度（4.30 μg/mL）低于对照组（4.95 μg/mL），差异有统计学意义（P＜0.05）。术后4、8、24 h试验组VAS评分明显低于对照组，差异有统计学意义（P＜0.05）。 结论 帕瑞昔布钠可以减少术中丙泊酚的用量，并可得到满意的术后镇痛效果。
【摘要】 目的 观察帕瑞昔布钠超前镇痛在小儿上肢骨折手术的镇痛效果及不良反应发生情况。 方法 选择2009年6月－2010年12月气管插管全身麻醉下择期行单侧上肢骨折切开复位内固定手术患儿90例，随机分为帕瑞昔布钠组（P组）、曲马多组（T组）及对照组（C组），每组各30例患儿；于麻醉前分别静脉注射帕瑞昔布钠1 mg/kg、曲马多2 mg/kg、等容量生理盐水。3组患儿年龄、性别、体重、手术时间等一般情况差异无统计学意义（Pgt;0.05）。各组均于术后2、4、6、8 h各时间点观察患儿疼痛评分、镇静评分；观察拔除患儿气管导管后5 min躁动评分；记录患儿术中芬太尼总用量及术后镇痛药物用量；随访术后24 h内不良反应的发生情况。 结果 术后各个时间点P组疼痛评分明显低于T、C组（Plt;0.01）；T组镇静评分于术后2、4、6 h明显高于P、C组（Plt;0.01），镇静评分在P、C组之间比较差异无统计学意义（Pgt;0.05）；P组术后躁动评分明显低于T、C组（Plt;0.01）；P组患儿围手术期芬太尼用量明显少于T、C组（Plt;0.01）；T组术后恶心呕吐发生率明显高于P、C组（Plt;0.05）。P组无呼吸抑制、伤口异常出血等严重不良反应。 结论 帕瑞昔布钠超前镇痛用于小儿上肢骨折手术可产生明显镇痛作用，并可有效预防苏醒期躁动发生，明显减少围手术期芬太尼用量，恶心呕吐等不良反应发生率明显低于曲马多。【Abstract】 Objective To study the efficacy and safety of preemptive analgesia with parecoxib sodium in children undergoing upper limb orthopedic surgery. Methods Ninety children from June 2009 to December 2010 scheduled for elective upper limb orthopedic surgery under general anesthesia were selected and randomly divided into three groups with 30 children in each. For the children in group P (parecoxib sodium), group T (tramadol) and group C (control), preemptive analgesia was induced by an intravenous injection of parecoxib sodium at 1 mg/kg, tramadol at 2 mg/kg, and normal saline respectively before anesthesia. Pain intensity score and sedation score were recorded 2, 4, 6, and 8 hours respectively after operation. The agitation score was measured 5 minutes after extubation. The perioperative fentanyl consumption and postoperative analgesic medicine consumption were recorded. The adverse effects were observed within 24 hours after operation. Results The demographic data such as age, gender, weight, and operation time did not differ statistically among the three groups of children (Pgt;0.05). Compared with groups T and C, the pain score in group P was significantly lower at all time points after operation (Plt;0.01). The sedation score in group T was significantly higher than those in group P and C 2, 4, and 6 hours after operation (Plt;0.01), but the sedation score did not differ significantly between groups P and C (Pgt;0.05). The agitation score after trachea extubation in group P was significantly lower than the other two groups (Plt;0.01). The quantity of fentanyl used in group P was significantly lower than in groups T and C (Plt;0.01). The incidence of postoperative nausea or vomiting in group T was higher than those in groups P and C (Plt;0.05). There was no depression of breath or abnormal hemorrhage in group P. Conclusion Parecoxib sodium has a better analgesic effect in children undergoing upper limb orthopedic surgery. The agitation score and the incidence of postoperative nausea or vomiting are significantly lower, and the use of parecoxib sodium can also significantly reduce the perioperative fentanyl consumption.
【摘要】 目的 观察在腹腔镜胆囊切除术中，氯胺酮超前镇痛对瑞芬太尼麻醉后急性疼痛的影响。 方法 2009年10月-2010年1月，将择期行腹腔镜胆囊切除术患者90例，随机分为对照组（C组）、氯胺酮超前镇痛组（K组）、氯胺酮术毕镇痛组（K1组），每组30例。所有患者均采用瑞芬太尼复合丙泊酚静脉麻醉，K组在切皮前静脉给予氯胺酮0.5 mg/kg，K1组在关腹前静脉给予氯胺酮0.5 mg/kg，C组不给予任何药物。记录术毕患者麻醉恢复情况，各时间点疼痛程度。 结果 K组、K1组躁动发生率均明显低于C组（Plt;0.05）；术后2、4、8、24 h，K组VAS评分及镇痛药使用率明显低于C组和K1组（Plt;0.05）。 结论 氯胺酮超前镇痛能明显降低瑞芬太尼术后疼痛，并且不增加并发症发生率。【Abstract】 Objective To evaluate the preemptive analgesia of ketamine on remifentanil induced acute postoperative pain after laparoscopic cholecystectomy. Methods Ninty patients scheduled for laparoscopic cholecystectomy between october 2009 to Jannary 2010 were randomly assigned to three groups (n=30). Group K was administrated with 0. 5 mg/kg ketamine intravenously before skin incision, and Group K1 were administrated with 0. 5 mg/kg ketamine intravenously before abdominal closure, while Group C received nothing. The recovery and the side effects were recorded, the VAS at two, four, eight and 24 hours after surgery, and the use of anodyne were recorded. Results The incidence of restlessness in Groups K and K1 was remarkably lower than that of Group C (Plt;0. 05). The analgesic effects two, four, eight and 24 hours after surgery were obviously better in group K than those of Group C and Group K1 (Plt;0. 05). Conclusion Ketamine can produce preemptive analgesia to relieve remifentanil-induced acute pain, and it would not increase incidence of side effects.
【摘要】 目的 通过不同方式静脉滴注曲马多用于腹腔镜胆囊切除术以评价其镇痛作用。 方法 2007年8月-2009年8月择期行腹腔镜胆囊切除术患者90例，ASAⅠ或Ⅱ级，随机分成A、B、C、D组，在全身麻醉诱导后和手术结束时两个时间点分别给予曲马多2.5 mg/kg或生理盐水，A组曲马多，生理盐水；B组生理盐水，曲马多；C 组曲马多；D组生理盐水。分别于手术后2、4、8、24 h进行视觉模拟评分法（VAS）评分，了解不良反应的发生情况及镇痛药的使用情况。 结果 手术后2、4、8、24 h，A、B、C组VAS评分低于D组（Plt;0.05）；手术后8 h，A、C组明显低于B、D组（Plt;0.05）。 结论 曲马多2.5 mg/kg预注用于腹腔镜胆囊切除术的超前镇痛是可行而有效的。【Abstract】 Objective To evaluate the analgesic effect of intravenous tramadol in laparoscopic cholecystectomy through different ways. Methods Ninety patients of elective laparoscopic cholecystectomy (ASA Ⅰ or Ⅱ) from August 2007 to August 2008 were randomly divided into group A, B, C, and D, which were given Tramadol (2.5 mg/kg) or normal saline after the induction of general anesthesia and end of surgery. Group A: first tramadol then normal saline, group B: first saline then tramadol; group C: only given tramadol; group D: only given normal saline, respectively give VAS scores two, four, eight and 24 hours after surgery to understand the occurrence of adverse reactions and the use of analgesic drugs. Results The VAS scores two, four, eight and 24 hours after surgery, the scores of group A, B and C were lower than that of group D (Plt;0.05), VAS scores eight hours after surgery of group A and C were lower than that of group B and D (Plt;0.05). Conclusions The tramadol (2.5 mg/kg) pre-injection for analgesia of laparoscopic cholecystectomy is feasible and effective analgesia.
【摘要】 目的 观察曲马多超前镇痛对经腹子宫切除术患者术后疼痛和恶心呕吐的影响。 方法 2008年11月-2009年5月，40例全身麻醉下行经腹子宫切除术的患者，分为超前镇痛组和对照组（n=20）。超前镇痛组和对照组于麻醉诱导前30 min分别静脉注射曲马多（3 mg/kg）和生理盐水。术后12、24 h，观察Bolus次数和芬太尼的用量，患者疼痛评分及术后恶心呕吐的发生率。 结果 术后12、24 h，曲马多超前镇痛组Bolus次数和芬太尼的用量均小于对照组（Plt;0.05），术后恶心呕吐的发生率差异无统计学意义（Pgt;0.05）。 结论 经腹子宫切除术手术前给予曲马多超前镇痛能够减少术后镇痛药的需要量，且不增加术后恶心呕吐的发生率。【Abstract】 Objective To observe the effects of tramadonl preemptive analgesia on postoperative pain and postoperative nausea and vomiting (PONV) in patients with hysterectomy. Methods Form November 2008 to May 2009, fourty patients who had undergone hysterectomy were divided into preemptive analgesia (PA) group and control group, 20 patients in each. The PA and control group were intravenously injected with tramadol (3 mg/kg) and normal saline respectively. Twelve and 24 hours after hysterectomy, the Bolus times, consumption of fentanil, pain score and incidence of PONV were observed. Results Twelve and 24 hours after hysterectomy, the Bolus times and consumption of fentanil were both lower than those in control group(Plt;0.05), the difference of PONV incidences between two groups was not statistically significant (Pgt;0.05). Conclusion Intravenously injected with tramadol before hysterectomy can recduce the dosage of analgesic, and don′t increase the incidence of PONV.
ObjectiveTo evaluate the preemptive analgesic efficiency of parecoxib on patients undergoing inguinal hernia repair. MethodsOne hundred and twenty patients scheduled for surgery between May and August 2013 were randomized into group A (n=60) and group B (n=60). Patients in group A received intravenous parecoxib sodium (40 mg) for 45 minutes before surgery while group B received equivalent normal saline. All patients underwent tension-free hernia repair under local anesthesia with simplex lidocaine. Visual analogy scores (VAS) after surgery and the maximum VAS were recorded. The number of patients requiring rescue analgesic (tramadol injection) or with adverse effects related to analgesia were observed and recorded. Postoperative hospital stay and patient satisfaction score with analgesic effect were compared between the two groups. Concentrations of plasma prostaglandin E2(PGE2) before surgery and 24 hours after surgery were measured in both groups. ResultsVAS scores were significantly lower in group A at 2, 4, 8 and 12 hours after surgery than group B, while no significant difference was seen after 24 hours of the surgery. The number of patients requiring tramadol (3/60) or with adverse effects (2/60) in group A were significantly lower than that in group B (11/60 and 8/60 respectively). Postoperative hospital stay was shorter while patient satisfaction score with analgesic effect was higher in group A than in group B. There were no significant differences in concentration of plasma PGE2 between the two groups before surgery and after 24 hours of the surgery (P>0.05). ConclusionPreemptive administration of parecoxib for hernia repair can result in significant analgesic effect with fewer adverse effects, higher patient satisfaction and faster recovery.
ObjectiveTo investigate whether parecoxib sodium preemptive analgesia reduces inflammatory cytokines and stress hormones production in elderly patients after total hip replacement. MethodSixty patients with American Society of Anesthesiologists Classification Ⅰ-Ⅱ undergoing total hip replacement for femoral neck fracture or aseptic necrosis of the femoral head, aged between 60 and 90 years with a body weight more than 50 kg, were randomly divided into preemptive analgesia group (group P, n=30) and control group (group C, n=30). The patients in group P received parecoxib sodium 40 mg intravenously 30 min before skin incision, and another 20 mg 8 hours after the first administration. All the patients in the two groups received the administration of patient-controlled analgesia sufentanyl. We recorded blood levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), cortisol (COR), adrenaline (AD) and noradrenaline (NAD) 30 min before skin incision, and 1 hour, 6 hours, 12 hours and 24 hours postoperatively. ResultsThe blood levels of IL-6, TNF-α, COR, AD and NAD in group P at 1 hour, 6 hours, 12 hours or 24 hours postoperatively were significantly lower than those in group C (P<0.05). ConclusionsParecoxib sodium preemptive analgesia reduces postoperative inflammatory cytokines and stress hormones production in elderly patients undergoing total hip replacement.
ObjectiveTo investigate the effectiveness of preemptive analgesia with imrecoxib on analgesia after anterior cruciate ligament (ACL) reconstruction. MethodsA total of 160 patients with ACL injuries who met the selection criteria and were admitted between November 2020 and August 2021 were selected and divided into 4 groups according to the random number table method (n=40). Group A began to take imrecoxib 3 days before operation (100 mg/time, 2 times/day); group B began to take imrecoxib 1 day before operation (100 mg/time, 2 times/day); group C took 200 mg of imrecoxib 2 hours before operation (5 mL of water); and group D did not take any analgesic drugs before operation. There was no significant difference in gender, age, body mass index, constituent ratio of meniscal injuries with preoperative MRI grade 3, constituent ratio of cartilage injury Outerbridge grade 3, and visual analogue scale (VAS) score at the time of injury and at rest among 4 groups (P>0.05). The operation time, hospitalization stay, constituent ratio of perioperative American Society of Anesthesiologists (ASA) grade 1, postoperative opioid dosage, and complications were recorded. The VAS scores were used to evaluate the degree of knee joint pain, including resting VAS scores before operation and at 6, 24, 48 hours, and 1, 3, 6, and 12 months after operation, and walking, knee flexion, and night VAS scores at 1, 3, 6, and 12 months after operation. The knee injury and osteoarthritis score (KOOS) was used to evaluate postoperative quality of life and knee-related symptoms of patients, mainly including pain, symptoms, daily activities, sports and entertainment functions, knee-related quality of life (QOL); and the Lysholm score was used to evaluate knee joint function. ResultsAll patients were followed up 1 year. There was no significant difference in operation time, hospitalization time, or constituent ratio of perioperative ASA grade 1 among 4 groups (P>0.05); the dosage of opioids in groups A-C was significantly less than that in group D (P<0.05). Except for 1 case of postoperative fever in group B, no complications such as joint infection, deep vein thrombosis of the lower extremities, or knee joint instability occurred in each group. The resting VAS scores of groups A-C at 6 and 24 hours after operation were lower than those of group D, and the score of group A at 6 hours after operation was lower than those of group C, and the differences were significant (P<0.05). At 1 month after operation, the knee flexion VAS scores of groups A-C were lower than those of group D, the walking VAS scores of groups A and B were lower than those of groups C and D, the differences were significant (P<0.05). At 1 month after operation, the KOOS pain scores in groups A-C were higher than those in group D, there was significant difference between groups A, B and group D (P<0.05); the KOOS QOL scores in groups A-C were higher than that in group D, all showing significant differences (P<0.05), but there was no significant difference between groups A-C (P>0.05). There was no significant difference in VAS scores and KOOS scores between the groups at other time points (P>0.05). And there was no significant difference in Lysholm scores between the groups at 1, 3, 6, and 12 months after operation (P>0.05). ConclusionCompared with the traditional analgesic scheme, applying the concept of preemptive analgesia with imrecoxib to manage the perioperative pain of ACL reconstruction can effectively reduce the early postoperative pain, reduce the dosage of opioids, and promote the early recovery of limb function.