Analgesic Effects Of
Parecoxib In Neurosurgery In Patients Undergoing
Lumbosacral Herniotomy: Pilot
Study.
Anesthesiological
Science Department, surgical and of the Emergecies
Second
University of Naples, Naples Italy
Surgery and the postoperative
period are two moments where pain assumes an important role, and the treatment
of postoperative pain is crucial to establish the psychophysical integrity of
the patient. The present study was undertaken to evaluate and compare the
analgesic efficacy of single
intravenous (IV) doses of parecoxib in patients undergoing neurosurgery for
lumbosacral hernia.
In the month of march and april
2004, after informed consent, we enrolled at the DAS of neurosurgery, Second
University of Naples Italy 20 patients (12 M and 8 F) between the ages of 30 and
45 years, ASA I and II, that were randomized into two groups: the parecoxib
group P and the Ketorolac group K. Both groups have been premedicated with
midazolam 5 mg i.m. 30 minutes
before surgery, induction with propofol (1,5
- 2 mg/kg e.v.), cisatracurium
(0,20 mg/kg e.v.); maintenance of
anesthesia was obtained with propofol in TCI (4 - 12 mg/kg/h), remifentanil
(0,05 - 1 mcg/kg/min) and cisatracurium when needed using TOF. Single doses of
Parecoxib 40 mg IV was administrated to the P group, and ketorolac 30 mg IV in
the K group, 15-20 minutes before the end of surgery. Blood pressure, heart
rate, SpO2, EtCO2 was monitored. Pain scores (VAS 0-10 scale) were collected to
evaluate post operative pain and vital signs monitored
in the immediate post-operative (T0), 30’ (T1),60’ (T2), 90’
(T3),120’ (T4), 4 – 24 hr (T5 – T11). In both groups no rescue medicine
was given before T4; and only when VAS > 5
a single dose of rescue drug was given.
In the P group blood pressure and heart rate had a constant course without any meaningful statistical variation within the 24hours. VAS score never exceeded the value of 4, and had a progressive decrease from T0 to T24. On the other side in the K group, VAS score was higher than the P group at T5, T6, T7 and T8; and rescue medicine was necessary in two patients in single dose between T7 and T8; no patients in the P group needed supplement analgesia; blood pressure and heart rate was higher only in T0 and T1 in the P group. Our experience has shown encouraging results, improved postoperative pain management, lower pain score with parecoxib, in patients that underwent lumbar sacral hernectiomy. This pilot study statistical analysis data are expressed as mean. The X2 test was used, statistical significance was set a P< 0.05. Patients in the two groups did not have any adverse reaction to the treatment, and all patients maintained hemodynamic and respiratory stability.
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