帕瑞昔布钠联合盐酸羟考酮缓释片在全膝关节置换术后镇痛中的应用

目的 评估帕瑞昔布钠联合盐酸羟考酮控释片对全膝关节置换（TKA）术后镇痛的临床效果.方法选择单侧TKA术患者60例,分为帕瑞昔布钠组（A组,30例） 及帕瑞昔布钠联合盐酸羟考酮控释片组（B组,30例）.两组术毕即采用静脉注射帕瑞昔布钠40 mg q12 h镇痛.术后24 h起,A组：当视觉模拟评分（VAS）〉5分时,静脉注射帕瑞昔布钠40 mg,随后每隔12 h再静注帕瑞昔布钠40 mg;B组：当VAS〉5分时,静脉注射帕瑞昔布钠40 mg,10 min后口服盐酸羟考酮控释片10 mg,随后每隔12h静注帕瑞昔布钠40 mg并口服盐酸羟考酮控释片10 mg.观察并记录：患者术后24、32、40、48及72 h静息及运动时VAS、Ramsay镇静评分（RSS）,术后48、72 h膝关节被动活动最大可忍受度,药物不良反应情况.结果与A组比较,B组术后32、40、48、72 h的静息及运动疼痛 VAS 评分降低（P〈0.05）,镇静评分增加（P〈0.05）,术后48 h和72 h患者可忍受最大屈曲角度增大（P〈0.05）.两组均未出现严重副反应.结论 帕瑞昔布钠与盐酸羟考酮控释片联合应用符合多模式镇痛趋势,可基本实现TKA患者术后无痛的目标,使患者顺利度过术后疼痛期.

Analgesic effect of parecoxib sodium and oxycodone for postoperative pain after total knee arthroplasty

Objective To investigate the analgesic effect of parecoxib sodium and oxycodone for postoperative pain after total knee arthroplasty. Methods Sixty patients undergoing elective TKA were randomly divided into 2 groups （n = 30 each） ： parecoxib group （group A）, parecoxib and oxycodone group （group B）. All the patients were received parecoxib sodium for analgesia at the first 24h after surgery. From then on, if the visual analogue score （VAS） 〉5 the supplements（parecoxib sodium, oxyeodone） would be infused in turn till the patient felt coznfortable or the analgesic effect reached the clinical maximum. The VAS and Ramsay sedation score（RSS） were recorded at 24, 32, 40,48 ,and 72 hours after surgery. Adverse effects related to analgesia and the maximum tolerable degree of passive exercise were investigated and compared between the two groups. Results Compared with group A, the resting and exercising VAS was decreased in group B at 24, 32, 40, 48, and 72 hours after surgery, while the sedation score increased （ P 〈 0.05 ）. And the maximum tolerable degree of passive exercise was higher in group B at the 48 and 72 hours after surgery （ P 〈 0. 05 ）. No serious adverse effects occurred between the two groups. Conclusions Intravenous injection of parecoxib sodium combined with oral oxycodone is consistent trend of muhimodal analgesia. It can realize the basic goal of postoperative analgesia in patients undergoing total knee arthroplasty.