帕瑞昔布在日间手术患者术后瑞芬太尼诱导痛觉过敏中的作用

doi:10.5246/jcps.2013.04.053

帕瑞昔布在日间手术患者术后瑞芬太尼诱导痛觉过敏中的作用

穆东亮, 王东信^*, 曲元, 李春晶

北京大学第一医院麻醉科, 北京 100034

收稿日期:2012-10-18 修回日期:2012-12-04 出版日期:2013-07-10 发布日期:2013-07-10
通讯作者: 王东信*

Effect of parecoxib on remifentanil-induced hyperalgesia after ambulatory surgery

Dongliang Mu, Dongxin Wang^*, Yuan Qu, Chunjing Li

Department of Anesthesiology and Surgical Intensive Care, Peking University First Hospital, Beijing 100034, China

Received:2012-10-18 Revised:2012-12-04 Online:2013-07-10 Published:2013-07-10
Contact: Dongxin Wang*

摘要/Abstract

摘要：

最新的研究发现, 帕瑞昔布可以有效缓解健康受试者短期输注瑞芬太尼后诱导的痛觉过敏。本研究旨在探索临床实践中帕瑞昔布对短期输注瑞芬太尼诱导痛觉过敏的作用。120例接受日间手术的患者随机分为4组, 所有患者在麻醉诱导前30分钟接受帕瑞昔布40 mg或安慰剂(生理盐水)治疗。A组(安慰剂+异丙酚)和B组(帕瑞昔布+异丙酚)患者仅使用异丙酚进行麻醉诱导和维持; C组(安慰剂+异丙酚+瑞芬太尼)和D组(帕瑞昔布+异丙酚+瑞芬太尼)患者接受异丙酚和瑞芬太尼进行麻醉诱导和维持。研究人员使用视觉模拟评分法(visual analogue score), 在固定时间点(患者清醒即刻、术后30、60、90、120、180、240和300分钟)对患者进行疼痛评估(0 mm 代表无痛, 100 mm代表疼痛程度最强)。结果显示患者清醒即刻至术后240分钟期间, 各组患者之间的疼痛评分有显著统计学差异: B组<A组<D组<C组(P<0.001)。与A组和B组比较, 接受瑞芬太尼麻醉的C组患者疼痛分值最高; 而接受帕瑞昔布治疗的B组和D组患者的疼痛评分明显降低 (P<0.001)。B组和D组患者恢复到对指令有反应和回忆起生日的时间明显短于A、C两组, 且患者麻醉和围术期疼痛的满意程度明显改善(P<0.001)。研究提示, 在临床实践中短期输注瑞芬太尼可以诱导显著的痛觉过敏, 但是给予帕瑞昔布40 mg可以有效缓解痛觉过敏, 并缩短患者恢复时间和改善患者满意度。

关键词: 帕瑞昔布, 短期输注, 瑞芬太尼, 痛觉过敏

Abstract:

In previous human studies, pretreatment with parecoxib can effectively relieve hyperalgesia after short-term infusion of remifentanil. In this study, we aim to investigate the effect of parecoxib on hyperalgesia after short-term infusion of remifentanil in clinical practice. Totally, 120 patients who underwent ambulatory surgery were randomly divided into four groups. All patients received either parecoxib (40 mg) or normal saline (as placebo) 30 min before induction of anesthesia. Group A (placebo + propofol) and Group B (parecoxib + propofol) received only propofol for anesthesia, while Group C (placebo + propofol + remifentanil) and Group D (parecoxib + propofol + remifentanil) received both propofol and remifentanil for anesthesia. Visual analogue score (VAS) was used to evaluate pain score at various time points, including the time of birth date recollection and 30, 60, 90, 120, 180, 240, and 300 min after surgery, respectively. During the phase from discontinuation of anesthesia to 240 min after surgery, there is significant difference in the severity of pain among four groups with the order of: Group B <Group A <Group D <Group C (P<0.001). Compared with patients in Groups A and B, patients in Group C suffered significantly higher pain score. After administration of parecoxib, patients in Groups B and D experienced similar low pain score with comparison to Groups A and C (P<0.001). Patients in Groups B and D experienced shorter recovery time to eye opening on verbal command and recollection of birth date among the four groups (P<0.001). Groups B and D also had significantly improved satisfaction of pain management (P<0.001). In conclusion, short-term infusion of remifentanil can induce significant hyperalgesia in clinical practice, while pretreatment with parecoxib at 40 mg is effective in relieving such remifentani-induced hyperalgesia. In addition, we also found that pretreatment with parecoxib could significantly improve patients' satisfaction of pain management.

Key words: Parecoxib, Short-term infusion, Remifentanil, Hyperalgesia

中图分类号:

R969.3

Supporting:

^*Corresponding author. Tel.: +86-10-83575138

穆东亮, 王东信^*, 曲元, 李春晶. 帕瑞昔布在日间手术患者术后瑞芬太尼诱导痛觉过敏中的作用[J]. , DOI: 10.5246/jcps.2013.04.053.

Dongliang Mu, Dongxin Wang^*, Yuan Qu, Chunjing Li . Effect of parecoxib on remifentanil-induced hyperalgesia after ambulatory surgery[J]. , DOI: 10.5246/jcps.2013.04.053.

参考文献

[1] Eikaas, H.; Raeder, J. Curr. Opin. Anaesthesiol. 2009, 22, 725-729.
[2] Angst, M.S.; Koppert, W.; Pahl, I.; Clark, D.J.; Schmelz, M. Pain. 2003, 106, 49-57.
[3] Guignard, B.; Bossard, A.E.; Coste, C.; Sessler, D.I.; Lebrault, C.; Alfonsi, P.; Fletcher, D.; Chauvin, M. Anesthesiology. 2000, 93, 409-417.
[4] Zhao, M.; Joo, D.T. Anesthesiology. 2008, 109, 308-317.
[5] Quintero, L.; Cardenas, R.; Suarez-Roca, H. Pain. 2011, 152, 1909-1922.
[6] Hewett, S.J.; Uliasz, T.F.; Vidwans, A.S.; Hewett, J.A. J. Pharmacol. Exp. Ther. 2000, 293, 417-425.
[7] Jain, N.K.; Ishikawa, T.O.; Spigelman, I.; Herschman, H.R. Prostaglandins Leukotrienes Essent. Fatty Acids. 2008, 79, 183-190.
[8] Lenz, H.; Raeder, J.; Draegni, T.; Heyerdahl, F.; Schmelz, M.; Stubhaug, A. Pain. 2011, 152, 1289-1297.
[9] Martin, F.; Fletcher, D.; Chauvin, M.; Bouhassira, D. Anesthesiology. 2007, 106, 1013-1018.
[10] Tröster, A.; Sittl, R.; Singler, B.; Schmelz, M.; Schüttler, J.; Koppert, W. Anesthesiology. 2006, 105, 1016-1023.
[11] Chung, F.J. Clin. Anesthesiol. 1993, 5, 64-68.
[12] American Society of Anesthesiologists Task Force on Postanesthetic Care. Practice guidelines for postanesthetic care: a report by the American Society of Anesthesiologists Task Force onPostanesthetic Care. Anesthesiology. 2002, 96, 742-752.
[13] Coll, A.M.; Ameen, J.R.; Mead, D. J. Adv. Nurs. 2004, 46, 124-133.
[14] Malan, T.P. Jr.; Gordon, S.; Hubbard, R.; Snabes, M. Anesth. Analg. 2005, 100, 454-460.
[15] Jordan, B.; Devi, L.A. Br. J. Anaesth. 1998, 81, 12-19.
[16] Koenig, J.A.; Edwardson, J.M. Trends Pharmacol. Sci. 1997, 18, 276-287.
[17] Hahnenkamp, K.; Nollet, J.; Van Aken, H.K.; Buerkle, H.; Halene, T.; Schauerte, S.; Hahnenkamp, A.; Hollmann, M.W.; Strumper, D.; Durieux, M.E.; Hoenemann, C.W. Anesthesiology. 2004, 100, 1531-1537.
[18] Guntz, E.; Dumont, H.; Roussel, C.; Gall, D.; Dufrasne, F.; Cuvelier, L.; Blum, D.; Schiffmann, S.N.; Sosnowski, M. Anesthesiology. 2005, 102, 1235-1241.
[19] Ahmadi, S.; Muth-Selbach, U.; Lauterbach, A.; Lipfert, P.; Neuhuber, W.L.; Zeilhofer, H.U. Science. 2003, 300, 2094-2097.
[20] Koppert, W.; Sittl, R.; Scheuber, K.; Alsheimer, M.; Schmelz, M.; Schüttler, J. Anesthesiology. 2003, 99, 152-159.
[21] Jun, N.H.; Shim, J.K.; Choi, Y.S.; An, S.H.; Kwak, Y.L. Korean. J. Anesthesiol. 2011, 61, 308-314.
[22] Buvanendran, A.; Kroin, J.S.; Berger, R.A.; Hallab, N.J.; Saha, C.; Negrescu, C.; Moric, M.; Caicedo, M.S.; Tuman, K.J. Anesthesiology. 2006, 104, 403-410.
[23] Weng, H.R.; Chen, J.H.; Cata, J.P. Neuroscience. 2006, 138, 1351-1360.
[24] Padi, S.S.; Jain, N.K.; Singh, S.; Kulkarni, S.K. Eur. J. Pharmacol. 2004, 491, 69-76.
[25] Luscombe, K.S.; McDonnell, N.J.; Muchatuta, N.A.; Paech, M.J.; Nathan, E.A. Anaesth. Intensive. Care. 2010, 38, 141-148.
[26] Martinez, V.; Belbachir, A.; Jaber, A.; Cherif, K.; Jamal, A.; Ozier, Y.; Sessler, D.I.; Chauvin, M.; Fletcher, D. Anesth. Analg. 2007, 104, 1521-1527.
[27] Kapila, A.; Glass, P.S.; Jacobs, J.R.; Muir, K.T.; Hermann, D.J.; Shiraishi, M.; Howell, S.; Smith, R.L. Anesthesiology. 1995, 83, 968-975.
[28] Absalom, A.R.; Mani, V.; De Smet, T.; Struys, M.M. Br. J. Anaesth. 2009, 103, 26-37.