关键词: 帕瑞昔布, 芬太尼, 小儿, 术后镇痛, 病人自控

Abstract: AIM: To investigate the analgesic effect and safty of patient controlled intravenous analgesia (PCIA) by using fentanyl in association with Parecoxib after pediatric orthopaedics operation. METHODS: 84 ASA Ⅰ children undergoing four limbs orthopaedic operation were randomly divided into 4 groups: A, B, C, D. General anesthesia was induced by fentanyl 3 μg/kg, cisatracurium 0.2 mg/kg and propofol 3 mg/kg, children in each group except group A were administered with different single dosage of Parecoxib intravenously after intubation (group B 0.5 mg/kg, group C 1.0 mg/kg, group D 1.5 mg/kg respectively). Continuous fentanyl was infused postoperatively for PCIA within 48 hours. (continuous infusion 0.1 μg·kg^-1·h^-1, bolus injection 0.05 μg/kg, lockout interval 7 mins). Any children with pain score >3 were administered with a bolus injection (“press”) by a nurse. The vital signs(HR, RR, BP), SpO₂, score of pain and sedation, degree of satisfaction, total dosage of fentanyl, frequency of press (D1), frequency of effective press (D2), adverse reactions were recorded postoperatively at 0.5 h, 1 h, 2 h, 4 h, 8 h, 24 h and 48 h respectively. RESULTS: (1) The pain score of group A was higher at 0.5 h, 1 h, 2 h, 4 h, 8 h compared with group C, as well as higher at 0.5 h, 1 h, 2 h, 4 h compared with group D. The pain score of group B was higher at 0.5 h, 1 h, 2 h compared with group C, as well as higher at 1 h, 2 h, 4 h compared with group D. (P<0.05)(2)The sedation score of group A was lower at 1 h compared with group C and D, and the sedation score of group B was lower at 0.5h and 1h compared with group C and D(P<0.05). (3) The total dosage of fentanyl and the total times of press of group A and B was higher compared with group C and D(P<0.01). (4)The incidence of postoperative adverse reactions in group A was higher compared with C and D, and the incidence of nausea and vomiting in group C was higher compared with group B(P<0.05). CONCLUSION: The intravenous single-dose of Parecoxib followed by fentanyl PCIA after padiatric orthopaedics operation is safe and can provide better analgesia. It can also reduce total dosage of fentanyl and the incidence of postoperative adverse reactions.

Key words: Fentanyl, Parecoxib, Children, Postoperative analgesia, Patient controlled