Application of parecoxib preanalgesia in liver radiofrequency ablation: A propensity score matching analysis

doi:10.3877/cma.j.issn.1674-0793.2021.06.009

Abstract

Abstract:

Objective

To investigate the preanalgesic effect of selective cyclooxygenase-2 inhibitor parecoxib after liver radiofrequency ablation (RFA).

Methods

The clinical data of 188 cases of liver cancer (including 122 primary cancers and 66 metastases) receiving radiofrequency ablation in Sun Yat-sen University Cancer Center from April 2015 to January 2016 were retrospectively analyzed, and they were divided into the parecoxib group and control group. Parecoxib group was given 40 mg parecoxib 30 min before surgery and every 12 hours after surgery for 2 consecutive days, while the control group was not given the medication, to evaluate whether perioperative application of parecoxib would benefit patients in terms of pain, vomiting, fever, inflammatory response, postoperative hospital stay and other aspects.

Results

We matched 44 pairs of patients in the two study groups by propensity-score matching analysis. And further data analysis showed a significant reduction in VAS scores on the day after surgery and the first day after surgery in the parecoxib group (P<0.001, 0.001, respectively). The serum levels of alanine aminotransferase and C-reactive protein were also lower than those in the control group [(177.0±88.0) mmol/L vs (327.7±387.1) mmol/L, P=0.043; (20.0±29.0) mg/L vs (49.7±44.1) mg/L, P<0.001], respectively.

Conclusion

Parecoxib can significantly reduce postoperative pain and inflammation in patients with RFA, thus accelerating postoperative recovery.

Key words: Analgesia, Pain, Visual analogue scale, Enhanced recovery after surgery, Parecoxib

Jiancong Chen, Jiaming Lai, Jiongliang Wang, Zhongguo Zhou. Application of parecoxib preanalgesia in liver radiofrequency ablation: A propensity score matching analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(06): 442-446.

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References 21

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项目	对照组（61例）	帕瑞昔布组（66例）	统计值	P值
性别（男：女）	53:8	58:8	χ²=0.028	0.866^a
年龄（岁）	55.6±12.3	55.1±14.1	t=-0.199	0.843^b
白细胞（×10⁹/L）	8.2±19.5	5.1±1.6	U=1 569.500	0.032^c
血红蛋白（×10⁹/L）	132.3±31.6	138.8±17.3	U=2 214.500	0.331^c
血小板（×10⁹/L）	155.8±73.0	137.3±54.9	t=-1.618	0.108^b
丙氨酸氨基转移酶（mmol/L）	45.8±43.4	41.8±40.0	U=1 784.500	0.270^c
天冬氨酸氨基转移酶（mmol/L）	39.7±34.2	38.1±33.2	U=1 924.000	0.668^c
白蛋白（g/L）	41.9±5.0	42.5±3.5	t=0.873	0.385^b
总胆红素（mmol/L）	13.2±6.6	15.4±6.4	U=2 534.500	0.012^c
甲胎蛋白（ng/ml）	318.7±783.5	192.3±489.8	U=1 977.500	0.892^c
凝血酶原时间（s）	11.7±2.3	11.5±1.8	U=1 980.500	0.868^c
活化部分凝血活酶时间（s）	29.3±6.3	30.0±5.3	U=2 032.000	0.674^c
乙肝病毒DNA定量（lg U/ml）	3.7±1.8	3.1±1.5	t=-1.358	0.181^b

项目	对照组（61例）	帕瑞昔布组（66例）	统计值	P值
性别（男：女）	53:8	58:8	χ²=0.028	0.866^a
年龄（岁）	55.6±12.3	55.1±14.1	t=-0.199	0.843^b
白细胞（×10⁹/L）	8.2±19.5	5.1±1.6	U=1 569.500	0.032^c
血红蛋白（×10⁹/L）	132.3±31.6	138.8±17.3	U=2 214.500	0.331^c
血小板（×10⁹/L）	155.8±73.0	137.3±54.9	t=-1.618	0.108^b
丙氨酸氨基转移酶（mmol/L）	45.8±43.4	41.8±40.0	U=1 784.500	0.270^c
天冬氨酸氨基转移酶（mmol/L）	39.7±34.2	38.1±33.2	U=1 924.000	0.668^c
白蛋白（g/L）	41.9±5.0	42.5±3.5	t=0.873	0.385^b
总胆红素（mmol/L）	13.2±6.6	15.4±6.4	U=2 534.500	0.012^c
甲胎蛋白（ng/ml）	318.7±783.5	192.3±489.8	U=1 977.500	0.892^c
凝血酶原时间（s）	11.7±2.3	11.5±1.8	U=1 980.500	0.868^c
活化部分凝血活酶时间（s）	29.3±6.3	30.0±5.3	U=2 032.000	0.674^c
乙肝病毒DNA定量（lg U/ml）	3.7±1.8	3.1±1.5	t=-1.358	0.181^b

项目		对照组（44例）	帕瑞昔布组（44例）	统计值	P值
VAS疼痛评分
	手术当天	3.18±2.39	1.41±1.93	529.000	<0.001^a
	术后第1天	1.61±1.73	0.64±1.30	616.000	0.001^a
	术后第2天	0.49±0.88	0.26±0.85	682.500	0.061^a
	术后第3天	0.07±0.37	0.13±0.45	377.500	0.443^a
术后发热（℃）
	手术当天	36.9±0.3	36.8±0.3	842.500	0.290^a
	术后第1天	37.2±0.5	37.1±0.4	865.000	0.386^a
	术后第2天	37.1±0.6	37.1±0.5	853.500	0.742^a
	术后第3天	36.9±0.3	36.9±0.4	296.500	0.992^a
呕吐[例（%）]
	手术当天	11(25.0)	5(11.4)	5.833	0.212^b
	术后第1天	5(11.4)	1(2.3)	4.195	0.241^b
	术后第2天	1(2.3)	0(0)	0.918	0.338^b
	术后第3天	0(0)	0(0)	-	1.000
丙氨酸氨基转移酶（mmol/L）		327.7±387.1	177.0±88.0	691.500	0.043^a
天门冬氨酸氨基转移酶（mmol/L）		235.4±266.7	170.9±73.1	903.500	0.996^a
白蛋白（g/L）		39.1±6.2	38.5±3.9	-0.602	0.549^c
总胆红素（mmol/L）		27.1±28.9	27.9±11.6	1 118.000	0.059^a
C反应蛋白(mg/L)		49.7±44.1	20.0±29.0	388.500	<0.001^a
术后住院时间(d)		2.6±0.6	2.4±0.7	-1.332	0.186^c

项目		对照组（44例）	帕瑞昔布组（44例）	统计值	P值
VAS疼痛评分
	手术当天	3.18±2.39	1.41±1.93	529.000	<0.001^a
	术后第1天	1.61±1.73	0.64±1.30	616.000	0.001^a
	术后第2天	0.49±0.88	0.26±0.85	682.500	0.061^a
	术后第3天	0.07±0.37	0.13±0.45	377.500	0.443^a
术后发热（℃）
	手术当天	36.9±0.3	36.8±0.3	842.500	0.290^a
	术后第1天	37.2±0.5	37.1±0.4	865.000	0.386^a
	术后第2天	37.1±0.6	37.1±0.5	853.500	0.742^a
	术后第3天	36.9±0.3	36.9±0.4	296.500	0.992^a
呕吐[例（%）]
	手术当天	11(25.0)	5(11.4)	5.833	0.212^b
	术后第1天	5(11.4)	1(2.3)	4.195	0.241^b
	术后第2天	1(2.3)	0(0)	0.918	0.338^b
	术后第3天	0(0)	0(0)	-	1.000
丙氨酸氨基转移酶（mmol/L）		327.7±387.1	177.0±88.0	691.500	0.043^a
天门冬氨酸氨基转移酶（mmol/L）		235.4±266.7	170.9±73.1	903.500	0.996^a
白蛋白（g/L）		39.1±6.2	38.5±3.9	-0.602	0.549^c
总胆红素（mmol/L）		27.1±28.9	27.9±11.6	1 118.000	0.059^a
C反应蛋白(mg/L)		49.7±44.1	20.0±29.0	388.500	<0.001^a
术后住院时间(d)		2.6±0.6	2.4±0.7	-1.332	0.186^c

项目	匹配前				匹配后
项目	对照组	帕瑞昔布组	统计值	P值	对照组	帕瑞昔布组	统计值	P值
例数	61	66			44	44
年龄（岁）	55.6±12.3	55.1±14.1	-0.199	0.843^a	55.1±11.4	55.5±12.8	0.141	0.888^a
性别（男：女，例）	53:8	58:8	0.028	0.866^b	37:7	37:7	0.001	1.000^b
直径（mm）	23.9±9.4	21.9±10.9	-1.036	0.303^a	24.2±8.2	23.7±10.8	-0.253	0.801^a
肿瘤数目（个）	1.3±0.7	1.6±1.3	1 942.500	0.529^c	1.3±0.5	1.3±0.7	911.000	0.489^c
消融时间（min）	15.2±4.7	12.8±7.0	-1.144	0.262^a	14.1±6.1	12.6±8.1	-1.000	0.320^a

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