Abstract
Purpose:To investigate efficacy of combined use of parecoxib and dexmedetomidine on postoperative pain and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients.Methods:The present prospective randomized controlled study included a total of 80 patients who underwent laparoscopic cholecystectomy surgery during January 2016 to November 2017 in our hospital. All patients were randomly divided into 4 groups, the parecoxib group, the dexmedetomidine group, the parecoxib and dexmedetomidine combined group, and the control group. Demographic data and clinical data were collected. Indexes of heart rate (HR), mean arterial pressure (MAP), levels of jugular venous oxygen saturation (SjvO2) and jugular venous oxygen pressure (PjvO2) were recorded at different time points before and during the surgery. The mini-mental state examination (MMSE) score, Ramsay score and Visual Analogue Score (VAS) were measured.Results:Levels of both SjvO2 and PjvO2 were significantly higher in parecoxib group, dexmedetomidine group and the combined group than the control group. Meanwhile, levels of both SjvO2 and PjvO2 in the combined group were the highest. VAS scores were significantly lower in the combined group than all other groups, and total patient controlled intravenous analgesia (PCIA) pressing times within 48 h after surgery were the lowest in the combined group. Both Ramsay and MMSE scores were the highest in the combined group compared with other groups, while were the lowest in the control group.Conclusion:The combined use of parecoxib and dexmedetomidine could reduce the postoperative pain and improve the postoperative sedation and cognitive conditions of patients after laparoscopic cholecystectomy.
Highlights
Laparoscopic cholecystectomy is widely accepted as the standard operation for benign gallbladder disease[1], including gallstones[2], acute or chronic cholecystitis[3,4] and biliary pancreatitis[5]
We aimed to investigate whether the combined use of parecoxib and dexmedetomidine could improve postoperative pain and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients
24 (30%) patients were diagnosed as symptomatic gallstones, 36 (45%) patients were diagnosed as acute or chronic cholecystitis and 20 (25%) patients were diagnosed as biliary pancreatitis
Summary
Laparoscopic cholecystectomy is widely accepted as the standard operation for benign gallbladder disease[1], including gallstones[2], acute or chronic cholecystitis[3,4] and biliary pancreatitis[5]. Despite the well-known advantages of laparoscopic cholecystectomy compared to open cholecystectomy, such as being a safer, more effective procedure, with less complications[6], the postoperative pain and cognitive dysfunction (POCD) are still two major problems influencing patients’ recovery[7,8]. Studies show that Parecoxib could be used in postoperative pain control in many surgeries such as laparoscopic surgeries[11], total hip arthroplasty[12], and cancer related operations[13]. Previous studies showed that dexmedetomidine can be used in surgery of laparoscopic cholecystectomy and could reduce postoperative pain[14]. To our best knowledge, few studies focused on efficacy of the combined use of parecoxib and dexmedetomidine on postoperative pain and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients
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