围术期镇痛面面观摘要.ppt

* COX-2 selective inhibition reduces pain and inflammation without the adverse events traditionally associated with COX-1 inhibition.1,2 No effect on platelet aggregation and bleeding time2 COX-2 safety profile1,2 Reduced opioid consumption and enhanced analgesia with multimodal therapy3 Non-narcotic—not generally associated with traditional opioid side effects3 Used in conjunction with morphine as part of a multimodal pain management strategy, DYNASTAT? (parecoxib sodium for injection) has been shown to enhance the analgesic effect (vs opioids alone)4,5 Significantly lower upper GI ulceration/erosion rates than ketorolac6 COX-2 selective inhibitors carry certain risks, including CV risks (particularly in CABG surgery); rare incidence of serious skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme; and a risk of GI bleeding.7 While the renal effects of DYNASTAT appear to be similar to those of nonselective NSAIDs, caution should be observed when administering DYNASTAT to patients with renal impairment. Like all NSAIDs, COX-2 selective inhibitors may mask fever. After surgery, the site of incision should be carefully observed to detect signs of infection. References: 1. Needleman P, Isakson PC. The discovery and function of COX-2. J Rheumatol. 1997;24(suppl 49):6-8. 2. Noveck RJ, Laurent A, Kuss M, Talwalker S, Hubbard RC. Parecoxib sodium does not impair platelet function in healthy elderly and non-elderly individuals: two randomised, controlled trials. Clin Drug Invest. 2001;21:465-476. 3. Power I, Barratt S. Analgesic agents for the postoperative period. Nonopioids. Surg Clin North Am. 1999;79:275-295. 4. Hubbard RC, Naumann TM, Traylor L, Dhadda S. Parecoxib sodium has opioid-sparing effects in patients undergoing total knee arthroplasty under spinal anaesthesia. Br J Anaesth. 2003;90:166-172. 5. Malan TP Jr, Marsh G, Hakki SI, Grossman E, Traylor L, Hubbard RC. Parecoxib sodium, a parenteral cyclooxygenase 2