Protective efficacy of combined use of parecoxib and dexmedetomidine on postoperative hyperalgesia and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients

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.

The Influence of Different Dexmedetomidine Doses on Cognitive Function at Early Period of Patients Undergoing Laparoscopic Extensive Total Hysterectomy

“…Recent studies have shown that dexmedetomidine can reduce the stress response, the secretion and release of inflammatory factors, and the use of anesthetics during operation [ 10 ]. Related animal studies show that dexmedetomidine can reduce nerve damage after cerebral ischemia in animals, thereby effectively protecting the central nervous system [ 11 ].…”

Effect of Systemic Lidocaine on Postoperative Early Recovery Quality in Patients Undergoing Supratentorial Tumor Resection

“… 31 , 32 It was obvious that higher pain scores in our study significantly lowered postoperative recovery quality, especially POH 12 and POH 24; and this was consistent with the study by Licina et al 33 Pain not only causes short-term or long-term fluctuations in hemodynamics, but also delays brain function returning to normal levels, leading to postoperative cognitive dysfunction or abnormal mental activity; afterwards it slows down the postoperative recovery process. 34 , 35 The former was revealed by lower fluctuations of intraoperative hemodynamic parameters (such as MAP and HR) and lower utilization of vasoactive drugs in our study; and the incidence and extent of agitation reduced significantly during extubation, suggesting that lidocaine played a positive role in postoperative brain function recovery. Furthermore, there was no significant difference in peripheral fluid infusion between groups in this study.…”

Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients: A Systematic Review and Meta-analysis

“…The screening included 833 elderly patients during perioperative period for meta-analysis, including 546 dexmedetomidine patients and 287 control patients (blank or saline). The basic characteristics of the 12 studies included in the meta-analysis are presented in Table 1 [19][20][21][22][23][24][25][26][27][28][29][30] .…”

“…Ten RCT articles provided HR of elderly patients before and after operation with dexmedetomidine treatment. The merged results of 10 RCT articles showed that the increase of HR was not statistically significant (SMD = 0.13, 95%CI: -0.44 to 0.70; Figure 3A and Table 2) [19][20][21][22]24,25,26,27,28,30] . Sensitivity analysis revealed that the source of heterogeneity might be related to QIAO et al2020 [19] , ZHANG et al 2017 [25] , and Du et al 2019 [30] .…”