Effect of perioperative parecoxib sodium combined with dexmedetomidine on the gastrointestinal function of elderly patients after laparoscopic gastric cancer surgery

Abstract

Objective To investigate the effect of perioperative parecoxib sodium combined with dexmedetomidine (Dex) on the gastrointestinal function of elderly patients after laparoscopic gastric cancer surgery. Methods Ninety gastric cancer patients scheduled for laparoscopic surgery, aged 65-85, American Society of Anesthesiologists (ASA) class Ⅰ or Ⅱ were enrolled. They were divided into three groups by the random number table method (30 patients in each group): a parecoxib sodium group (group P), a Dex group (group D), and a combination group (group PD). Then, 15 min before anesthesia induction, patients in groups P and PD were intravenously infused with parecoxib sodium 40 mg diluted with normal saline into 5 ml. Patients in groups D and PD were injected with Dex at a loading dose of 1 μg/kg for 10 min, which was maintained by 0.3 μg·kg-1·min-1 pump infusion, and the infusion was stopped 30 min before the end of operation. All patients were treated with sufentanil plus flurbiprofen injection for intravenous controlled analgesia. Blood samples were collected from the radial artery 15 min before anesthesia (T0), 1 h after the beginning of surgery (T1) and at the end of surgery (T2) respectively. Inflammatory factors [interleukin (IL)-2, IL-6, and tumor necrosis factor-α (TNF-α)] were detected by enzyme-linked immunosorbent assay (ELISA). The time of the first postoperative ventilation, time to take fluid diet, time of getting out of bed, postoperative length of hospitalization stay, hospitalization expenses, Visual Analogue Scale (VAS) scores at rest and during movement (2, 12 h and 24 h after surgery) and postoperative complications were recorded. Results Compared with those at T0, patients in the three groups produced remarkably increased levels of IL-6 and TNF-α as well as significantly decreased levels of IL-2 at T1 and T2 (P<0.05). At T1 and T2, group PD produced remarkably lower levels of IL-6 and TNF-α and higher levels of IL-2 than groups P and D (P<0.05). In the PD group, the time of the first postoperative ventilation, time to take fluid diet, time of getting out of bed, postoperative length of hospitalization stay and hospitalization expenses were all lower than those in groups P and D (P<0.05). The incidence of postoperative complications in the PD group was lower than those in groups P and D (P<0.05). Conclusions Parecoxib sodium combined with Dex can effectively relieve inflammatory stress response after laparoscopic gastric cancer surgery in elderly patients, facilitate rapid recovery of the gastrointestinal tract, and reduce postoperative length of hospitalization stay, hospitalization expenses and postoperative complications. Key words: Parecoxib sodium; Dexmedetomidine; Aged; Therapeutic laparoscopy; Gastrointestinal surgery