title: [Combined efficacy of parecoxib and incisional ropivacaine infiltration on pain management after diagnostic hysteroscopy and laparoscopy].
abstract: OBJECTIVE
  To evaluate the combined effect of premedication of parecoxib sodium and local infiltration of ropivocaine on postoperative shoulder pain and incisional pain in patients undergoing diagnostic hysteroscopy and laparoscopy.
  
  
  METHODS
  In the study, 60 patients undergoing elective diagnostic hysteroscopy and laparoscopy were randomly allocated to two groups (each with 30 patients). The patients in group 1 were premedicated with 40 mg parecoxib sodium (diluted with 2 mL normal saline), and 0.5% ropivacaine (20 mL) were infiltrated around the incision site before establishment of CO2 pneumoperitoneum. The patients in group 2 received 2 mL normal saline intraveniously before anesthesia induction, and infiltration of 0.5% ropivacaine 20 mL were also applied as group 1. After anesthetic withdrawal, the patients' postoperative anesthesia recovery time and the time point of opening eyes on verbal command were noted. The intensities of postoperative shoulder pain and incisional pain were evaluated at 0, 2, 4, 8, 12, 24, and 48 h after surgery. The postoperative analgesic requirement was met by administration of tramadol.
  
  
  RESULTS
  Compared with group 2, the incidence of postoperative shoulder pain was less in group 1 (37% vs. 67%, P=0.020), and the occurence of severe pain was lower (4 vs. 11, P=0.037). The numerical rating scales (NRS) of right shoulder pain of group 1 were significantly reduced than those of group 2 at 12 h postoperatively [0 (0, 2) vs. 0 (0, 8), P=0.012]. Left shoulder pain did not appear at 0 h and 2 h in both groups, while at 12 h and 24 h postoperatively, the NRS scores of group 1 were lower than those of group 2 [0 (0, 1) vs. 0 (0, 8), P=0.026; 0 (0, 4) vs. 2 (0, 9), P=0.014]. The dynamic and static abdominal pain scores of group 1 were significantly decreased than those of group 2 in post-anesthesia care unit (PACU) after surgery (P=0.001, P=0.005). The NRS scores of static abdominal pain of group 1 were significantly reduced than those of group 2 at 12 h and 24 h postoperatively (P=0.042, P=0.029). More patients in group 2 needed tramadol within 24 h postoperatively (8 vs. 0, P=0.002).
  
  
  CONCLUSIONS
  Premedication of parecoxib sodium combined with local infiltration of ropinvocaine before incision could significantly reduce the postoperative shoulder pain and incisional pain as well as reduce opioid consumption in patients undergoing diagnostic hysteroscopy and laparoscopy.
authors.affiliation: Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Hui-li
authors.initials: HL
authors.lastname: Liu
authors.affiliation: Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Cai-hong
authors.initials: CH
authors.lastname: Ma
authors.forename: Xiao-qing
authors.initials: XQ
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Yang
authors.forename: Xue-ling
authors.initials: XL
authors.lastname: Song
authors.forename: Xiang-yang
authors.initials: XY
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects; D007555:Isoxazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D010535:Laparoscopy / Q000009:adverse effects; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D000077212:Ropivacaine; D020069:Shoulder Pain / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D007555:Isoxazoles; D000077212:Ropivacaine; C409945:parecoxib