Objective:To observe the effect of parecoxib sodium on the level of plasma prostaglandin E2 ( PGE2 ) and β-endorphine (β-EP),and to explore the mechanism related to parecoxib sodium alleviating postoperative acute pain in patients with lower limb fracture undergoing remifentanil anesthesia. Methods:Sixty inpatients undergoing lower limbs fracture were randomly assigned into 3 groups. The patients in group A received a preoperative dose of normal saline 10 ml by intravenous administration. Group B received a preoperative dose of parecoxib sodium 40 mg ( saline 10 ml ) by intravenous administration before the operation. Group C received parecoxib sodium 40 mg before the operation, and received parecoxib sodium 40 mg every 12 h till 48 h after operation. Patient controlled intravenous analgesia was started 30 min before the end of operation,with the model( load volume 5 ml,continuous infusion at 1. 5 ml/h,and bolus 0. 5 ml at locked time 10 min). Analgesia mixture was consisted of fentanyl 15 μg/kg(total volume 100 ml). Visual analogue scale was recorded at 1,12,24,48 h after the operation. Valid/invalid presses,the need for additional analgesia drug within 48 h after the operation were recorded. The concentration of PGE2 and β-EP were determined at before anesthesia induction ( T1 ) ,1 hour after the operation( T2 ) ,24 hours after the operation( T3 ) ,48 hours after the operation( T4 ) . Results:The patients among three groups were not significantly different in demographics and doses of narcotic(P>0. 05). Compared with group A,Visual analogue scale scores in group B and group C significantly decreased. Presses in Patient controlled intravenous analgesia in group C were least in three groups(P0.05)。与A组比较,B、C组术后视觉模拟评分明显降低,其中C组自控镇痛泵所需按压次数最少、镇痛效果最好(P<0.05)。 B、C组血浆PGE2 T2、T3、T4时点均低于A组(P<0.05~P<0.01)。 C组T3和T4时点β-EP水平均较A组和B组升高(P<0.05~P<0.01)。结论：帕瑞昔布钠能增强阿片类药物镇痛效果,显著减轻瑞芬太尼麻醉下肢骨折手术后急性痛。其主要机制可能与抑制PGE2生成、增加内源性β-EP释放有关。
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