A Randomised Controlled Trial of Parecoxib, Celecoxib and Paracetamol as Adjuncts to Patient-Controlled Epidural Analgesia after Caesarean Delivery

Abstract

The benefit of combining non-opioid analgesics with neuraxial opioids for analgesia after caesarean delivery has not been clearly established. larger doses of paracetamol or cyclooxygenase-2 inhibitors have not been evaluated. A randomised, double blind, double-dummy, parallel group placebo-controlled clinical trial was conducted among women having elective caesarean delivery under spinal anaesthesia, followed by pethidine patient-controlled epidural analgesia. Patients received placebos (group C); intravenous parecoxib 40 mg then oral celecoxib 400 mg at 12 hours (group PC); intravenous paracetamol 2 g then oral 1 g six-hourly (group PA); or these regimens combined (group PCPA). The primary outcome was 24-hour postoperative patientcontrolled epidural pethidine use and the main secondary outcome was postoperative pain. One hundred and thirty-eight women were recruited but 27 subsequently met exclusion criteria, leaving 111 who were randomised, allocated and analysed by intention-to-treat (n=23, 30, 32 and 26 in groups C, PC, PA and PCPA respectively). There were no differences between groups for pethidine consumption, based on either intention-to-treat (median 365, 365, 405 and 360 mg in groups C, PC, PA and PCPA respectively, P=0.84) or per protocol analysis (17 major violations). Dynamic pain scores did not differ between groups but requirement for, and dose of, supplementary oral tramadol was least in group PCPA (incidence 23% versus 48%, 70% and 58% in groups C, PC and PA respectively, P=0.004). The addition of regular paracetamol, cyclooxygenase-2 inhibitors or both to pethidine patient-controlled epidural post-caesarean analgesia did not provide a pethidine dose-sparing effect during the first 24 hours.

Efficacy of a single 40‐mg intravenous dose of parecoxib for postoperative pain control after elective cesarean delivery: A double‐blind randomized placebo‐controlled trial

“…In 2009, a Cochrane review reported that a single dose of 20 or 40 mg parecoxib, by either intramuscular or i.v. route, is an effective medication for acute postoperative pain and it can reduce total requirement of supplemental analgesia over a 24‐h period . However, none of the studies within this meta‐analysis evaluated the effects of parecoxib in CD.…”

“…The protocol for this double‐blind, randomized, parallel‐group, placebo‐controlled trial was approved by the Siriraj Institutional Review Board (EC090/2557). Relatively few studies have been conducted on the efficacy of parecoxib after CD and no studies have compared the efficacy of parecoxib with placebo. The sample size was calculated based on data from Ng et al ., who reported a 22‐mg difference in postoperative morphine consumption compared with placebo after total abdominal hysterectomy – a common gynecological procedure .…”

Post-caesarean analgesia: What is new?

“…There are three studies using COX-2 inhibitors for post-CS analgesia. [575859] One study evaluated single dose of oral celecoxib 200 mg added to PCEA and compared it to analgesia provided by PCEA only. [57] There was no difference in the total drug consumption in either group.…”

“…compared the combination of oral celecoxib and intravenous parecoxib to paracetamol for post-CS analgesia. [59] They found that the combination of COX-2 inhibitors to be more effective in reducing analgesic requirement. Celecoxib and parecoxib provide a safe profile for both surgical patients and breastfeeding mothers.…”

Obstetric Anesthesiologists as Perioperative Physicians: Improving Peripartum Care and Patient Safety

“…The goal of postpartum pain management is to reduce total opioid consumption and its side effects, and to facilitate early ambulation and interaction with the newborn [79]. The efficacy of neuraxial opioids for post cesarean delivery pain is well documented in the literature [80][81][82], and its use with multimodal analgesia consisting of non-opioid medications, including paracetamol, NSAIDs, and COX-2 inhibitors, has been shown to further reduce the amount of morphine consumed postoperatively [79,[83][84][85][86][87]. No clear difference, however, has been demonstrated between these adjuncts [85].…”