Comparing parecoxib and ketorolac as preemptive analgesia in patients undergoing posterior lumbar spinal fusion: a prospective randomized double-blinded placebo-controlled trial

Abstract

BackgroundPoor postoperative pain control is frequently associated with complications and delayed discharge from a hospital. Preemptive analgesia is one of the methods suggested for reducing postoperative pain. Opioids are effective for pain control, but there known addictive properties make physicians cautious about using them. Parecoxib and ketorolac are potent non-opioid NSAIDs that are attractive alternative drugs to opioids to avoid opioid-related side effects. However, there are no good head-to-head comparisons between these two drugs in the aspect of preemptive analgesic effects in lumbar spinal fusion surgery. This study aimed to compare the efficacy in terms of postoperative pain control and safety of parecoxib with ketorolac as preemptive analgesia in posterior lumbar spinal fusion patients.MethodsA prospective, double-blinded randomized controlled trial was carried out in patients undergoing posterior lumbar spinal fusion, who were randomized into 3 groups (n = 32). Parecoxib, ketorolac or a placebo was given to each patient via injection around 30 minutes prior to incision. The efficacy of postoperative pain control was assessed by a verbal numerical rating score (0–10). And various postoperative things were monitored for analysis, such as total opioid consumption, complications, and estimated blood loss.ResultsBoth the ketorolac and parecoxib groups showed significantly better early postoperative pain reduction at the postanesthesia care unit (PACU) than the control group (p < 0.05). There were no differences between the pain scores of ketorolac and parecoxib at any time points. Complications and bleeding were not significantly different between all three groups.ConclusionsPreemptive analgesia using both ketorolac and parecoxib showed a significantly better early postoperative pain control in the PACU than the control group in patients undergoing lumbar spinal fusion.Trial registrationClinicalTrials.gov NCT01859585. Registered 15 May 2013.

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

“…Of the 14 RCTs that evaluated systemic pharmacological therapies to prevent and treat postoperative pain after lumbar spine procedures, pregabalin was tested in 7 RCTs, nonsteroidal anti‐inflammatory drugs (NSAIDs) in 2 RCTs, and other drugs (dexamethasone, minocycline, propofol, sevoflurane, paracetamol, naproxen, ketamine, and clonidine) in the remaining 5 RCTs . Of the 7 RCTs that tested pregabalin, 4 demonstrated that pregabalin alone or in association with other drugs was more effective than placebo, 1 that it was as effective as placebo, and 2 that it was more effective than morphine in preventing postoperative pain .…”

“…Of the 7 RCTs that tested pregabalin, 4 demonstrated that pregabalin alone or in association with other drugs was more effective than placebo, 1 that it was as effective as placebo, and 2 that it was more effective than morphine in preventing postoperative pain . The 2 RCTs that tested NSAIDs showed that parecoxib, ketorolac, and etoricoxib were more effective than placebo in preventing postoperative pain . Dexamethasone, paracetamol, and the combination of ketamine‐clonidine led to positive results on postoperative pain prevention.…”

“…The 23 RCTs that tested therapies administered in the preoperative period included systemic pharmacological therapies (14 studies), [25][26][27][28][29][30][31][32][33][34][35][36][37][38] locoregional therapies (7 studies), [39][40][41][42][43][44][45] and electrical stimulation (2 studies) 46,47 (see Table 2).…”

“…[25][26][27][28][29][30][31] The 2 RCTs that tested NSAIDs showed that parecoxib, ketorolac, and etoricoxib were more effective than placebo in preventing postoperative pain. 32,33 Dexamethasone, paracetamol, and the combination of ketamine-clonidine led to positive results on postoperative pain prevention. Furthermore, propofol proved to be as effective as sevoflurane, while minocycline use led to controversial results.…”

“…60,61 The RCTs that tested systemic lidocaine, ketorolac, and NSAIDs (tenoxicam) led to controversial results. [62][63][64]66 Upton et al found that fentanyl administered while maintaining an Analgesia Nociception Index of > 50 with 26 L L L L L L Khurana et al 27 L L L L L L Choi et al 28 L L L L L L Kumar et al 29 L L L U U U Kim et al 30 L L H U H U Garcia et al 31 L L L U L L Siribumrungwong et al 32 L L L L L L Srivastava et al 33 U L L U U U Nielsen et al 34 L L L L L L Martinez et al 35 L L L U L U Konstantopoulos et al 36 L L H L L L Polat et al 37 L L L L L L Nitta et al 38 L 49 L L L U L L Hwang et al 50 L L U L U L Bekker et al 51 L U L U U U Song et al 52 L L L L L U Song et al 53 L L L L U U Yeom et al 54 L L L L L L Kim et al 55 L L L L L U Pacreu et al 56 L L L L U U Nielsen et al 57 L L L L L L Yilmaz et al 58 L L L L L U Lin et al 59 L L L L L L Tunali et al 60 L L L L L L Shimia et al 61 L L L U L L Dewinter et al 62 L L L L L L Kim et al 63 L Locoregional Delivery. Of the 10 RCTs that studied drugs locoregionally administered to prevent and treat postoperative pain after lumbar spine procedures, 5 tested morphine in various combinations and dosages, 67-71 2 tested ropivacaine, 72,73 1 tested levobupivacaine, 74 1 tested fentanyl, 75 and 1 tested MgSO 4 injection.…”