Effects of Preemptive Analgesia with Parecoxib Sodium on Haemodynamics and Plasma Stress Hormones in Surgical Patients with Thyroid Carcinoma

Wang, Liandong; Gao, Xia; Li, Junying; Yu, Hongyan; Su, Hai-Wen; Liu, Lianzhong; Qi, Jun

doi:10.7314/apjcp.2015.16.9.3977

Cited by 10 publications

(5 citation statements)

References 11 publications

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“…T he idea of preemptive analgesia was first proposed by Woolf in Harvard Medical School 8 , with the purpose to block the pain sensation center before harmful stimulation occurs, to inhibit the center sensitization and to raise the threshold of pain sensation. Recently, there have been many studies published on the preoperative use of local anesthesia agents, including opiates and NSAIDS [9][10][11][12] , but the value of preemptive analgesia is still controversial [13][14][15] . It has been proved that synthesis of COX-2 increases after inflammatory stimulation, and increases the production of prostaglandins, which induces inflammatory pain.…”

Section: Discussionmentioning

confidence: 99%

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Bian

Wang

Qian

et al. 2018

Orthopaedic Surgery

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Objective Total knee arthroplasty (TKA) is an established surgical technique and is the standard treatment for degenerative knee joint diseases. However, severe pain after TKA makes it difficult for many patients to perform early postoperative rehabilitation and functional exercise, which might result in subsequent unsatisfactory recovery of knee joint function and great reduction in patients’ satisfaction and quality of life. Orthopaedic surgeons have tried a large variety of analgesics and analgesic modes to relieve patients’ pain after TKA. There are many analgesic regimens available in clinical practice but all have some deficiencies. Parecoxib sodium, a highly selective inhibitor of cyclooxygenase‐2 (COX‐2), can reduce the synthesis of peripheral prostaglandin to exert the effect of analgesia, and relieve inflammation and prevent central sensitization through inhibition of peripheral and central COX‐2 expression. In addition, it can be used as a preemptive analgesic without affecting platelet aggregation. However, there does seem to be conflicting evidence in the current research as to whether parecoxib sodium can be used successfully as a preemptive analgesic; the effect of preemptive analgesia with parecoxib sodium in multimodal analgesia is still controversial. This research investigated the effects of parecoxib sodium in a preemptive multimodal analgesic regimen. Methods Eighty‐eight patients were randomized into two groups. The experimental group received parecoxib (46 patients) and the control group received saline (42 patients), administered 30 min before the initiation of the surgical procedure. A patient‐controlled analgesia (PCA) pump was applied within 48 h after surgery. The visual analogue scale (VAS), drug consumption through the PCA pump, use of salvaging analgesia, range of motion (ROM) of the knee joints, and postoperative complications were observed. Results The VAS score in the post‐anesthesia care unit (PACU) of the parecoxib group was significantly lower than that of the control group (P = 0.039). There was no significant difference in the demographic profiles, duration of operation, hemorrhage in surgery, postoperative hemorrhage, postoperative drainage, VAS at different time points, function of knee joints, length of hospital stay, use of salvaging analgesia, and postoperative drug consumption through the PCA between the two groups (P > 0.05). Conclusion In preemptive multimodal analgesia regimens, parecoxib sodium can significantly decrease the VAS score in the short term, relieve pain shortly after surgery, and does not increase the incidence of complications. Parecoxib sodium is a safe and effective drug in the perioperative analgesic management for TKA.

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Section: Discussionmentioning

confidence: 99%

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Bian

Wang

Qian

et al. 2018

Orthopaedic Surgery

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“…Therefore, the idea of preemptive analgesia was proposed with the purpose of blocking the pain sensation center prior to nociceptive stimulation; this process may inhibit hyperalgesia and raise the threshold of pain sensation (6). Despite the many studies investigating the preoperative use of local anesthesia agents, including opioids and NSAIDS (7-10), the value of preemptive analgesia is still controversial (4,11,12).…”

Section: Discussionmentioning

confidence: 99%

Preemptive Analgesia with Parecoxib in Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

Peng

Wang

et al. 2018

Pain Phys

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Background: Total hip arthroplasty (THA) is a well-accepted surgical treatment for terminal hip diseases. Objective: To evaluate the effect of preemptive analgesia with parecoxib in patients undergoing primary unilateral THA. Study Design: A randomized, double-blind, placebo-controlled study. Setting: This study was conducted at Peking Union Medical College Hospital and Beijing Jishuitan Hospital in Beijing, China. Methods: A total of 94 patients scheduled for primary unilateral THA in 2 centers (Peking Union Medical College Hospital and Beijing Jishuitan Hospital) were randomly assigned to receive 40 mg parecoxib (n = 48) or 0.9% normal saline solution (n = 46) 30 minutes before incision. All patients received standardized intravenous patient-controlled analgesia (PCA) postoperatively. Preoperative baseline data, surgery-related conditions, postoperative Visual Analog Scale (VAS) pain score, cumulative narcotic consumption of PCA, and complications were compared between the parecoxib group and the placebo group. Results: There were no significant differences in postoperative VAS pain score, cumulative narcotic consumption of PCA, proportion of analgesic remedy, and complications between the 2 groups. Limitations: Only a single dose of parecoxib was used without including a dose-dependent control group. Conclusion: A single dose of parecoxib 30 minutes before incision did not provide effective preemptive analgesia for the management of postoperative pain after primary unilateral THA. The possible effect of preemptive analgesia with parecoxib needs further investigation. Key words: Total hip arthroplasty, pain, parecoxib, COX-2 selective inhibitor, preemptive analgesia, clinical trial, patient-controlled analgesia, analgesics

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“…4,5,13,14 In addition to preincision infiltration of local anesthetic agents, studies indicate that preemptive analgesia with anti-inflammatory agents such as parecoxib may reduce plasma levels of stress hormones and produce better analgesia for patients undergoing thyroid surgery. [15][16][17] There may be a role for ketorolac in reduction in nausea, vomiting, and dizziness episodes, without statistically significant contribution to the risk of postoperative hematoma formation, when used as an adjunct to narcotics. 18,19 Combination regimens with use of NSAIDs and acetaminophen or its analogs have similarly demonstrated decreased narcotic use in thyroid and parathyroid surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The role for such protocols has been investigated in a variety of surgical specialties such as orthopedic, gastrointestinal, and head and neck surgery . In addition to preincision infiltration of local anesthetic agents, studies indicate that preemptive analgesia with anti-inflammatory agents such as parecoxib may reduce plasma levels of stress hormones and produce better analgesia for patients undergoing thyroid surgery . There may be a role for ketorolac in reduction in nausea, vomiting, and dizziness episodes, without statistically significant contribution to the risk of postoperative hematoma formation, when used as an adjunct to narcotics .…”

Section: Discussionmentioning

confidence: 99%

Multimodal Analgesia in Outpatient Head and Neck Surgery

Oltman

Militsakh

D’Agostino

et al. 2017

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Perioperative analgesia strategies that rely solely on narcotics may contribute to adverse effects and concerns about opioid abuse or dependence. Multimodal analgesia protocols incorporating nonnarcotic agents may reduce the need for postoperative narcotic use.OBJECTIVE To evaluate the feasibility and safety of a multimodal analgesia protocol for outpatient head and neck surgical procedures and to identify the association of the multimodal analgesia protocol with postoperative pain perception scores and patient satisfaction. DESIGN, SETTING, AND PARTICIPANTSRetrospective evaluation of prospectively collected data on adults who underwent outpatient thyroid, parathyroid, and parotid surgery between July 2016 and February 2017 at the head and neck surgery service of a tertiary care hospital using a multimodal analgesia strategy with use of immediate preoperative acetaminophen and gabapentin, and intention to treat with a nonnarcotic postoperative outpatient analgesia strategy. MAIN OUTCOMES AND MEASURESOverall patient satisfaction scores, Overall Benefit of Analgesia Score (OBAS), and median resting and peak pain scores were recorded. Incidence of reliance on a narcotic-based postoperative outpatient analgesia strategy and adverse events related to altered analgesia strategy were identified.RESULTS Sixty-four patients (48 [75%] female; mean [SD] age, 54.6 [14.3] years) underwent outpatient thyroid, parathyroid, or parotid surgery with use of a multimodal analgesia protocol. On a 10-point rating scale, patients reported low resting pain perception scores (median, 2 [range, 0-8]) and peak pain scores (median, 4 [range, 0-9]). The OBAS assessment for composite effectiveness of analgesia indicated a favorable median score of 1 (range, 0-10; permissible range, 0-28, with lower scores better). Thirty-nine (61%) patients were able to avoid postoperative narcotic use on discharge. Fifty-six (88%) patients reported "high" or "very high" satisfaction with the multimodal analgesia strategy. No complications related to bleeding, hematoma, significant adverse events, or readmissions were observed. CONCLUSION AND RELEVANCEA multimodal analgesia strategy was feasible and safe in patients undergoing outpatient head and neck surgery and may reduce the need for narcotic use. It was associated with low pain perception scores, favorable OBAS, and overall satisfaction scores. The role of multimodal analgesia needs additional evaluation through comparative effectiveness assessment vs conventional pain management strategies.

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Effects of Preemptive Analgesia with Parecoxib Sodium on Haemodynamics and Plasma Stress Hormones in Surgical Patients with Thyroid Carcinoma

Cited by 10 publications

References 11 publications

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Preemptive Analgesia with Parecoxib in Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

Multimodal Analgesia in Outpatient Head and Neck Surgery

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