Evaluation of the Efficacy of Methylprednisolone, Etoricoxib and a Combination of the Two Substances to Attenuate Postoperative Pain and PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Placebo-controlled Trial

Abstract

BackgroundEstablishment of laparoscopic cholecystectomy as an outpatient procedure has accentuated the clinical importance of reducing early postoperative pain, as well as postoperative nausea and vomiting (PONV). We therefore planned to evaluate the role of a multimodal approach in attenuating these problems.MethodsOne hundred and twenty adult patients of ASA physical status I and II and undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized, placebo-controlled study. Patients were divided into four groups of 30 each to receive methylprednisolone 125 mg intravenously or etoricoxib 120 mg orally or a combination of methylprednisolone 125 mg intravenously and etoricoxib 120 mg orally or a placebo 1 hr prior to surgery. Patients were observed for postoperative pain, fentanyl consumption, PONV, fatigue and sedation, and respiratory depression. Results were analyzed by the ANOVA, a Chi square test, the Mann Whitney U test and by Fisher's exact test. P values of less than 0.05 were considered to be significant.ResultsPostoperative pain and fentanyl consumption were significantly reduced by methylprednisolone, etoricoxib and their combination when compared with placebo (P<0.05). The methylprednisolone + etoricoxib combination caused a significant reduction in postoperative pain and fentanyl consumption as compared to methylprednisolone or etoricoxib alone (P<0.05); however, there was no significant difference between the methylprednisolone and etoricoxib groups (P>0.05). The methylprednisolone and methylprednisolone + etoricoxib combination significantly reduced the incidence and severity of PONV and fatigue as well as the total number of patients requiring an antiemetic treatment compared to the placebo and etoricoxib (P<0.05).ConclusionsA preoperative single-dose administration of a combination of methylprednisolone and etoricoxib reduces postoperative pain along with fentanyl consumption, PONV, antiemetic requirements and fatigue more effectively than methylprednisolone or etoricoxib alone or a placebo.

Effect of Transversus Abdominis Plane Block on Cost of Laparoscopic Cholecystectomy Anesthesia

“…The dose of fentanyl used intraoperatively was 119.55±10.37 μg in Group 1, and 124.70±17.31 μg in Group 2. Lu et al [ 8 ] and Gautam et al [ 12 ] used similar doses of intraoperative fentanyl in colorectal surgery and laparoscopic surgery, respectively.…”

The Influence of Etoricoxib on Pain Control for Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Trials

“…Finally, 4 RCTs that meet our inclusion criteria are included in the meta-analysis. 8,[16][17][18] The baseline characteristics of the 4 eligible RCTs in the meta-analysis are summarized in Table 1. The 4 studies are published between 2006 and 2016, and sample sizes range from 47 to 120 with a total of 351.…”

“…Preemptive etoricoxib 120 mg is administered orally before the surgery, and 1 RCT reports diazepam in both groups. 8 Among the 4 studies included here, 2 studies report pain scores within 4 hours, 8 hours, 12 hours, and 24 hours, 8,17 3 studies report analgesic consumption, 8,16,17 4 studies report nausea and vomiting, 8,16-18 and 2 studies report headache. 8,16 Jadad scores of the 4 included studies vary from 3 to 5, and all 4 studies are considered to be highquality ones according to quality assessment.…”

Comparative evaluation of continuous thoracic paravertebral block and thoracic epidural analgesia techniques for post-operative pain relief in patients undergoing open nephrectomy: A prospective, randomized, single-blind study

“…Modified Bromage scale was utilized for the assessment of motor block. [ 10 ] The assessment of PONV was done a four-point ordinal scale with 0 = no nausea or vomiting and 3 = severe nausea with vomiting;[ 11 ] all the patients with PONV grade of two or more received rescue antiemetic ondansetron 4 mg IV. The sedation of patients was evaluated using the Ramsay sedation scale; patient having Ramsay sedation scale of >4 was designated as sedated.…”