Intravenous Parecoxib for Pain Relief after Orthopedic Surgery: A Systematic Review and Meta-analysis

Li, Xiaofei; Zhou, Pengxiang; Li, Zhengqian; Tang, Huilin; Zhai, Suodi

doi:10.1007/s40122-022-00400-1

Cited by 9 publications

(6 citation statements)

References 55 publications

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“…It inhibits the aggregation of leukocytes, reduces the formation of bradykinin, inhibits platelet agglutination, and induces apoptosis and anti-angiogenesis by selectively inhibiting the activity of COX-2, thus producing antipyretic, analgesic, anti-inflammatory, and anti-cancer effects ( Kaduševičius, 2021 ). Studies have shown that in major surgeries such as thoracic surgery and orthopedics, parecoxib sodium can reduce pain levels and postoperative serum inflammatory factor levels, reduce the incidence of adverse reactions such as nausea and vomiting and pulmonary infections, reduce analgesic drug consumption, reduce hemodynamic instability, and reduce surgery-related stress reactions ( Yang et al, 2020 ; Li et al, 2022a ). Basic research has revealed that parecoxib sodium can exert neuroprotective effects by inhibiting and improving mitochondrial dysfunction in the substantia nigra via the COX-2/PGE2 pathway ( Yan et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty

Wang

Liu²,

Yongquan³

et al. 2023

Front. Pharmacol.

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Objective: This study aimed to clarify the effect of parecoxib sodium on the occurrence of postoperative delirium and to investigate its possible mechanism.Methods: A total of 80 patients who underwent elective hip arthroplasty in our hospital between December 2020 and December 2021 were selected and randomly divided into two groups: a parecoxib sodium group (group P, n = 40) and a control group (group C, n = 40). Patients in group P were intravenously injected with 40 mg of parecoxib sodium 30 min before anesthesia and at the end of the surgery. Patients in group C were intravenously injected with the same volume of normal saline at the same time points. The primary endpoint was the incidence of POD, and the secondary endpoints were the levels of inflammatory factors (tumor necrosis factor- α [TNF-α], interleukin [IL]-1β, IL-6, and IL-10), nerve injury-related factors (brain-derived neurotrophic factor [BDNF], S-100β protein, neuron-specific enolase [NSE], and neurofilament light chain [NfL]), and antioxidant factors (heme oxygenase-1 [HO-1]), as well as the Visual Analogue Scale (VAS) and Confusion Assessment Method-Chinese Reversion (CAM-CR) scores.Results: The incidence of POD was 10% in group P and 27.5% in group C. Intergroup comparison revealed that the levels of TNF-α, IL-1β, S-100β, NfL, and NSE were lower, and BDNF was higher, in group P than in group C at each postoperative time point. The levels of IL-6 were lower, and the levels of IL-10 and HO-1 were higher, in group P than in group C at 1 h and 1 day postoperatively (p < 0.05). Three days after surgery, the differences in the levels of IL-6, IL-10, and HO-1 were not statistically significant between the two groups (p > 0.05). The VAS and CAM-CR scores were lower at each postoperative time point in group P than in group C (p < 0.05).Conclusion: Parecoxib sodium could reduce postoperative pain, decrease the plasma levels of inflammatory and nerve injury-related factors, upregulate HO-1 levels, and reduce the incidence of POD. The results of this study suggest that parecoxib sodium may reduce the occurrence of POD through the effects of anti-inflammation, analgesia, and antioxidants.

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Section: Discussionmentioning

confidence: 99%

The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty

Wang

Liu²,

Yongquan³

et al. 2023

Front. Pharmacol.

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“…Few meta-analyses have been conducted to investigate the efficacy and safety of parecoxib or flurbiprofen axetil for perioperative analgesia in children, but evidence in adults is constantly being updated. A previous meta-analysis by Li et al ( 68 ) reported that low to moderate evidence indicated that parecoxib relieved postoperative orthopedic pain while sparing opioid analgesic consumption without increasing the incidence of adverse events ( 68 ). Sun et al ( 69 ) reported that the perioperative administration of flurbiprofen was effective in reducing postoperative pain, nausea, and vomiting in Chinese surgical patients ( 69 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of parecoxib and flurbiprofen axetil for perioperative analgesia in children: a network meta-analysis

Chen

et al. 2023

Front. Med.

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ObjectiveThe aim of this study was to systematically review the efficacy and safety of parecoxib and flurbiprofen axetil for perioperative analgesia in children through Bayesian network meta-analysis.MethodsWe systematically searched PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI, VIP, and Wanfang Data databases on 18 July 2022 to obtain randomized controlled trials comparing perioperative parecoxib or flurbiprofen with placebo or standard treatment for pediatric analgesia. The outcomes were the postoperative pain score and the incidence of adverse events. The Gemtc package of R-4.0.3 and Stata 17.0 were used for Bayesian network meta-analysis.ResultsWe retrieved 942 articles and 49 randomized controlled trials involving 3,657 patients who met the inclusion criteria. Compared with children who received placebo treatment, those who received flurbiprofen axetil had lower pain sores at each time point within 24 h postoperatively, and those who received parecoxib had lower pain sores at each time point within 12 h postoperatively. Compared with children who received tramadol treatment, both the children who received flurbiprofen axetil or parecoxib had lower pain scores at 8 h postoperatively. The ranking results demonstrated that flurbiprofen axetil had significant superiority in reducing pain scores at 2, 4, and 12 h postoperatively, and parecoxib had significant superiority in reducing pain scores at 0, 0.5, 1, 6, 8, and 24 h postoperatively. In terms of safety, compared with children who received placebo, those who received flurbiprofen axetil or parecoxib had a lower incidence of total adverse events and postoperative agitation. Compared with tramadol, flurbiprofen axetil and parecoxib both significantly reduced the incidence of total adverse events and postoperative nausea and vomiting. Compared with flurbiprofen axetil or fentanyl, parecoxib significantly reduced the incidence of postoperative nausea and vomiting. The ranking results showed that parecoxib was advantageous in decreasing the incidence of total adverse events and postoperative nausea and vomiting.ConclusionFlurbiprofen axetil was most effective at reducing pain scores at 2, 4, and 12 h postoperatively. Parecoxib had an advantage in terms of reducing pain scores at 0, 0.5, 1, 6, 8, and 24 h postoperatively, as well as the incidence of total adverse events and postoperative nausea and vomiting.Systematic trial registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=348886, PROSPERO (CRD42022348886).

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“…However, despite this fact, research on IV NOA in the orthopedic field is relatively scarce compared to other areas. In 2022, in the field of orthopedic surgery, Li et al reported a meta-analysis about the effects of IV parecoxib following overall orthopedic surgery [25]. They finally included 27 articles that dealt with general orthopedic surgery, but only three of them addressed hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Intravenous Non-Opioid Analgesics for Postoperative Pain Management of in Patients Undergoing Hip Surgery: A Systematic Review and Meta-Analysis

Chang,

Lee,

Kang

et al. 2023

Medicina

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Background and Objectives: Intravenous (IV) non-opioid analgesics (NOAs) have been extensively investigated as a multimodal analgesic strategy for the management of acute pain after hip surgery. This pair-wise meta-analysis examined IV NOA effects following hip surgery. Materials and Methods: A systematic search of the MEDLINE (PUBMED), Embase, and Cochrane Library databases was performed for studies investigating the effect of IV NOA for postoperative pain management following hip surgery up to 7 June 2023. We compared in-admission opioid use, postoperative VAS (visual analogue scale) score, hospital stay duration, and opioid-related adverse events between IV NOA and control groups. Results: Seven studies were included with a total of 953 patients who underwent hip surgery. Of these, 478 underwent IV NOA treatment, and 475 did not. The IV NOA groups had lower opioid use within 24-h following hip surgery (SMD, −0.48; 95% CI, −0.66 to −0.30; p < 0.01), lower VAS score (SMD, −0.47; 95% CI, −0.79 to −0.16; p < 0.01), shorter hospital stay (SMD, −0.28; 95% CI, −0.44 to −0.12; p < 0.01), and lower incidence of nausea and vomiting (OR, 0.32; 95% CI, 0.15 to 0.67; p < 0.01) compared with the control groups. Conclusions: This meta-analysis demonstrated that IV NOA administration following hip surgery may have more favorable postoperative outcomes than those in control groups.

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Intravenous Parecoxib for Pain Relief after Orthopedic Surgery: A Systematic Review and Meta-analysis

Cited by 9 publications

References 55 publications

The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty

The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty

Efficacy and safety of parecoxib and flurbiprofen axetil for perioperative analgesia in children: a network meta-analysis

Effectiveness of Intravenous Non-Opioid Analgesics for Postoperative Pain Management of in Patients Undergoing Hip Surgery: A Systematic Review and Meta-Analysis

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