Multiple-, But Not Single-, Dose of Parecoxib Reduces Shoulder Pain after Gynecologic Laparoscopy

Zhang, Hufei; Shu, Haihua; Lei, Yang; Cao, Minghui; Zhang, Jingjun; Liu, Ke-Xuan; Xiao, Lei; Zhang, Xuyu

doi:10.7150/ijms.4916

Cited by 10 publications

(16 citation statements)

References 42 publications

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“…The data indicated that administration of multi-dose parecoxib (40 mg every 12 h) relieved postoperative pain intensity and incidence, and reduced the requirement for analgesics. These observations are in accordance with results of other studies that indicated that 40 mg parecoxib twice daily ameliorated post- A B C laparoscopic pain, and attenuated the incidence of visceral and shoulder pain with a reduced requirement for analgesics following gynecological laparoscopy (29,30). In contrast to the traditional opioid drugs, parecoxib exerts its analgesic effect without opioid-induced hyperalgesia.…”

Section: A B C Discussionsupporting

confidence: 91%

“…Increasing evidence indicates that patients with cervical cancer exhibit an imbalance in the functions of Th1 and Th2 cells, with a Th2-predominant response mode (29), and the Th17/Treg balance has been noted to be disrupted in peripheral blood from patients with cervical cancer (13,32,33). In the present study, in order to improve understanding of the underlying mechanisms of postoperative immune suppression, alterations in the levels of Th1, Th2, Th17 and Treg cytokines following gynecological laparoscopy were observed in patients with cervical cancer.…”

Section: A B C Discussionmentioning

confidence: 99%

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Multi-dose parecoxib provides an immunoprotective effect by balancing T helper 1 (Th1), Th2, Th17 and regulatory T cytokines following laparoscopy in patients with cervical cancer

Wang

et al. 2014

Molecular Medicine Reports

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Analgesic treatment with anti‑inflammatory drugs may aid the prevention of postoperative pain and the attenuation of the postoperative immune inflammatory response. The current study presents a randomized, double‑blind controlled study, which was performed to investigate the levels of Th1, Th2, Th17 and Treg cytokines, including interleukin (IL)‑2, interferon (IFN)‑γ, IL‑4, IL‑10, IL‑17, IL‑23 and transforming growth factor (TGF)‑β in the peripheral blood of patients with cervical cancer following laparoscopy. The effects of perioperative multi‑dose parecoxib on postoperative immune function was evaluated. A total of 80 patients with cervical cancer (stage IB/IIA, ASA I‑III, aged 18‑65 years) that were scheduled for laparoscopy were randomly assigned into either the parecoxib (I; n=40) or control (II; n=40) groups. Group I received 40 mg parecoxib 30 min prior to surgery and then every 12 h subsequent to surgery for 60 h, and group II received normal saline at the corresponding time points. Intravenous tramadol (100 mg) was prescribed for pain relief as required. The mRNA and protein expression levels of cytokines in the peripheral blood were detected by quantitative polymerase chain reaction and ELISA. Pain visual analog scales (VAS) and incidence, analgesic relief, adverse events and the length of hospital stay were recorded. It was demonstrated that the mRNA and protein levels of IL‑2, IFN‑γ and IL‑17 in the two groups were reduced subsequent to surgery, while mRNA and protein expression levels of IL‑4, IL‑10 and TGF‑β were enhanced. Administration of multi‑dose parecoxib may diminish the increase in postoperative IL‑2, IFN‑γ and IL‑17 levels, and suppress the excessive production of IL‑4, IL‑10 and TGF‑β. This effect is accompanied by lower VAS scores, pain incidence, postoperative nausea/vomiting and infections. In conclusion, perioperative multi‑dose parecoxib was able to alleviate postoperative pain and ameliorate surgery‑induced immune suppression by balancing Th1, Th2, Th17 and Treg cytokines following laparoscopy in patients with cervical cancer. The current study provides support to the hypothesis that parecoxib may be a more effective therapeutic strategy than the currently available options, for postoperative pain and immune function management of patients with cancer.

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Section: A B C Discussionsupporting

confidence: 91%

Section: A B C Discussionmentioning

confidence: 99%

Multi-dose parecoxib provides an immunoprotective effect by balancing T helper 1 (Th1), Th2, Th17 and regulatory T cytokines following laparoscopy in patients with cervical cancer

Wang

et al. 2014

Molecular Medicine Reports

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“…However, as in this study, after neuraxial opioid (spinal morphine) neither intravenous ketorolac, regular oral valdecoxib nor celecoxib are of benefit 21,24,25 . It is possible that alternative dosing regimens (for example repeated parecoxib dosing or celecoxib 400 mg BD) would have improved efficacy, given that these higher doses may be more effective for some patients 34,35 and that the pharmacokinetics of parecoxib and celecoxib in pregnancy are unknown.…”

Section: Discussionmentioning

confidence: 99%

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

Paech

McDonnell

Sinha

et al. 2014

Anaesth Intensive Care

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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.

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“…dosis berulang dapat menurunkan nyeri bahu pasca laparaskopi ginekologik sedangkan parecoxib dosis tunggal tidak dapat menurunkan angka kejadian nyeri bahu. 3 Injeksi parecoxib sama efektifnya dengan ketorolak dalam menurunkan nyeri pascabedah pada operasi laparatomi ginekologi. Penggunaan parecoxib 40 mg iv pada histerektomi total abdominal direkomendasikan sebagai sparing morfin.…”

Section: Parecoxibunclassified

Pengaruh Pemberian Parecoxib Terhadap Kadar Il-6 dan Intensitas Nyeri Pascabedah Laparotomi Ginekologi

Haeruddin

Ahmad

2013

JAI b

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Background: Post operative pain still an issue in the post operative management. Approximately 80% patients undergo surgery has had acute post operative pain which hipothetically mediated by interleukin 6 (IL-6): a proinflamation cytokine that has important role in pain physiology. Purpose: The aim of this research is to measure Interleukin 6 (IL-6) concentration and post operative pain intensity in the use of combination Parecoxib 40 mg intravenous with epidural analgesic bupivakain and fentanyl for patients undergo gyneacology laparotomy. Methods: This is an experimental research using double blind random technique. Total sample 50, which divided into 2 groups consist of 25 subjects each which had done gyneacologic laparotomy. One group had Parecoxib 40 mg before surgery and 12 hours after surgery, while the control group had placebo. Both of groups had epidural analgesic using bupivacain 0,5% and fentanyl, and post operative analgesic continuous with bupivacain 0,125% and fentanyl 2 ug/ml 5 ml/hour. The pain asessment using NRS chart at 2, 12, and 24 hours post operative. Result: IL-6 serum on both groups had elevation with the peak level on 24 hours post operative. No significant difference in IL-6 serum elevation (p>0,05). No difference also in assessment post operative pain scale using NRS chart in both groups. Conclusion: Analgesic combination between Parecoxib 40 mg IV with epidural analgesic bupivacain 0,125% can't lower IL-6 patient serum who undergo gynecologic laparotomy. ABSTRAKLatar Belakang: Nyeri pascabedah masih merupakan masalah dalam periode pascabedah. Sekitar 80% pasien yang menjalani pembedahan mengalami nyeri akut pascabedah. Interleukin-6 (IL-6) merupakan sitokin proinflamasi yang berperan penting dalam fisiologi nyeri. Tujuan: Penelitian ini bertujuan mengukur kadar IL-6 dan intensitas nyeri pascabedah pada penggunaan kombinasi Parecoxib 40 mg intravena dengan analgesia epidural bupivacain dan fentanyl pada pasien yang menjalani laparotomi ginekologi. Metode: Dilakukan penelitian eksperimental secara acak pada 50 pasien yang dibagi *Bagian ilmu anestesi, perawatan intensif dan manajemen nyeri FK Unhas, Makassar

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Multiple-, But Not Single-, Dose of Parecoxib Reduces Shoulder Pain after Gynecologic Laparoscopy

Cited by 10 publications

References 42 publications

Multi-dose parecoxib provides an immunoprotective effect by balancing T helper 1 (Th1), Th2, Th17 and regulatory T cytokines following laparoscopy in patients with cervical cancer

Multi-dose parecoxib provides an immunoprotective effect by balancing T helper 1 (Th1), Th2, Th17 and regulatory T cytokines following laparoscopy in patients with cervical cancer

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

Pengaruh Pemberian Parecoxib Terhadap Kadar Il-6 dan Intensitas Nyeri Pascabedah Laparotomi Ginekologi

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