Parecoxib for analgesia after craniotomy

Abstract

We found only limited evidence to support parecoxib as an analgesic after craniotomy.

Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature

“…Although the number of trials identified from 2007 to 2010 was substantially higher than those previously reported, still no firm recommendation on analgesic therapy following craniotomy could be provided, as well‐performed RCTs were quite limited . Our systematic review identified a notable number of RCTs examining the efficacy of systemic pharmacological intervention on postcraniotomy pain management, while up to 2010 only 2 RCTs related to this issue were encountered . Another interesting finding was that the interest on scalp blocks or infiltration seems to be declining, while alternative analgesic modalities such as acupuncture emerge as attractive alternatives.…”

“…Despite the concern about their potential dose‐dependent cardiovascular adverse effects and thromboembolic events, their relevance to “single‐shot” administration is debatable, while parecoxib has been shown to be safe in the perioperative period in noncardiac surgery . Nevertheless, existing evidence on the use of parecoxib in postcraniotomy pain setting is not supportive of its analgesic superiority . Failure to attribute a clear analgesic benefit to the use of parecoxib could possibly be explained in the light of study design and analgesic protocol applied in the most recent RCTs conducted on this topic .…”

“…38 COXIBs were initially proposed as ideal alternatives to traditional NSAIDs for postcraniotomy analgesia, as they have no antiplatelet action and do not incur increased bleeding risk. 39,40 Despite the concern about their potential dose-dependent cardiovascular adverse effects and thromboembolic events, their relevance to "single-shot" administration is debatable, while parecoxib has been shown to be safe in the perioperative period in noncardiac surgery. 40 Nevertheless, existing evidence on the use of parecoxib in postcraniotomy pain setting is not supportive of its analgesic superiority.…”

‘Anesthesia’ for awake neurosurgery

“…Although some evidence suggests titrating propofol infusion with intraoperative bispectral index monitoring [2,16], in patients undergoing awake neurosurgery an equally important concern is to set up an adequate strategy also for postoperative pain control [36,37]. Remifentanil is a well tolerated opioid and provides good intraoperative pain control but sometimes induces postoperative complications including hyperalgesia and hypertension or tachycardia [38,39 ].…”

Evaluation of a single preoperative dose of etoricoxib for postoperative pain relief in therapeutic knee arthroscopy

“…Parecoxib has been shown to have an opioid-sparing effect after coronary bypass surgery and discectomy, but not after craniotomy (Khalil et al 2006, Riest et al 2008, Jones et al 2009). Of the currently registered COX-2 inhibitors, etoricoxib has the longest duration of analgesic action, lasting 22–24 hours.…”