Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial

Abstract

ObjectivesPostlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT.Materials and methodsThe patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery.ResultsPreoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P<0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07–0.382; P<0.001) and the intensity of bilateral shoulder pain (both P<0.01).ConclusionPreoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologic laparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP.

Analysis of risk factors of postlaparoscopic shoulder pain

“…Zhang et al . showed perioperative injections of parecoxib reduced the occurrence of SP after gynecologic laparoscopy . Valadan et al .…”

Comparison of analgesic efficacy of oblique subcostal and lateral transversus abdominis plane block after laparoscopic cholecystectomy

“…Preoperative PPTs and tolerances after fentanyl administration are useful for assessing the severity of postoperative pain and are well correlated with postoperative opioid consumption during the first 24 hours after surgery [34,35]. In addition, postoperative VAS scores are positively correlated with total PCA consumption, and negatively correlated with total intraoperative consumption of remifentanil [27].…”

<p>Simultaneous Determination of Parecoxib and Its Metabolite Valdecoxib Concentrations in Beagle Plasma by UPLC-MS/MS and Application for Pharmacokinetics Study</p>

“…15,16 Compared with opioids, COX-2 inhibitors could effectively reduced the synthesis of peripheral and central prostaglandins, inhibited hypersensitivity to pain and improved the pain threshold. 17 The analgesic efficacy of parecoxib had been confirmed in several studies including anesthesiology, 8 orthopedics, 18 gynecology, 19 and general surgery. 20 Parecoxib was a second-generation specific inhibitor of COX-2, that could be rapidly converted to its metabolite valdecoxib by liver enzyme hydrolysis.…”