Postoperative analgesia with parecoxib, acetaminophen, and the combination of both: a randomized, double-blind, placebo-controlled trial in patients undergoing thyroid surgery

Gehling, M.; Arndt, Christian; Eberhart, Leopold; Koch, T.; Krüger, Tillmann H.C.; Wulf, Hinnerk

doi:10.1093/bja/aeq096

Cited by 28 publications

(24 citation statements)

References 29 publications

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“…In our present study, parecoxib analgesia resulted in an average reduction of cumulative morphine requirements by 24% compared to placebo in patients undergoing open prostatectomy. This finding is in accordance with previous studies describing an opioid sparing effect of COX-2 inhibitors in the postoperative period [8-13]. However, opioid sparing is not by itself considered a clinically meaningful endpoint [7,28].…”

Section: Discussionsupporting

confidence: 92%

“…Selective cyclooxygenase-2 (COX-2) inhibitors have been proposed to be a safe alternative for several years. Parecoxib (a prodrug of valdecoxib) is a parenterally selective cyclooxygenase-2 (COX-2) inhibitor that reduces postoperative opioid consumption, following thyroid surgery [8], hernia repair [9], gynecological laparotomy [10], total hip [11] and knee arthroplasty [12], as well as spine surgery [13]. However, the use of parecoxib in cardiac surgery has been associated with an increased incidence of cardiovascular events in at-risk patients [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Effects of parecoxib on analgesia benefit and blood loss following open prostatectomy: a multicentre randomized trial

et al. 2015

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BackgroundThis multi-centre, prospective, randomized, double-blind, placebo-controlled study was designed to test the hypotheses that parecoxib improves patients’ postoperative analgesia without increasing surgical blood loss following radical open prostatectomy.Methods105 patients (64 ± 7 years old) were randomized to receive either parecoxib or placebo with concurrent morphine patient controlled analgesia. Cumulative opioid consumption (primary objective) and the overall benefit of analgesia score (OBAS), the modified brief pain inventory short form (m-BPI-sf), the opioid-related symptom distress scale (OR-SDS), and perioperative blood loss (secondary objectives) were assessed.ResultsIn each group 48 patients received the study medication for 48 hours postoperatively. Parecoxib significantly reduced cumulative opioid consumption by 24% (43 ± 24.1 mg versus 57 ± 28 mg, mean ± SD, p=0.02), translating into improved benefit of analgesia (OBAS: 2(0/4) versus 3(1/5.25), p=0.01), pain severity (m-BPI-sf: 1(1/2) versus 2(2/3), p < 0.01) and pain interference (m-BPI-sf: 1(0/1) versus 1(1/3), p=0.001), as well as reduced opioid-related side effects (OR-SDS score: 0.3(0.075/0.51) versus 0.4(0.2/0.83), p=0.03). Blood loss was significantly higher at 24 hours following surgery in the parecoxib group (4.3 g⋅dL−1 (3.6/4.9) versus (3.2 g⋅dL−1 (2.4/4.95), p=0.02).ConclusionsFollowing major abdominal surgery, parecoxib significantly improves patients’ perceived analgesia. Parecoxib may however increase perioperative blood loss. Further trials are needed to evaluate the effects of selective cyclooxygenase-2 inhibitors on blood loss.Trial registrationClinicalTrials.gov Identifier: NCT00346268

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Effects of parecoxib on analgesia benefit and blood loss following open prostatectomy: a multicentre randomized trial

et al. 2015

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“…Our study is comparable with the study conducted by M. Gehling et al (2010), 28 who in their study concluded that parecoxib, acetaminophen and their combination reduced postoperative opioid requirement significantly by 50% (p<0.05). However, the combination of parecoxib and acetaminophen is not associated with a further reduction in opioid consumption.…”

Section: Graph 3: Showing Episodes Of Nausea and Vomiting In Studied supporting

confidence: 92%

Study of Preemptive Ana L Gesic Effects of Intravenous Paracetamol in Reducing Doses of Morphine in Patients Undergoing Laparoscopic Cholecystectomy

Khan¹,

Sofi²,

Munshi³

et al. 2015

jemds

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ABSTRACT:Paracetamol is primarily thought to be a cyclo-oxygenase inhibitor acting through central nervous system. Indirect effects of paracetamol are through serotonergic system as a nonopioid analgesic. We studied intravenous paracetamol 1 gram preoperatively to assess its intraoperative and post-operative analgesic effects, in reducing intraoperative morphine requirements, to reduce the requirement of postoperative analgesia, enable early recovery from anaesthesia and to reduce postoperative nausea and vomiting. One hundred patients from either sex classified in ASA Class I and II scheduled for laparoscopic cholecystectomy were randomly allocated into two groups of 50 patients each. Group I (Study group) received paracetamol 1 gram infusion prior to induction with 50µg/kg morphine diluted with normal saline to a total volume of 5ml. Group II (Control group) received l00µg/kg morphine diluted with normal saline to a total volume of 10ml at induction. We observed that there was significant increase in mean time for rescue analgesia from induction of anaesthesia in Group I (study group) was 11.25±1.827 hours and Group II (Control group) was 6.98±4.568 hours (p value < 0.001). The median value of visual analogue score was lower at all-time points in group I when compared to group II at each interval and it was statistically significant (p value < 0.001). A significant decrease in mean number of administered doses of rescue analgesia during 24 hours was seen in the study group (0.52±0.505) as compared to the control group (1.3±0.463) with a p value of < 0.001. Mean modified Aldrete score in the study group was 9.78±0.465 and in control group it was 8.1±1.15. It was statistically significant p value of <0.001. The mean number episodes of nausea and vomiting in group I were 0.74±0.633 and in group II 0.94±0.652 and was statistically insignificant with p value of 0.361. CONCLUSION: Administration of intravenous paracetamol and 50% doses of morphine prior to induction in patients undergoing laparoscopic cholecystectomy ensures effective analgesic intra-operatively as well as postoperatively and was associated with earlier discharge from post anaesthetic care unit when compared with full doses of IV morphine, however above combination was not able to decrease significantly reduction in morphine related adverse effects in these patients.

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“…concluded that single parenteral injection of parecoxib 40 mg compares favorably with two infusions of propacetamol 2 g within the first 12 in adult patients. [1718] The COX-2 selective NSAIDs rofecoxib or celecoxib usually demonstrated analgesic efficacy superior to paracetamol when given orally. [1920]…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of intravenous paracetamol versus Parecoxib for postoperative analgesia after general anaesthesia

et al. 2012

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Background:Postoperative pain has a significant impact on patient's recovery and optimal nonopioid analgesia would reduce postoperative pain and pain-related complications. This study was aimed to evaluate the analgesic efficacy and safety of intravenous paracetamol versus parecoxib for postoperative analgesia after surgery.Materials and Methods:Sixty-eight adult consented patients belonging to ASA I and II, scheduled for surgery, were randomly allocated in two treatment groups receiving either infusion of paracetamol (1 gm) or parecoxib (40 mg). The surgical and anesthetic techniques were standardized. Postoperative pain was assessed using visual analog score (VAS) at rest, during coughing and movement. The primary variables were the differences between the mean values of postoperative pain scores, time of first dose of rescue analgesic (tramadol) required, and patient satisfaction throughout the first 12 postoperatively.Results:There was no significant difference among groups to first request for tramadol. The VAS score was significantly less in parecoxib group at rest compared to paracetamol group (P<0.05), but the same did not differ for pain score while coughing and movement. Patients in the parecoxib group were more satisfied regarding the postoperative pain management at 12 h postoperatively. The incidence of adverse side effects was infrequent in both the groups.Conclusion:Postoperative nonopioid intravenous analgesia with paracetamol and parecoxib is comparable in the early postoperative period with no adverse effects.

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Postoperative analgesia with parecoxib, acetaminophen, and the combination of both: a randomized, double-blind, placebo-controlled trial in patients undergoing thyroid surgery

Abstract: Parecoxib and acetaminophen effectively reduce postoperative opioid requirements after thyroid or parathyroid surgery. The combination of these drugs is not associated with a further reduction in opioid consumption.

Cited by 28 publications

References 29 publications

Effects of parecoxib on analgesia benefit and blood loss following open prostatectomy: a multicentre randomized trial

Effects of parecoxib on analgesia benefit and blood loss following open prostatectomy: a multicentre randomized trial

Study of Preemptive Ana L Gesic Effects of Intravenous Paracetamol in Reducing Doses of Morphine in Patients Undergoing Laparoscopic Cholecystectomy

Clinical evaluation of intravenous paracetamol versus Parecoxib for postoperative analgesia after general anaesthesia

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