Pre-emptive parecoxib and post-operative cognitive function in elderly patients

Abstract

Background: To investigate the effect of pre-emptive parecoxib sodium, given in addition to routine analgesic treatment, on post-operative cognitive function in elderly patients. Methods: Seventy elderly patients were included, who were 65-82 years of age, 48-75 kg of weight, and ASA grade I-II. Preoperative mini mental state examination (MMSE) score was ≥21 points. Patients were randomly divided into two groups: control group (group C) and parecoxib sodium group (group P). Before induction of general anesthesia, 40 mg of parecoxib sodium was injected intravenously in group P and the same volume of saline was injected in group C. Patient-controlled intravenous analgesia (PCIA) containing fentanyl and tramadol was used for post-operative pain control. A 3 ml blood sample was obtained from the peripheral vein one day before surgery, 1, 4, 24, and 72 h after surgery, and plasma cortisol, IL-6 and S100β concentrations were measured. Cognitive function was evaluated by measuring the MMSE score and a neurological test battery within 72 h after surgery. The occurrence of post-operative cognitive dysfunction (POCD), the dosage of fentanyl and tramadol used in PCIA, and the rate of additional fentanyl administration were recorded. Results: Compared to group C, post-operative plasma cortisol concentration decreased, the amount of fentanyl and tramadol used in PCIA was reduced, the rate of additional fentanyl administration decreased, and the rate of POCD was reduced in group P (P < 0.05). Conclusion: Pre-emptive analgesia with 40 mg of parecoxib sodium can reduce the incidence of POCD in elderly patients.

Influence of Cyclooxygenase-2 Inhibitors on Kynurenic Acid Production in Rat Brain in Vitro

“…Parecoxib was reported to decrease the incidence of postoperative cognitive dysfunction in patients after total knee arthroplasty (Zhu et al 2016 ). Similar results were presented by Tian et al ( 2014 ) and Lu et al ( 2017 ) in elderly patients that received parecoxib before general anesthesia was performed. However, celecoxib failed to improve cognitive performance in randomized controlled trial in patients with Alzheimer’s disease (ADAPT Research Group et al 2008 ), whereas according to other researchers the inhibition of cognitive decline after celecoxib administration was observed (Leoutsakos et al 2012 ).…”

Effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy: A randomized double blinded controlled trial

“…Animal experimental study showed this cox-2 mediated neurodegeneration is related to impairments of memory parameters [20] . Clinical study confirmed that parecoxib sodium premedication could reduce the incidence of POCD, and the percent of POCD in parecoxib sodium group was 28.6% [21] , and intraoperative dexmedetomidine administration could also reduce the incidence of POCD, the percent of POCD in DEX group was 26.6% [22] . Dexmedetomidine may involve the following mechanisms to improve cognitive dysfunction: 1. inhibited inflammation [23] .…”

Effect of parecoxib in the treatment of postoperative cognitive dysfunction

“…Zhu and colleagues [23] assessed the neuropsychological state of enrolled patients using a brief battery of neuropsychological test, any patient demonstrated deficit in 2 or more tests was considered as having POCD. The other three studies [22–24] determined the incidence of POCD using MMSE scale, POCD was defined if the difference between post- and preoperative MMSE score was equal or larger than the standard deviation of preoperative MMSE scores…”

“…Two studies [22,24] reported clinical characteristics and postoperative situation, such as consumption of analgesic and nausea. In the study conducted by Mu et al, the incidence of nausea and vomiting, NRS pain score at rest and cumulative morphine consumption were lower in parecoxib group than control group.…”