Preemptive analgesic efficacy of parecoxib vs placebo in infertile women undergoing diagnostic laparoscopy: randomized controlled trial

Time Characteristics of Shoulder Pain after Laparoscopic Surgery

Objective:

To explore the time characteristics of shoulder pain after laparoscopic gynecological operation.

Methods:

We conducted prospective clinical observations and literature review. We studied 442 cases of laparoscopic gynecological surgery. We used a visual analogue scale to evaluate the pain of patients at different time points after operation. We searched the English literature of shoulder pain after gynecological laparoscopic surgery. The observation time points of these studies included 12–24 hours or the first day after surgery, and at least one time point before this time point.

Results:

The total incidence of shoulder pain was 68%. More than 90% of patients begin to feel shoulder pain on the first day after surgery, not on the day of surgery. 26 articles observed the severity of postlaparoscopic shoulder pain (PLSP) at different time points, of which 17 articles found that the intensity of the shoulder pain peaked at 12–24 hours or the first day after operation.

Discussion:

The occurrence of PLSP presents obvious time characteristics. The incidence and severity of PLSP peaked on the first day or 12–24 hours after operation. To prevent and treat PLSP better, clinicians should make a more in-depth study according to the time characteristics of PLSP.

The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients

Postlaparoscopic shoulder pain (PLSP) is a common clinical problem that needs to be addressed by medical professionals who are currently perform laparoscopic surgeries. The purpose of this study was to determine the perioperative clinical factors and demographic characteristics associated with PLSP. A prospective observational study was performed with 442 inpatients undergoing laparoscopic surgery for infertility. The pain visual analogue scale was used as the measuring instrument. To identify the predictors of PLSP, we performed multivariate conditional logistic regression. PLSP was correlated with body mass index (BMI, odds ratio = 0.815). The incidence of shoulder pain and more severe shoulder pain in patients with a lower BMI was significantly higher than it was in patients with a higher BMI, and BMI was significantly negatively correlated with PLSP. Most of the patients (95%) began to experience shoulder pain on the first postoperative day, and it rarely occurred on the day of surgery. Patients with lower BMI presented a higher risk of reporting shoulder pain on the first postoperative day. We should identify high-risk patients in advance and make specific treatment plans according to the characteristics of their symptoms.

Efficacy and Safety of Postoperative Pain Relief by Parecoxib Injection after Laparoscopic Surgeries: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

This study aims to evaluate the efficacy and safety of parecoxib injection in pain relief after laparoscopic surgeries.

METHODS

A comprehensive literature search based on 4 online databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) was applied to retrieve all related randomized controlled trials (RCTs). Two independent reviewers screened each article for eligibility according to the predetermined inclusion criteria. The Cochrane Collaboration's tool was applied to evaluate the methodological quality of included studies. A standardized data collection sheet was designed to extract data from included studies. RevMan version 5.3 (The Cochrane Collaboration, Copenhagen, Denmark) was selected to perform meta-analysis.

RESULTS

A total of 1,060 participants who were scheduled for gynecological laparoscopic surgery or laparoscopic cholecystectomy (LC) were enrolled in 12 selected RCTs. The methodological qualities of the studies were evaluated as moderate to high. The combined data showed that perioperative parecoxib injection could significantly reduce the proportion of patients who required adjuvant pain relieve after laparoscopic surgeries. Significantly lower pain scores in the parecoxib groups were observed, which proved that preoperative or intraoperative injection of 40 mg parecoxib was more effective than placebo for immediate pain relief after LC. But preoperative injection of 40 mg parecoxib showed no improvement compared with placebo in the management of immediate pain following gynecological laparoscopic surgery. The occurrence of adverse events showed no differences between perioperative parecoxib administration and placebo control.

CONCLUSION

Perioperative parecoxib administration was effective in reducing the proportion of patients who required adjuvant pain relief after laparoscopic surgeries without significant adverse events compared with placebo. The effect of parecoxib injection on immediate pain relief remains in question. Future RCTs with larger sample sizes are encouraged.

Post-Operative Pain Management in Patients Undergoing Robotic Urological Surgery

Robotic urological surgery is being increasingly performed worldwide. The main focus currently is on the operative technique but post operative patient care is an essential part of the process to make this technique safe and successful. We present a review on multiple analgesic techniques available to prevent and treat pain specifically caused after by urological robotic surgery; this article will explain the mechanism of pain pathways involved in laparoscopic procedures and review current evidence pertaining to systemic and regional analgesia methods.

Parecoxib for the prevention of shivering after general anesthesia

BACKGROUND

Shivering is the most common complication during the recovery period after general anesthesia, and there is no clear consensus about the best strategy for its prophylactic. The aim of the study was to evaluate the efficacy of parecoxib in prevention of postoperative shivering.

METHODS

Eighty patients with American Society of Anesthesiologists physical status I-II, who were scheduled for minor urological surgeries under general anesthesia, were randomly assigned to two groups (n = 40 in each group): group P received 40 mg of parecoxib by intravenous bolus injection and group S received the same volume of normal saline in the same way just after the induction of anesthesia. Hemodynamic parameters and body temperatures including tympanic and axillary temperature were monitored. The occurrence of shivering and pain intensity score were recorded during the recovery period.

RESULTS

Parecoxib significantly reduced the incidence and severity of shivering in comparison with the placebo. Postoperative shivering was observed in 22 patients in group S (55%), compared with nine in group P (22.5%) (P = 0.003). In addition, pain intensity scores were lower in group P during recovery period; consequently, less rescue analgesics were required in group P when compared with group S (P = 0.001). Regarding the body temperature, it was found that core temperature decreased but peripheral temperature increased significantly in both groups. There was no significant difference between groups in all time intervals.

CONCLUSIONS

Prophylactic administration of parecoxib produces dual effects on antishivering and postoperative analgesia. This implies that cyclooxygenase 2-prostaglandin E2 pathways may be involved in the regulation of shivering.

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.

Multiple-, but not single-, dose of parecoxib reduces shoulder pain after gynecologic laparoscopy

BACKGROUND

The aim of this study was to investigate effect of single- and multiple-dose of parecoxib on shoulder pain after gynecologic laparoscopy.

METHODS

126 patients requiring elective gynecologic laparoscopy were randomly allocated to three groups. Group M (multiple-dose): receiving parecoxib 40mg at 30min before the end of surgery, at 8 and 20hr after surgery, respectively; Group S (single-dose): receiving parecoxib 40mg at 30min before the end of surgery and normal saline at the corresponding time points; Group C (control): receiving normal saline at the same three time points. The shoulder pain was evaluated, both at rest and with motion, at postoperative 6, 24 and 48hr. The impact of shoulder pain on patients' recovery (activity, mood, walking and sleep) was also evaluated. Meanwhile, rescue analgesics and complications were recorded.

RESULTS

The overall incidence of shoulder pain in group M (37.5%) was lower than that in group C (61.9%) (difference=-24.4%; 95% CI: 3.4~45.4%; P=0.023). Whereas, single-dose regimen (61.0%) showed no significant reduction (difference with control=-0.9%; 95% CI: -21.9~20.0%; P=0.931). Moreover, multiple-dose regimen reduced the maximal intensity of shoulder pain and the impact for activity and mood in comparison to the control. Multiple-dose of parecoxib decreased the consumption of rescue analgesics. The complications were similar among all groups and no severe complications were observed.

CONCLUSIONS

Multiple-, but not single-, dose of parecoxib may attenuate the incidence and intensity of shoulder pain and thereby improve patients' quality of recovery following gynecologic laparoscopy.