Effect of Parecoxib as an Adjunct to Patient-Controlled Epidural Analgesia after Abdominal Hysterectomy: A Multicenter, Randomized, Placebo-Controlled Trial

Parecoxib Reduced Postsurgical Pain and Facilitated Movement More Than Patient Controlled Analgesia

Background

Postoperative pain management is an imperative issue for patients undergoing lumbar spinal fusion surgery. Delayed pain relief is associated with poor clinical outcomes. This study compared the effects of intravenously administered patient-controlled analgesia (PCA) with intravenous parecoxib, both commonly used methods for analgesic pain control after surgery.

Methods

A non-randomized study was used to recruit 68 patients who were scheduled to receive lumbar spinal fusion surgery at a hospital in Taiwan from April through December of 2020. The group treated with parecoxib received an initial perioperative dose of parecoxib 40 mg during a 30-min period and then postoperative intravenous parecoxib at 40 mg per 12-h period, for 72 h. Those with PCA received morphine (0.4 mg/ml), droperidol (0.02 mg/ml), diphenhydramine (0.48 mg/ml), midazolam (0.02 mg/ml) and saline solution during the 3-day study course. Major outcomes, including visual scale pain score and Barthel index of activities of daily living, were collected via review of medical records at 4 times: 12, 24, 48 and 72 h after surgery. Comparative effects between two groups were assessed by the generalized estimating equations.

Results

After adjusting for potential confounders, the administration of parecoxib was associated with a significant decrease in pain scores and an increase in the Barthel Index, when compared with the PCA group (all p < 0.05). Notably, both effects would maintain for 72 h after surgery.

Discussion

This is the first trial of which the authors are aware, that supports intravenous parecoxib as significantly enhancing patient mobility, in addition to having pain control efficacy, when compared with PCA. This study could be used as a reference when instituting interventions to improve the adaptation process and clinical prognoses after lumbar spinal fusion surgery.

Evaluating the association of preoperative parecoxib with acute pain trajectories after video-assisted thoracoscopic surgery: a single-centre cohort study in Taiwan

OBJECTIVE

The efficacy of parecoxib as pre-emptive analgesia still remains controversial. This study aimed to investigate how pre-emptive analgesia with parecoxib affected postoperative pain trajectories over time in patients undergoing thoracic surgery.

DESIGN

Retrospective cohort study.

SETTING

A single medical centre in Taiwan.

PARTICIPANTS

We collected 515 patients undergoing video-assisted thoracoscopic surgery at a tertiary medical centre between September 2016 and August 2017.

INTERVENTIONS

Pre-emptive parecoxib before surgery.

PRIMARY AND SECONDARY OUTCOME MEASURES

Daily numeric rating pain scores in the first postoperative week.

RESULTS

A total of 196 (38.1%) of the recruited patients received parecoxib preoperatively. The latent curve analysis revealed that woman, higher body weight and postoperative use of parecoxib were associated with increased baseline level of pain scores over time (p=0.035, 0.005 and 0.048, respectively) but epidural analgesia and preoperative use of parecoxib were inclined to decrease it (both p<0.001). Regarding the decreasing trends of changes in daily pain scores, older age and epidural analgesia tended to steepen the slope (p=0.014 and <0.001, respectively). Preoperative use of parecoxib were also related to decreased frequency of rescue morphine medication (HR=0.4; 95% CI 0.25 to 0.65).

CONCLUSIONS

Pre-emptive analgesia with parecoxib was associated with decreased baseline pain scores but had no connection with pain decreasing trends over time. Latent curve analysis provided insights into the dynamic relationships among the analgesic modalities, patient characteristics and postoperative pain trajectories.

Study on Main Drugs and Drug Combinations of Patient-Controlled Analgesia Based on Text Mining

In recent years, with the continuous understanding of pain knowledge and the continuous improvement of quality of life requirements, patient-controlled analgesia (PCA) has been widely used in a variety of pain patients. In this study, text mining technology was used to analyze relevant literature, try to find out the main drugs of PCA, classify the drugs, and dig out the important drug combination rules. PCA studies were retrieved from PubMed database in recent 10 years, and the bibliographic information of the literatures was taken as mining sample. First, the names of the drugs in the sample were identified by MetaMap package; then, Bicomb software was used to extract high-frequency drugs for the word frequency analysis and to construct a drug-sentence matrix. Finally, “hclust” package and “arules” package of R were used for the cluster analysis and association analysis of drugs. 39 main PCA drugs were screened out. Morphine, dexmedetomidine, and fentanyl were the top three drugs. Through cluster analysis, these drugs were divided into two clusters, one containing 26 common drugs and the other containing 13 core drugs. The association analysis of these drugs was carried out, and 22 frequent itemsets and 6 association rules were obtained. The maximum frequent 1-itemset was {Morphine} and the maximum frequent 2-itemset was {Morphine, Ropivacaine}. The research results have certain guidance and reference value for clinicians and researchers. In addition, it provides a way to study the relationship between drugs from the perspective of text mining.

The efficacy of parecoxib for pain control after hysterectomy: a meta-analysis of randomized controlled studies

Introduction: The efficacy of parecoxib for pain control after hysterectomy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of parecoxib versus placebo on pain intensity after hysterectomy.Methods: We search PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases through March 2019 for randomized controlled trials (RCTs) assessing the effect of parecoxib versus placebo on pain intensity after hysterectomy. This meta-analysis is performed using the random-effect model.Results: Six RCTs are included in the meta-analysis. Overall, compared with control group after hysterectomy, parecoxib treatment is associated with substantially reduced pain scores in 4-6 h at rest (MD = -0.98; 95%CI = -1.14 to -0.81; p < .00001), pain scores in 12 h at rest (MD = -0.70; 95%CI = -0.77 to -0.63; p < .00001), pain scores in 12 h on sitting up (MD = -0.90; 95%CI = -1.03 to -0.77; p < .00001), pain scores in 24 h on sitting up (MD = -1.19; 95%CI = -1.94 to -0.44; p = .002), dose of analgesic need in parecoxib group is notably lower than that in control group (std. MD = -2.54; 95%CI = -3.97 to -1.10; p = .0005), but shows no obvious effect on pain scores in 24 h at rest (MD = -0.40; 95%CI = -1.47-0.67; p = .47), pain scores in 4-6 h on sitting up (MD = -0.54; 95%CI = -2.50-1.42; p = .59), first time to analgesic requirement between two groups (std. MD = -0.10; 95%CI = -0.47-0.26; p = .57), nausea or vomiting (RR = 0.92; 95%CI = 0.59-1.43; p = .70), and adverse events (RR = 0.86; 95%CI = 0.64-1.17; p = .34).Conclusions: Parecoxib treatment provides additional benefits for pain control after hysterectomy.