Improving the Analgesic Efficacy of Intrathecal Morphine with Parecoxib After Total Abdominal Hysterectomy

Niruthisard, Supranee; Werawataganon, Thewarug; Bunburaphong, Pavena; Ussawanophakiat, Montson; Wongsakornchaikul, Chuthayuth; Toleb, Kusonsi

doi:10.1213/01.ane.0000277489.87015.1d

Cited by 21 publications

(11 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compliance was notably low with administration of nonsteroidal anti-inflammatory drugs, which highlights an area for improvement. In women undergoing abdominal hysterectomy, a randomized trial demonstrated a reduction in pain scores and opioid consumption with integration of nonsteroidal anti-inflammatory drugs 28. Additionally the combination of nonsteroidal anti-inflammatory drugs with acetaminophen provided more effective postoperative pain control as compared with either analgesic alone 29 30.…”

Section: Discussionmentioning

confidence: 99%

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

Schwartz

Lim

Broadwater

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

ObjectiveEnhanced Recovery After Surgery (ERAS) protocols are designed to mitigate the physiologic stress response created by surgery, to decrease the time to resumption of daily activities, and to improve overall recovery. This study aims to investigate postoperative recovery outcomes following gynecologic surgery before and after implementation of an ERAS protocol.MethodsA retrospective chart review was performed of patients undergoing elective laparotomy at a major academic center following implementation of an ERAS protocol (11/4/2014–7/27/2016) with comparison to a historical cohort (6/23/2013–9/30/2014). The primary outcome was length of hospital stay. Secondary outcomes included surgical variables, time to recovery of baseline function, opioid usage, pain scores, and complication rates. Statistical analyses were performed using Wilcoxon rank sum, Fisher’s exact, and chi squared tests.ResultsOne hundred and thirty-three women on the ERAS protocol who underwent elective laparotomy were compared with 121 historical controls. There was no difference in length of stay between cohorts (median 4 days; P = 0.71). ERAS participants had lower intraoperative (45 vs 75 oral morphine equivalents; P < 0.0001) and postoperative (45 vs 154 oral morphine equivalents; P < 0.0001) opioid use. ERAS patients reported lower maximum pain scores in the post-anesthesia care unit (three vs six; P < 0.0001) and on postoperative day 1 (four vs six; P = 0.002). There was no statistically significant difference in complication or readmission rates.ConclusionsERAS protocol implementation was associated with decreased intraoperative and postoperative opioid use and improved pain scores without significant changes in length of stay or complication rates.

show abstract

Section: Discussionmentioning

confidence: 99%

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

Schwartz

Lim

Broadwater

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

show abstract

“…The combination of NSAIDs and opioids effectively treats postoperative pain via the interruption of nociceptive impulses at central and peripheral sites of the pain transmission pathway, which reduces the need for opioids during the postoperative period [ 11 ]. Many studies demonstrated that parecoxib improves postoperative analgesia and decreases PCA opioid consumption by 30–63% following various types of surgery [ 16 , 17 , 28 – 30 ]. However, few studies evaluated coxibs as adjuvants to PCEA in postoperative pain management [ 20 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

View full text Add to dashboard Cite

ObjectiveThis multicenter, randomized, placebo-controlled study evaluated the efficacy and side effects of parecoxib during patient-controlled epidural analgesia (PCEA) after abdominal hysterectomy.MethodsA total of 240 patients who were scheduled for elective abdominal hysterectomy under combined spinal-epidural anesthesia received PCEA plus postoperative intravenous parecoxib 40 mg or saline every 12 h for 48 h after an initial preoperative dose of parecoxib 40 mg or saline. An epidural loading dose of a mixture of 6 mL of 0.25% ropivacaine and 2 mg morphine was administered 30 min before the end of surgery, and PCEA was initiated using 1.25 mg/mL ropivacaine and 0.05 mg/mL morphine with a 2-mL/h background infusion and 2-mL bolus with a 15-min lockout. The primary end point of this study was the quantification of the PCEA-sparing effect of parecoxib.ResultsDemographic data were similar between the two groups. Patients in the parecoxib group received significantly fewer self-administrated boluses (0 (0, 3) vs. 7 (2, 15), P < 0.001) and less epidural morphine (5.01 ± 0.44 vs. 5.95 ± 1.29 mg, P < 0.001) but experienced greater pain relief compared with the control group (P < 0.001). Patient global satisfaction was higher in the parecoxib group than the control group (P < 0.001). Length of hospitalization (9.50 ± 2.1, 95% CI 9.12~9.88 vs. 10.41 ± 2.6, 95% CI 9.95~10.87, P = 0.003) and postoperative vomiting (17% vs. 29%, P < 0.05) were also reduced in the parecoxib group. There were no serious adverse effects in either group.ConclusionOur data suggest that adjunctive parecoxib during PCEA following abdominal hysterectomy is safe and efficacious in reducing pain, requirements of epidural analgesics, and side effects.Trial RegistrationClinicalTrials.gov (NCT01566669)

show abstract

“…Thus, novel NSAIDs that selectively inhibit COX-2 have been developed to reduce these adverse effects, with similar efficacy to that of conventional NSAIDs [ 5 ]. Parecoxib is a COX-2 inhibitor effective and safe in postoperative analgesia of noncardiac surgery [ 2 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of a Single Dose of Parecoxib on Inflammatory Response and Ischemic Tubular Injury Caused by Hemorrhagic Shock in Rats

Takaku

Silva

Iritsu

et al. 2018

Pain Research and Treatment

View full text Add to dashboard Cite

Parecoxib, a selective COX-2 inhibitor, is used to improve analgesia in postoperative procedures. Here we evaluated whether pretreatment with a single dose of parecoxib affects the function, cell injury, and inflammatory response of the kidney of rats subjected to acute hemorrhage. Inflammatory response was determined according to serum and renal tissue cytokine levels (IL-1α, IL-1β, IL-6, IL-10, and TNF-α). Forty-four adult Wistar rats anesthetized with sevoflurane were randomized into four groups: placebo/no hemorrhage (Plc/NH); parecoxib/no hemorrhage (Pcx/NH); placebo/hemorrhage (Plc/H); and parecoxib/hemorrhage (Pcx/H). Pcx groups received a single dose of intravenous parecoxib while Plc groups received a single dose of placebo (isotonic saline). Animals in hemorrhage groups underwent bleeding of 30% of blood volume. Renal function and renal histology were then evaluated. Plc/H showed the highest serum levels of cytokines, suggesting that pretreatment with parecoxib reduced the inflammatory response in rats subjected to hemorrhage. No difference in tissue cytokine levels between groups was observed. Plc/H showed higher percentage of tubular dilation and degeneration, indicating that parecoxib inhibited tubular injury resulting from renal hypoperfusion. Our findings indicate that pretreatment with a single dose of parecoxib reduced the inflammatory response and tubular renal injury without altering renal function in rats undergoing acute hemorrhage.

show abstract

Improving the Analgesic Efficacy of Intrathecal Morphine with Parecoxib After Total Abdominal Hysterectomy

Abstract: Perioperative parecoxib enhanced the postoperative analgesia of intrathecal morphine and bupivacaine and improved patient satisfaction.

Cited by 21 publications

References 14 publications

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

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

Effects of a Single Dose of Parecoxib on Inflammatory Response and Ischemic Tubular Injury Caused by Hemorrhagic Shock in Rats

Contact Info

Product

Resources

About