Perioperative analgesia with parecoxib sodium improves postoperative pain and immune function in patients undergoing hepatectomy for hepatocellular carcinoma

Abstract

Rationale, aims, and objectives: Acute postoperative pain can result in immune dysfunction, which can be partly mitigated by efficient pain management. Opioids that have been widely applied to analgesia have been shown to suppress immune function, which has a negative impact on the treatment of patients with cancer. This study investigated the effects of perioperative fentanyl analgesia alone or in combination with parecoxib sodium on postoperative pain, immune function, and prognosis in patients undergoing hepatectomy of hepatocellular carcinoma (HCC).Methods: A total of 80 patients scheduled for hepatectomy between October 2013 and August 2014 were included. Patients were randomly divided into two groups (n = 40) and allocated to receive parecoxibsodium 40 mg (group P) or placebo (group C) 30 minutes before induction of anaesthesia, followed by 40 mg every 12 hours for 48 hours after the operation. All patients had access to patient-controlled analgesia with intravenous fentanylpostoperatively. Venous blood samples were collected at the following time points: 30 minutes before induction of anaesthesia (T0), the end of the surgery (T1), 24 hours after surgery (T2), and 72 hours after surgery (T3). The percentages of CD3+, CD4+, CD8+, CD4+/CD8+ T cells, and CD3+CD16+CD56+ (NK) cells at these time points were quantified by flow cytometry (FCM).Visual analogue scale (VAS) scores, total fentanyl consumption, and adverse effects were recorded. The prognostic differences in overall survival (OS) and diseasefree survival (DFS) between the two groups was also investigated.Results: For both groups, the percentages of CD3+, CD4+ T cells, and the ratio of CD4+/CD8+ significantly decreased at T1 and T2 (P < .05). The percentages of CD3+ T cells were significantly lower in group C than that in group P at T2 (P < .05). In group C, the amount of CD3+ T cells was lower at T3 compared with T0 (P < .05).The percentages of NK cells significantly decreased at T1 in both groups (P < .05).

RETRACTED ARTICLE:Parecoxib inhibits esophageal squamous cell carcinoma progression via the PDK1–AKT pathway

“…Parecoxib is the most commonly used selective COX-2 inhibitor in the clinic, and is the only parenterally administered coxib available to date [ 10 , 11 ]. It has been reported that parecoxib could improve the postoperative analgesic effect and immune function when used for multimodal analgesia, and further postpone postoperative cancer recurrence [ 12 , 13 ]. Other studies have reported that parecoxib shows antitumor effects against human osteosarcoma, glioblastoma, and intestinal cancers [ 14 – 16 ].…”

Postoperative Analgesia after Open Liver Surgery: Systematic Review of Clinical Evidence

“…When compared to the placebo, the use of NSAIDs proved to be more effective in pain control and associated with a higher opioid-sparing effect. These studies also suggest that NSAID use is possibly associated with a more preserved immune function (by increasing CD3+ and NK cell levels), reduced systemic inflammatory response (decreased levels of IL-4 and increased TGF-β), associated with a longer tumor-free interval and disease-free survival time (Table 3) [40,45]. The use of parecoxib or ketorolac leads to similar results in terms of postoperative pain control (Table 3) [55].…”

“…The role of NSAIDs in preventing postoperative pain after open liver surgery was evaluated in three studies, which included a total of 186 patients: two compared to placebo (RCTs) and one compared parecoxib to ketorolac (RO) [40,45,55]. When compared to the placebo, the use of NSAIDs proved to be more effective in pain control and associated with a higher opioid-sparing effect.…”

A Water-Soluble Polysaccharide from the Fibrous Root of Anemarrhena asphodeloides Bge. and Its Immune Enhancement Effect in Vivo and in Vitro

“…In immunosuppressive organisms, the growth of immune organs, including the thymus and spleen, is inhibited, and the levels of natural killer (NK) cells and immunoglobulin in the serum decrease [4]. In addition, the level of CD3/CD4 lymphocytes also decreased due to immunosuppression [5]. RAW264.7 cells, one of the macrophages, play an important role in the innate immune system.…”