Abstract
Objective: The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate the opioid-sparing effects of orally administered celecoxib following total abdominal hysterectomy. Methods: The study population consisted of 52 patients scheduled for total abdominal hysterectomy (TAH) who were ASA I or II physical status females. Patients were allocated randomly to orally receive 400 mg of celecoxib (Group C, n = 26) or placebo (Group P, n = 26) 1 hour before anesthesia induction. All patients underwent the same standard general anesthesia with oral intubation. Morphine was self-administered for postoperative analgesia via a patient controlled analgesia (PCA) device. Results: Only 1 patient did not complete the study. Of the remaining 51 patients, there was no significant difference between the treatment groups in age, weight, ASA status, duration of surgery, or intraoperative dose of morphine. However, the mean (95% CI) 24 h morphine consumption of 17.5 (11.9, 23.2) mg in the celecoxib group was not significantly lower than that of 24.2 (18.6, 29.7) mg in the placebo group (P=0.089). There were no significant differences between groups in morphine consumption, initial analgesic requirement, and numeric rating scores for pain at rest or on movement, nausea or sedation during the first 24 hours after operation. Conclusion: We conclude that preemptive celecoxib did not confer additional analgesia in patients undergoing total abdominal hysterectomy.
Highlights
Anesthesia induction and postoperative pain always affect recovery [1]
One patient was discharged from the study because no patientcontrolled analgesia equipment was available for this patient
The study showed that prescription of 400 mg celecoxib could reduce the morphine required 24 hours after operation by 18.92 mg in the celecoxib group and 23.88 mg in placebo group
Summary
Anesthesia induction and postoperative pain always affect recovery [1]. Total abdominal hysterectomy is usually performed by Pfannenstiel incision, which leads to post operative pain that requires pain releasing medication usually in opioid group, especially given during 24-48 hours after operation [1,2,3]. Patients normally receive opioid treatment during operation, and it is known that high dosages of opiates result in complications, for example, difficult inhalation, drowsiness, nausea, itchiness, uroschesis, constipation, flatulence, which extend the time before discharge [4]. These complications can be exacerbated by opioid drugs, but the patient will suffer from post operative pain. The action is on COX2 and COX1 in the proportion 375 to 1 [7], which lessens inflammation and pain, and at the same time reduces complications in the gastrointestinal tract (such as peptic ulcers) This is common in old nonsteroidal anti-inflammatory drugs. Pain during resting and moving when the patient needed analgesic drugs for the first time after operation and complications from morphine and celecoxib were investigated
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