Abstract
BackgroundPoor postoperative pain control is frequently associated with complications and delayed discharge from a hospital. Preemptive analgesia is one of the methods suggested for reducing postoperative pain. Opioids are effective for pain control, but there known addictive properties make physicians cautious about using them. Parecoxib and ketorolac are potent non-opioid NSAIDs that are attractive alternative drugs to opioids to avoid opioid-related side effects. However, there are no good head-to-head comparisons between these two drugs in the aspect of preemptive analgesic effects in lumbar spinal fusion surgery. This study aimed to compare the efficacy in terms of postoperative pain control and safety of parecoxib with ketorolac as preemptive analgesia in posterior lumbar spinal fusion patients.MethodsA prospective, double-blinded randomized controlled trial was carried out in patients undergoing posterior lumbar spinal fusion, who were randomized into 3 groups (n = 32). Parecoxib, ketorolac or a placebo was given to each patient via injection around 30 minutes prior to incision. The efficacy of postoperative pain control was assessed by a verbal numerical rating score (0–10). And various postoperative things were monitored for analysis, such as total opioid consumption, complications, and estimated blood loss.ResultsBoth the ketorolac and parecoxib groups showed significantly better early postoperative pain reduction at the postanesthesia care unit (PACU) than the control group (p < 0.05). There were no differences between the pain scores of ketorolac and parecoxib at any time points. Complications and bleeding were not significantly different between all three groups.ConclusionsPreemptive analgesia using both ketorolac and parecoxib showed a significantly better early postoperative pain control in the PACU than the control group in patients undergoing lumbar spinal fusion.Trial registrationClinicalTrials.gov NCT01859585. Registered 15 May 2013.
Highlights
Poor postoperative pain control is frequently associated with complications and delayed discharge from a hospital
Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the options being trialed in order to reduce postoperative pain and avoid the adverse effects of opioids [6,7]
The purpose of this study was to compare the efficacy of preemptive parecoxib and ketorolac as postoperative pain control agents, especially in the postanesthesia care unit (PACU) in patients who have undergone posterior lumbar spinal fusion
Summary
Poor postoperative pain control is frequently associated with complications and delayed discharge from a hospital. This study aimed to compare the efficacy in terms of postoperative pain control and safety of parecoxib with ketorolac as preemptive analgesia in posterior lumbar spinal fusion patients. Inappropriate postoperative pain control has been associated with a number of complications such as delay in discharge from the hospital, atelectasis, pulmonary edema, hypoxemia, and cardiovascular system complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the options being trialed in order to reduce postoperative pain and avoid the adverse effects of opioids [6,7]. These drugs provide a potent analgesic effect with a lack of sedative and opioid side effects. NSAIDs have effective opioid-sparing analgesic effects while reducing morphine consumption up to 27% in the first postoperative 24 hours [8]
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