Comparison of the efficacy of parecoxib versus ketorolac combined with morphine on patient-controlled analgesia for post-cesarean delivery pain management

Abstract

we compared the clinical efficacy and safety between a new injectable cyclooxygenase-2 selective inhibitor, parecoxib, and an old nonselective, ketorolac combined with morphine in patient-controlled analgesia (PCA) for management of post-cesarean delivery pain. in this randomized, open-label study, 66 parturients undergoing cesarean section were divided into two groups: In Group P the patients received an initial intravenous bolus of 40mg parecoxib as a loading dose post-operatively and then two bolus doses of 20mg parecoxib were subsequently given at intervals of 24h. Morphine was basically used in PCA manner during the 3-day study course; and in Group K patients received an intravenous loading bolus of 30mg ketorolac post-operatively and then 90mg ketorolac combined with morphine in PCA fashion throughout the study course. Efficacy was evaluated by Verbal ranking scale (0-10) for pain intensity, Ramsay sedation score (1-6), profile of mood state (0-3) and quality of sleep (0-3), and patient satisfaction (0-4) with the analgesia. Efficacy evaluations and adverse effects were recorded every 24h and at 72h after initial loading boluses. The duration of hospital stay and total dose of morphine used throughout the study were also recorded. there were no significant differences of sedation scale, mood state, quality of sleep and satisfaction between two groups, except patients of Group P had a lower pain scores than those of the Group K at 24h (3.1, range 0-5 vs. 4.3, range 0-8, p = 0.005) and 72h (1.1, range 0-3 vs. 1.9, range 0-4, p = 0.005). Moreover, there were also no significant differences in the duration of hospital stay, but there was a lower total morphine requirement (22% reduction) in Group P in comparison with Group K (43.5 ± 19.2 vs. 55.5 ± 21.5, p = 0.02). Regarding adverse effects, there were no statistical differences between two groups. we noted that parecoxib with PCA morphine can be used for post-cesarean delivery analgesia with the same efficacy as ketorolac for an opioid-sparing effect.