Abstract
BackgroundChronic post-surgical pain (CPSP) has a negative impact on the recovery, quality of life, and physical functioning of elderly patients. This study aimed to test the superiority of parecoxib vs. placebo in preventing chronic post-hepatectomy pain in elderly patients under combined general-epidural anesthesia.MethodsA total of 105 elderly patients undergoing hepatectomy under combined general-epidural anesthesia were randomized into the parecoxib or placebo group. The primary outcome was the proportion of patients with CPSP 3 months postoperatively. The secondary outcomes included the Short-Form McGill Pain Questionnaire score in CPSP-positive responders, acute pain intensity, postoperative analgesic demand, inflammatory markers change, and postoperative complications within 28 days.ResultsThe parecoxib group provided a non-significant absolute 9.1% reduction in the rate of CPSP compared to the placebo group (P = 0.34). The average chronic pain visual analog scale in the parecoxib group was lower than that in the placebo group (P = 0.04). Significantly less moderate-to-severe acute pain at rest (P = 0.04) and with coughing (P < 0.001), less patient-controlled epidural analgesia (PCEA) consumption (P = 0.01), and less rescue analgesia (P < 0.001) were observed in the parecoxib group compared to the placebo group. Furthermore, no between-group difference was observed in inflammatory markers (P > 0.05) and postoperative complications (P = 0.65).ConclusionsParecoxib reduced the prevalence of CPSP in elderly patients after hepatectomy under combined general-epidural anesthesia from 44.4 to 35.3% with no statistical significance. Moreover, significantly alleviated CPSP intensity and improved acute pain management were observed.Trial registrationThis study was retrospectively registered in the Chinese Clinical Trial Registry (URL: http://www.chictr.org.cn/edit.aspx?pid=56961&htm=4) on August 3, 2020 (ChiCTR-2,000,035,198).
Highlights
Chronic post-surgical pain (CPSP) has a negative impact on the recovery, quality of life, and physical functioning of elderly patients
The baseline characteristics of the patients were similar between the two groups (Table 1), albeit the parecoxib group had significantly different depression scores from those in the placebo group (P = 0.03)
(See figure on previous page.) Fig. 4 Perioperative change of inflammatory indexes. a Leukocyte count change over time; (b) Neutron-lymphocyte ratio change over time; (c) Tumor necrosis factor-α change over time; (d) IL-1β change over time; (e) IL-6 change over time; (f) IL-10 change over time; (g) IL-8 change; (h) Highly sensitive CRP over time
Summary
Chronic post-surgical pain (CPSP) has a negative impact on the recovery, quality of life, and physical functioning of elderly patients. This study aimed to test the superiority of parecoxib vs placebo in preventing chronic post-hepatectomy pain in elderly patients under combined general-epidural anesthesia. In China, liver cancer is one of the most commonly diagnosed malignant tumors, mainly treated by surgical procedures. Chronic post-surgical pain (CPSP) is a common long-existing postoperative complication and has been studied extensively in various surgeries [3] but rarely in open hepatectomy. Half of the elderly patients complain of chronic pain after open hepatectomy during the postoperative follow-up in Zhongshan Hospital, Fudan University. CPSP has no beneficial biological significance in elderly patients and might negatively impact the recovery, quality of life, and physical function [5]. Preventing transformation from acute pain into chronic pain is an essential part of Enhanced Recovery After Surgery (ERAS) [6, 7]
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