Abstract
The effect of parecoxib sodium on the duration and severity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy has been inadequately studied. This randomized, controlled trial compared the effects of parecoxib, methylprednisolone, and placebo on the duration of acute postoperative pain after elective laparoscopic-assisted vaginal hysterectomy. Ninety-four eligible patients were randomized to three groups [parecoxib sodium 40 mg (Group P), methylprednisolone 1 mg/kg (Group M), and saline (Group S)]. The duration of pain during coughing [median (interquartile range)] was significantly lower in Group P than in Group M or Group S [26.0 (5.8–48.0) vs. 48.0 (30.0–55.5) vs. 48.0 (36.0–58.5) h; p = 0.025]. The duration of pain during rest was also significantly lower in Group P than in Group M or Group S [5.5 (3.8–21.0) vs. 24.0 (6.0–28.0) vs. 22.0 (5.8–36.0) h; p = 0.009]. Compared with those in Group M and Group S, the patients in Group P reported less intense visceral pain during coughing at 12 (p = 0.050) and 24 h (p = 0.009) as well as at rest at 12 h (p = 0.008). Compared with those in Group P and Group S, the patients in Group M showed lower serum C-reactive protein levels and higher blood glucose levels after surgery. No differences were noted in nausea, vomiting, length of hospital stay, wound infection, and delayed wound healing among the groups. Thus, parecoxib sodium reduces the duration and intensity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy.
Highlights
The duration of pain during coughing after surgery was significantly lower in groups [parecoxib sodium mg (Group P) [26.0 (5.8–48.0) h] than in Group M [48.0 (30.0–55.5) h; p = 0.028] and Group S [48.0 (36.0–58.5) h; p = 0.013]; the durations were similar between Groups M and S (p = 0.714)
The duration of pain during rest was significantly lower in Group P than in Group M (p = 0.008) and Group S (p = 0.008); the durations were similar between Groups M and S (p = 0.939)
The present trial demonstrated that intraoperative administration of parecoxib sodium 40 mg (Group P) significantly shortened the duration of pain during coughing and at rest after laparoscopic-assisted vaginal hysterectomy (LAVH) and that it reduced the intensity of acute visceral but not incisional pain
Summary
A survey revealed that 30% of 5,703 ambulatory patients experienced moderate-to-severe postoperative pain and that laparoscopic procedures were some of the most common reasons underlying this pain (McGrath et al, 2004). A cyclooxygenase-2 selective inhibitor commonly used in the postoperative period, exerts anti-inflammatory effects by inhibiting prostaglandin synthesis (FitzGerald and Patrono, 2001). The effect of parecoxib on pain intensity has been reported (Lloyd et al, 2009), there is a lack of information regarding its effect on the duration of postoperative pain. Methylprednisolone is a glucocorticoid with anti-inflammatory activities. Glucocorticoids reportedly inhibit spinal cord neuronal nociceptive afferent input and prevent peripheral and central sensitization (Woolf and Chong, 1993), the effects of methylprednisolone on postoperative pain remain controversial. Several trials have demonstrated its analgesic effects (Lunn et al, 2011; Acham et al, 2013); contradictory results have been reported (Aabakke et al, 2014)
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