Parecoxib Group Research Articles

Efficacy of parecoxib for the prevention of catheter-related bladder discomfort after transurethral resection of bladder

Objective The aim of this study was to assess the prevention profiles of parecoxib on catheter-related bladder discomfort (CRBD) after transurethral resection of bladder tumor(TURBT). Methods Fifty-six male adult patients undergoing transurethral resection of bladder tumor were enrolled. Induction and maintenance of anesthesia were standardized. Patients were randomly divided into two groups according to the random number table method that received either intravenous 0.9% NaCl solution[control group (group C)] or parecoxib (40 mg) (group P) at 10 min before the end of the operation. The incidence and severity of CRBD, postoperative pain, Ramsay scores, patient satisfaction, postoperative additional drugs and adverse effects were assessed at 5 min (T1), 1 h (T2), 6 h (T3) and 12 h (T4) after administration of the parecoxib by another observer who does not know research grouping situation. Results The incidence of CRBD in group P at T1, T2 and T3 was significantly lower than that in group C (89.3% vs 46.4%, 89.3% vs 35.7%, 67.9% vs 39.3%)(P 0.05). Conclusions Not only can a single intravenous injection of parecoxib 40 mg at the end of surgery effectively reduce the incidence and severity of postoperative CRBD in patients with TURBT, but also has certain analgesic effect without causing serious adverse reaction. Key words: Parecoxib; Catheter-related bladder discomfort; Transurethral resection of bladder tumor

Evaluation of Intravenous Parecoxib Infusion Pump of Patient-Controlled Analgesia Compared to Fentanyl for Postoperative Pain Management in Laparoscopic Liver Resection.

BackgroundAs laparoscopic liver resection is becoming a commonly used method for hepatic surgery, postoperative pain management is emerging as one of the trickiest problems after surgery. The ideal method of pain management is controversial and the optimal strategy for postoperative pain management after surgery remains unclear. The present study evaluated the postoperative analgesic efficacy of parecoxib and fentanyl, and the benefit of a new intravenous parecoxib infusion pump with patient-controlled analgesia after laparoscopic liver resection.Material/MethodsThis controlled, prospective, randomized, double-blind trial compared VAS scores among 3 groups of patients: a fentanyl group (FEN group) using a fentanyl citrate pump, an intravenous parecoxib group (IVPA group) receiving intravenous parecoxib, and a parecoxib pump group (PUPA group) receiving parecoxib sodium by analgesia pump. We enrolled 124 patients planned for laparoscopic liver resection. The primary outcome was VAS score at rest and with movement. Secondary outcomes were adverse effects (including nausea), sedation, pruritus, and quality of life.ResultFor all time intervals, the VAS scores were significantly lower in the PUPA group. VAS scores at rest and with movement in the PUPA group were the lowest among the 3 groups, while the scores in the FEN group were the highest. More adverse effects were detected in the FEN group, and no significant differences in adverse effects were found between the intravenous group and the parecoxib pump group.ConclusionsUse of the intravenous infusion parecoxib pump for patient-controlled analgesia provides superior analgesic efficacy and fewer adverse effects for patients after laparoscopic liver resection.

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double-blinded Controlled Trial.

Total knee arthroplasty (TKA) is an established surgical technique and is the standard treatment for degenerative knee joint diseases. However, severe pain after TKA makes it difficult for many patients to perform early postoperative rehabilitation and functional exercise, which might result in subsequent unsatisfactory recovery of knee joint function and great reduction in patients' satisfaction and quality of life. Orthopaedic surgeons have tried a large variety of analgesics and analgesic modes to relieve patients' pain after TKA. There are many analgesic regimens available in clinical practice but all have some deficiencies. Parecoxib sodium, a highly selective inhibitor of cyclooxygenase-2 (COX-2), can reduce the synthesis of peripheral prostaglandin to exert the effect of analgesia, and relieve inflammation and prevent central sensitization through inhibition of peripheral and central COX-2 expression. In addition, it can be used as a preemptive analgesic without affecting platelet aggregation. However, there does seem to be conflicting evidence in the current research as to whether parecoxib sodium can be used successfully as a preemptive analgesic; the effect of preemptive analgesia with parecoxib sodium in multimodal analgesia is still controversial. This research investigated the effects of parecoxib sodium in a preemptive multimodal analgesic regimen. Eighty-eight patients were randomized into two groups. The experimental group received parecoxib (46 patients) and the control group received saline (42 patients), administered 30 min before the initiation of the surgical procedure. A patient-controlled analgesia (PCA) pump was applied within 48 h after surgery. The visual analogue scale (VAS), drug consumption through the PCA pump, use of salvaging analgesia, range of motion (ROM) of the knee joints, and postoperative complications were observed. The VAS score in the post-anesthesia care unit (PACU) of the parecoxib group was significantly lower than that of the control group (P = 0.039). There was no significant difference in the demographic profiles, duration of operation, hemorrhage in surgery, postoperative hemorrhage, postoperative drainage, VAS at different time points, function of knee joints, length of hospital stay, use of salvaging analgesia, and postoperative drug consumption through the PCA between the two groups (P > 0.05). In preemptive multimodal analgesia regimens, parecoxib sodium can significantly decrease the VAS score in the short term, relieve pain shortly after surgery, and does not increase the incidence of complications. Parecoxib sodium is a safe and effective drug in the perioperative analgesic management for TKA.

Preemptive Analgesia with Parecoxib in Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

Total hip arthroplasty (THA) is a well-accepted surgical treatment for terminal hip diseases. To evaluate the effect of preemptive analgesia with parecoxib in patients undergoing primary unilateral THA. A randomized, double-blind, placebo-controlled study. This study was conducted at Peking Union Medical College Hospital and Beijing Jishuitan Hospital in Beijing, China. A total of 94 patients scheduled for primary unilateral THA in 2 centers (Peking Union Medical College Hospital and Beijing Jishuitan Hospital) were randomly assigned to receive 40 mg parecoxib (n = 48) or 0.9% normal saline solution (n = 46) 30 minutes before incision. All patients received standardized intravenous patient-controlled analgesia (PCA) postoperatively. Preoperative baseline data, surgery-related conditions, postoperative Visual Analog Scale (VAS) pain score, cumulative narcotic consumption of PCA, and complications were compared between the parecoxib group and the placebo group. There were no significant differences in postoperative VAS pain score, cumulative narcotic consumption of PCA, proportion of analgesic remedy, and complications between the 2 groups. Only a single dose of parecoxib was used without including a dose-dependent control group. A single dose of parecoxib 30 minutes before incision did not provide effective preemptive analgesia for the management of postoperative pain after primary unilateral THA. The possible effect of preemptive analgesia with parecoxib needs further investigation. Total hip arthroplasty, pain, parecoxib, COX-2 selective inhibitor, preemptive analgesia, clinical trial, patient-controlled analgesia, analgesics.

Ameliorative effects of parecoxib in combination with ultrasound-guided paravertebral block (UGPB) on stress and inflammatory responses following thoracoscopic surgery

Purpose : To investigate the ameliorative effects of parecoxib combined with ultrasound-guided paravertebral block (UGPB) on stress and inflammatory responses after thoracoscopic surgery. Methods : Forty thoracoscopic surgery patients were randomized into placebo (control) and parecoxib groups. Parecoxib was administered pre-operation, 24 h and 48 h after operation. Arterial blood was collected, and endotoxin (ET), thromboxane A2 (TXA2), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) levels were measured. Opioid dosage, infusion volume, blood loss, operation time, visual analogue scale (VAS) score at 24 h and 48 h, and hospitalization period were recorded. Results : No significant differences were observed in age, sex, height, body weight, opioid dosage, surgery time, blood loss, or infusion volume between groups. VAS scores in the parecoxib group were significantly lower than the control group after 24 and 48 h. The hospitalization period of the parecoxib group was significantly shorter than the control group. Plasma levels of ET, TXA2, IL-6 and TNF-α in the parecoxib group were lower than the control group after 24 h; however, there was no significant difference after 48 h. Conclusion : Parecoxib, combined with UGPB, effectively relieves thoracoscopic pain, stress, and inflammatory responses of patients after thoracoscopic surgery. This treatment would improve the postoperative quality of life of lung cancer patients. Keywords : Parecoxib, Paravertebral block, Stress response, Inflammatory response

Early analgesic effects of intravenous parecoxib and rectal diclofenac following laparoscopic sterilization: A double-blind, double-dummy randomized controlled trial

The aim of this double-blind double-dummy randomized controlled trial was to investigate if there was any difference in analgesia between the maximum recommended doses of rectal diclofenac and iv parecoxib after laparoscopic sterilization. The authors studied 55 ASA I-II patients undergoing gynecological laparoscopy; each patient received either preoperative rectal diclofenac 100 mg and 2 mL of normal saline at induction of anesthesia, or preoperative placebo suppository and 2 mL of parecoxib 40 mg at induction. Pain intensity, sedation, and nausea were measured using a 100-mm visual analogue scale on awakening and at 1, 2, and 3 hour postoperatively. Median (interquartile range) pain intensity at rest on awakening and at 1, 2, and 3 hour postoperatively were 15 (0-40), 37 (10-56), 16 (6-29), and 13 (2-32) mm, respectively, in the parecoxib group, and 3 (0-34), 22 (5-45), 24 (6-37), and 10 (4-21) mm, respectively, in the diclofenac group. There was no significant difference in these scores. Furthermore, there was no significant difference between the two groups in sedation, nausea, rescue analgesia, or rescue antiemetic consumption. Preoperative rectal diclofenac 100 mg and parecoxib 40 mg iv at induction of anesthesia were found to have equianalgesic effects after laparoscopic sterilization. Both drugs appear to be useful after short anaesthetics.

Effect of preintravenous injection of parecoxib, combined with transversus abdominis plane block in strategy of enhanced recovery after radical resection of colorectal cancer.

The objective of this study was to investigate the effect of preintravenous injection of parecoxib, combined with transversus abdominis plane (TAP) block and postoperative patient-controlled intravenous analgesia (PCIA) pump, in strategy of enhanced recovery after surgery for patients with radical resection of colorectal cancer. In this prospective study, 80 patients that underwent radical resection for colorectal cancer were randomly divided into four groups: (1) the parecoxib group, with preintravenous injection of parecoxib and postoperative PCIA after surgery; (2) the TAP group, with TAP block and postoperative PCIA; (3) the parecoxib + TAP group, with parecoxib combined with TAP block and postoperative PCIA; and (4) the control group, with only postoperative PCIA and preinjection of normal saline. The visual analog score was used to measure the pain. The mean operative time, PCIA pressing time, time for first out-of-bed activity, first anus exhaust time, hospital stay duration, and complications were recorded. Operative time of the TAP group and parecoxib + TAP group was significantly longer than that of the parecoxib group and control group. The first out-of-bed activity time, first anus exhaust time, and hospital stay time of the parecoxib + TAP group were significantly shorter than those of the other groups, while the control group was all significantly higher than the other groups. Complication rates in all strategy groups were significantly lower than in the control group; however, no significant difference was found among the strategy groups. The combination of parecoxib, TAP, and PCIA pump could significantly reduce patient postoperative pain and enhance recovery.

Parecoxib's effects on anastomotic and abdominal wound healing: a randomized Controlled trial

BackgroundCurrent evidence regarding the effects of selective cyclooxygenase inhibitors on gastrointestinal anastomoses is controversial. An experimental randomized control study was conducted in our institution to histopathologically evaluate the consequences of parecoxib, on intestinal and abdominal wound healing. MethodsTwenty-four adult Wistar rats underwent laparotomy, ascending colon transection, and hand-sewn anastomosis. They were randomized to receive either parecoxib (0.5 mg/kg twice daily) or 0.9% normal saline by intraperitoneal injection postoperatively. Animals were euthanatized either on the third or the seventh postoperative day. Semiquantitative methods were used to evaluate both intestinal and abdominal wounds for inflammatory cell composition, angiogenesis, fibroblasts, granular tissue, collagen deposition, epithelization, and presence of necrosis, exudate, and abscess formation. Results are presented as (parecoxib: median [IQR] versus control: median [IQR], P-value). ResultsNo macroscopic anastomotic leakage or wound dehiscence was observed. Intestinal anastomoses in the parecoxib group, showed significantly decreased epithelization (2 [1] versus 3 [1], [P = 0.004]) and collagen deposition (2 [0] versus 3 [1], [P = 0.041]). No difference was observed in angiogenesis (3 [1] versus 2.5 [1], [P = 0.158]). Abdominal wall specimens appeared to demonstrate decreased epithelization (2 [2] versus 4 [0.5], [P = 0.0004]) in the treatment group. No difference between the two groups was identified regarding collagen deposition (2.5 [1] versus 2 [0.5], [P = 0.280]) and angiogenesis (2.5 [1] versus 2 [1], [P = 0.633]). Necrosis was significantly more present in the parecoxib group in both specimen types, (3.5 [1] versus 2.5 [1], [P = 0.017]) and (3 [1] versus 1 [0.5], [P < 0.0001]). ConclusionsThe present study shows that despite the absence of clinical adverse effects, parecoxib can impair anastomotic and abdominal wound healing on a histopathological level.

Efficacy and Safety of Postoperative Pain Relief by Parecoxib Injection after Laparoscopic Surgeries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

This study aims to evaluate the efficacy and safety of parecoxib injection in pain relief after laparoscopic surgeries. A comprehensive literature search based on 4 online databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) was applied to retrieve all related randomized controlled trials (RCTs). Two independent reviewers screened each article for eligibility according to the predetermined inclusion criteria. The Cochrane Collaboration's tool was applied to evaluate the methodological quality of included studies. A standardized data collection sheet was designed to extract data from included studies. RevMan version 5.3 (The Cochrane Collaboration, Copenhagen, Denmark) was selected to perform meta-analysis. A total of 1,060 participants who were scheduled for gynecological laparoscopic surgery or laparoscopic cholecystectomy (LC) were enrolled in 12 selected RCTs. The methodological qualities of the studies were evaluated as moderate to high. The combined data showed that perioperative parecoxib injection could significantly reduce the proportion of patients who required adjuvant pain relieve after laparoscopic surgeries. Significantly lower pain scores in the parecoxib groups were observed, which proved that preoperative or intraoperative injection of 40 mg parecoxib was more effective than placebo for immediate pain relief after LC. But preoperative injection of 40 mg parecoxib showed no improvement compared with placebo in the management of immediate pain following gynecological laparoscopic surgery. The occurrence of adverse events showed no differences between perioperative parecoxib administration and placebo control. Perioperative parecoxib administration was effective in reducing the proportion of patients who required adjuvant pain relief after laparoscopic surgeries without significant adverse events compared with placebo. The effect of parecoxib injection on immediate pain relief remains in question. Future RCTs with larger sample sizes are encouraged.

Chronic administration of parecoxib exerts anxiolytic-like and memory enhancing effects and modulates synaptophysin expression in mice

BackgroundPrevious studies have shown that cyclooxygenase-2, a key enzyme that converts arachidonic acid to prostaglandins, is involved in anxiety and cognitive processes, but few studies have investigated the effects of chronic administration of cyclooxygenase-2 inhibitors on anxiety, learning and memory under normal physiological conditions. The aim of the study was to investigate the effects of chronic administration of parecoxib, a cyclooxygenase-2 inhibitor, on anxiety behavior and memory performance under normal physiological conditions and to explore the possible neural mechanism underlying parecoxib-mediated effects.MethodsAdult male ICR mice were randomly divided into four groups: the control group and three parecoxib groups. Mice received normal saline or parecoxib (2.5, 5.0 or 10 mg/kg) intraperitoneal injection once a day for 21 days, respectively. Elevated plus-maze, novel object recognition and Y maze tests were conducted on day 23, 24 and 26, respectively. Four additional groups that received same drug treatment were used to measure synaptophysin protein levels by western blot and prostaglandin E2 (PGE2) levels by ELISA in the amygdala and hippocampus on day 26.ResultsChronic parecoxib exerted an anxiolytic-like effect in the plus-maze test test, and enhanced memory performance in the novel object recognition and Y maze tests. Western blot analysis showed that chronic parecoxib down-regulated synaptophysin levels in the amygdala and up-regulated synaptophysin levels in the hippocampus. ELISA assay showed that chronic parecoxib inhibited PGE2 in the hippocampus but not amygdala.ConclusionsChronic parecoxib exerts anxiolytic-like and memory enhancing effects, which might be mediated through differential modulation of synaptophysin and PGE2 in the amygdala and hippocampus.

The action of anti-inflammatory agents in healthy temporomandibular joint synovial tissues is sex-dependent

This study evaluated the effects of dexamethasone, parecoxib, and glucosamine on cartilage thickness and cytokine levels in the temporomandibular joint (TMJ). Forty-eight rats (24 female, 24 male) were assigned to four treatments administered once daily for 7 days: control (saline intramuscularly), parecoxib (0.3mg/kg intramuscularly), dexamethasone (0.1mg/kg intramuscularly), and glucosamine (80mg/kg orally). The thickness of TMJ cartilage and levels of four cytokines were measured. Median cartilage thickness was higher in males than in females in the control (253.2 vs. 240.4μm, P=0.0036), parecoxib (227.3 vs. 192.1μm, P<0.0001), and dexamethasone (227.1 vs. 170.5μm, P=0.017) groups, but was lower in males in the glucosamine group (214.5 vs. 239.6μm, P=0.0001). IL-1β was not detected. Median IL-1α levels differed between males and females in the parecoxib group (0.08 vs. 0.04ng/ml, P=0.0055), but not in the control (0.07 vs. 0.06ng/ml), dexamethasone (0.06 vs. 0.04ng/ml), or glucosamine (0.08ng/ml vs. 0.06ng/ml) groups (all P>0.05). Only dexamethasone induced lower IL-6 levels in males than in females (median 4.6 vs. 2.1ng/ml, P=0.0044). Median TNF-α levels did not differ between males and females in the control (0.07 vs. 0.05ng/ml) or parecoxib (0.07 vs. 0.05ng/ml) groups (both P>0.05), but dexamethasone (0.09 vs. 0.05ng/ml, P=0.0002) and glucosamine (0.09 vs. 0.07ng/ml, P=0.0259) induced higher TNF-α levels in females. Thus, the effects of the three treatments on the levels of cytokines and thickness of condylar cartilage were sex-dependent.

Parecoxib relieves pain and has an opioid-sparing effect following major gastrointestinal surgery.

PurposeParecoxib provides analgesia following a variety of surgeries, including minor gastrointestinal procedures. To our knowledge, there is no data on parecoxib following major gastrointestinal surgery. This study assessed the efficacy and opioid-sparing effects of parecoxib following major gastrointestinal surgeries.Patients and methodsPatients in this analysis were a subset from a large, randomized, double-blind, placebo-controlled trial of parecoxib following noncardiac surgeries and consisted of those undergoing a variety of major gastrointestinal surgeries via laparotomy. Pain, pain interference with function, supplemental opioid utilization, opioid-related symptoms, and Patient/Physician Global Evaluation of Study Medication were compared between placebo and parecoxib groups in the 2−3 days following surgery.ResultsSignificantly (p<0.001) lower pain scores were observed in the parecoxib group (n=111), relative to placebo (n=126), on Day 2 (−33%) and Day 3 (−35%). Pain interference with function scores was also significantly (p<0.001) lower among patients receiving parecoxib compared with placebo on Day 2 (−29%) and Day 3 (−36%). At 24, 48, and 72 hours, the cumulative amount of supplemental morphine consumed was 45%, 41%, and 40% less in patients receiving parecoxib compared with placebo (all p<0.001). The risk of experiencing ≥1 opioid-related symptoms was also significantly lower with parecoxib than with placebo on Day 2 (relative risk=0.75; p<0.001). Specifically, the risks of fatigue and drowsiness were significantly (both p<0.05) lower in patients receiving parecoxib compared to those receiving placebo. Patient and Physician Global Evaluation of Study Medication scores were significantly better in the parecoxib group than in the placebo group (p<0.001).ConclusionThis study is the first to demonstrate that multiple-dose parecoxib, initiated upon recovery from anesthesia, provides analgesia and opioid-sparing effects following a variety of major gastrointestinal surgeries employing laparotomy.

The Effectiveness of Intravenous Parecoxib on the Incidence of Ipsilateral Shoulder Pain After Thoracotomy: A Randomized, Double-Blind, Placebo-Controlled Trial

To determine the incidence of ipsilateral shoulder pain (ISP) with the therapeutic use of parecoxib compared with a placebo after thoracotomy. A prospective, randomized, double-blind, placebo-controlled trial. A tertiary-care university hospital. Adult patients undergoing an elective thoracotomy between June 2011 and February 2015. Patients were allocated randomly into the parecoxib group (n = 80) and the control group (n = 80). In the parecoxib group, 40 mg of parecoxib was diluted into 2 mL and given intravenously 30 minutes before surgery and then every 12 hours postoperatively for 48 hours. In the control group, 2 mL of normal saline was given to the patients at the same intervals. A numerical rating scale was used to assess the intensity of ISP at 2, 6, 12, 24, 48, 72, and 96 hours after surgery. Intravenous morphine (0.05 mg/kg) was used as the rescue medication for ISP during the 96-hour period. Baseline characteristics of patients in both groups were comparable. Patients in the parecoxib group had a significantly lower incidence of ISP, both overall (42.5% v 62.0%, p = 0.014) and of moderate-to-severe ISP when compared with the control group (26.2% v 49.4%, p = 0.003). Parecoxib reduced the risk of ISP by a statistically significant 32% (risk ratio, 0.68; 95% confidence interval, 0.50-0.93, p = 0.016). There were no significant differences in the occurrence of adverse effects between the groups. Intravenous parecoxib significantly can reduce the incidence and severity of ISP after thoracotomy.

Parecoxib Provides Analgesic and Opioid-Sparing Effects Following Major Orthopedic Surgery: A Subset Analysis of a Randomized, Placebo-Controlled Clinical Trial.

IntroductionOrthopedic surgeries are among the most common and most painful surgeries performed. A multimodal analgesic approach is recommended to reduce opioid consumption, provide effective pain relief, and improve outcomes following surgery. This study examined the efficacy and opioid-sparing effects of parecoxib following major orthopedic surgery.MethodsThis subset analysis of a large, multicenter, randomized, double-blind, placebo-controlled study of parecoxib examined treatment effects on postoperative pain severity, pain interference with function, opioid consumption, occurrence of opioid-related symptoms, safety, and patient satisfaction following major orthopedic surgery.ResultsPain scores were significantly lower in the parecoxib group (n = 142) compared with placebo (n = 139) on day 2 (−22%; p < 0.001) and day 3 (−17%; p = 0.004). Pain interference with function scores were also significantly lower in the parecoxib group on day 2 (−32%; p < 0.001) and day 3 (−27%; p = 0.003) relative to placebo. Additionally, significantly less supplemental morphine was required in the parecoxib group relative to placebo through 24 h (−28%; p = 0.008) and 48 h (−33%; p < 0.001). Patients in the parecoxib group had a reduced risk of experiencing opioid-related symptoms including fatigue, drowsiness, inability to concentrate, confusion, nausea, constipation, and confusion on day 2 and/or day 3. Finally, more patients receiving parecoxib (42%) rated treatment as “excellent” compared to those receiving placebo (21%).ConclusionsThese findings support the use of parecoxib for the management of pain following major orthopedic surgery.

Effect of Parecoxib as an Adjunct to Patient-Controlled Epidural Analgesia after Abdominal Hysterectomy: A Multicenter, Randomized, Placebo-Controlled Trial

ObjectiveThis multicenter, randomized, placebo-controlled study evaluated the efficacy and side effects of parecoxib during patient-controlled epidural analgesia (PCEA) after abdominal hysterectomy.MethodsA total of 240 patients who were scheduled for elective abdominal hysterectomy under combined spinal-epidural anesthesia received PCEA plus postoperative intravenous parecoxib 40 mg or saline every 12 h for 48 h after an initial preoperative dose of parecoxib 40 mg or saline. An epidural loading dose of a mixture of 6 mL of 0.25% ropivacaine and 2 mg morphine was administered 30 min before the end of surgery, and PCEA was initiated using 1.25 mg/mL ropivacaine and 0.05 mg/mL morphine with a 2-mL/h background infusion and 2-mL bolus with a 15-min lockout. The primary end point of this study was the quantification of the PCEA-sparing effect of parecoxib.ResultsDemographic data were similar between the two groups. Patients in the parecoxib group received significantly fewer self-administrated boluses (0 (0, 3) vs. 7 (2, 15), P < 0.001) and less epidural morphine (5.01 ± 0.44 vs. 5.95 ± 1.29 mg, P < 0.001) but experienced greater pain relief compared with the control group (P < 0.001). Patient global satisfaction was higher in the parecoxib group than the control group (P < 0.001). Length of hospitalization (9.50 ± 2.1, 95% CI 9.12~9.88 vs. 10.41 ± 2.6, 95% CI 9.95~10.87, P = 0.003) and postoperative vomiting (17% vs. 29%, P < 0.05) were also reduced in the parecoxib group. There were no serious adverse effects in either group.ConclusionOur data suggest that adjunctive parecoxib during PCEA following abdominal hysterectomy is safe and efficacious in reducing pain, requirements of epidural analgesics, and side effects.Trial RegistrationClinicalTrials.gov (NCT01566669)

Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy.

Thoracotomy results in severe postoperative pain potentially leading to chronic pain. We investigated the potential benefits of intravenous parecoxib on postoperative analgesia combined with thoracic epidural analgesia (TEA). Eighty-six patients undergoing thoracic surgery were randomized into two groups. Patient-controlled epidural analgesia (PCEA) was used until chest tubes were removed. Patients received parecoxib (group P) or placebo (group C) intravenously just 0.5 h before the operation and every 12 h after operation for 3 days. The intensity of pain was measured by using a visual analogue scale (VAS) and recorded at 2, 4, 8, 24, 48, 72 h after operation. The valid number of PCA, the side effects and the overall satisfaction to analgesic therapy in 72 h were recorded. Venous blood samples were taken before operation, the 1(st) and 3(rd) day after operation for plasma cortisol, adrenocorticotropic hormone (ACTH), interleukin-6 and tumor necrosis factor-α level. The occurrence of residual pain was recorded using telephone questionnaire 2 and 12 months after surgery. Postoperative pain scores at rest and on coughing were significantly lower with the less valid count of PCA and greater patient satisfaction in group P (P<0.01). Adverse effect and the days fit for discharge were comparable between two groups. The cortisol levels in placebo group were higher than parecoxib group at T2. The level of ACTH both decreased in two groups after operation but it was significantly lower in group P than that in group C. There were no changes in plasma IL-6 and TNF-α levels before and after analgesia at T1 and T2 (P>0.05). The occurrence of residual pain were 25% and 51.2% separately in group P and C 3 months postoperatively (P<0.05). Intravenous parecoxib in multimodal analgesia improves postoperative analgesia provided by TEA, relieves stress response after thoracotomy, and may restrain the development of chronic pain.

A Comparison of Intravenous Oxycodone and Parecoxib in the Treatment of Visceral Pain after Laparoscopic Cholecystectomy

Background: Visceral pain is the most common form of pain that affects human beings. Laparoscopic cholecystectomy (LC) is also accompanied by severe postoperative pain, especially visceral pain. Non-steroidal anti-inflammatory durgs (NSAIDs) can relieve the postoperative pain but with a high percentage of side effects. It has been suggested that the analgesic effect on visceral pain of oxycodone is superior and with less side effects. This study is to compare the effects of parecoxib sodium with oxycodone on visceral pain.Methods: Seventy patients were randomized to two groups. Patients in group oxycodone (group O, N=35) received oxycodone 0.05 mg/kg intravenously (i.v.) and patients in group parecoxib (group P, N=35) received parecoxib 40 mg i.v. before the end of surgery. Patients in both groups were local anesthetized with 10 ml 1% ropivacaine (10 mg/ml) at the four trocar sites. Then the numeric rating scale (NRS) scores at rest and when coughing were assessed at the following time points: at arrival to postanesthesia care unit (PACU) (T1), 30 minutes in the PACU (T2), 2 (T3), 6 (T4) and 24 hours (T5) postoperatively, furthermore, side effects and rescued analgesic were also recorded.Results: Deep abdominal pain on NRS scores in group O at 6 hours was significantly lower than that in group P at rest (2[1-3] vs. 3[2-4.5], P=0.002) and when coughing (2[2-3] vs. 4[3-6], P<0.001). Ratios of mild/severe deep abdominal pain at rest at 6 hours were 20/13 vs. 30/3 (P=0.008) in group P and group O, respectively. Ratios of mild/severe deep abdominal pain were 14/19 vs. 23/10 (P=0.046) at 2 hours and 14/19 vs. 25/8 (P=0.012) at 6 hours when coughing in group P and group O, respectively.Conclusions: Oxycodone was more potent than parecoxib for visceral pain relief with no obvious side effects. Citation: Rui Wang, Dong-Xu Yao, Tian-Long Wang, Wei Xiao, Yang Liu. A comparison of intravenous oxycodone and parecoxib in the treatment of visceral pain after laparoscopic cholecystectomy. J Anesth Perioper Med 2015; 2: 295-300. doi: 10.24015/JAPM.2015.0040This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Effect of parecoxib on wound healing in early third degree burn in mice

Objective To evaluate the effect of parecoxib on wound healing in the early third degree burn in mice. Methods Ninety ICR male mice, aged 6–8 weeks, weighing 20–25 g, were randomly divided into 3 groups (n= 10 each) using a random number table: burn group (B group); low-dose parecoxib group (LP group); high-dose parecoxib group (HP group). In LP and HP groups, at 4 h after Ⅲdegree burn model was established, parecoxib 0.75 mg/kg and 7.50 mg/kg were injected intraperitoneally, respectively, every 24 h (administration 3 times in total). The equal volume of normal saline 0.5 ml was given in group B. Ten rats were sacrificed at 24 h after each administration (T1-3), the tissues from and around the burn wound were obtained and observed for microscopic examination (under light microscope), and for determination of endothelial marker factor Ⅷ-related antigen expression, and microvessel count. Results Compared with group B, no significant change was found in inflammatory responses in the wound at each time point in group LP, and the inflammatory responses in the wound were significantly alleviated at T3, and the wound healing was better in group HP.Compared with group B, the microvessel count was significantly increased at T3 (P 0.05). Conclusion Parecoxib 7.50 mg/kg can promote wound healing in the early third degree burn in mice. Key words: Cyclooxygenase inhibitors; Burns; Wound healing

A comparison of parecoxib and thoracic epidural analgesia for postoperative analgesia following Nuss procedure

BackgroundThe purpose of this study was to compare the results of thoracic epidural analgesia (TEA) and parecoxib in controlling postoperative pain after the Nuss procedure. MethodsBetween August 2005 and July 2014, 120 adolescents and adults underwent Nuss procedures and received either TEA or parecoxib for postoperative pain control. Demographic data, preoperative preparation times, visual analog scale (VAS) pain scores from postoperative day 1 to day 5, medical costs of pain control, days to Foley catheter removal, days to being able to sit up, days to being able to walk, days of hospital stay, nausea/vomiting scores, and complications related to pain control were compared. ResultsA total of 106 patients received TEA, and 14 received parecoxib. No between-group differences in demographics were observed. Patients in the parecoxib group had shorter preparation times (p<0.001), lower VAS pain scores from postoperative day 2 to day 5 (day 2, p=0.006; day 3, p=0.006; day 4, p<0.001; day 5, p<0.001), shorter hospital stays (p<0.001), lower pain control costs (p<0.001), and lower nausea/vomiting scores (p=0.046). ConclusionsFor adolescents and adults undergoing the Nuss procedure, parecoxib affords better pain control efficacy, a shorter hospital stay, lower medical pain control costs, and fewer side effects compared with TEA.

Effects of parecoxib on pulmonary inflammation during lung ischemia- reperfusion injury in rats

Objective To investigate the effects of parecoxib on pneumocyet apoptosis during lung ischemia- reperfusion(I/R)injury in rats. Methods Seventy- two male SD rats were randomly divided into 3 groups(n= 24 each):group sham operation; group I/R and group parecoxib.lung I/R was induced by occlusion of hilum of the right lung for 60 min followed by 120 min of reperfusion.In P group parecoxib 5 mg/kg was injected iv at 30 min before occlusion of hilum of the right lung.The rats were sacrificed at 2 h of reperfusion and then the lungs were removed for measurement of lung wet/dry weight ratio, and the percentage of neutrophil in bronchoalveolar lavage fluid (BALF) were detected. The levels of malondialdehyde(MDA) and superoxide dismutase(SOD) were measured.The tumor necrosis(TNF-α) and interleukin 1β(IL- 1β) in BALF supernatant were determined by using enzyme linked immunosorbent assay(ELISA) method. Results Parecoxib significantly attenuated the I/R- induced changes in lung.wet/dry weight ratio(6.34±0.19 vs.5.28± 0.17, P< 0.05), the levels of malondialdehyde(MDA)[(9.26±1.85) mol/L vs.(5.45±1.12) mol/ L, P< 0.05], superoxide dismutase(SOD)[(98.1±12.6) U/ml vs.(155.8±14.4) U/ml, P< 0.05]and The rumor necrosis factor-α(TNF-α)[(425.2±41.8)ng/L vs.(335.4±33.2) ng/L, P<0.05].Interleukin 1β[(178.1±22.6)ng/L vs.(105.4±15.9)ng/L, P<0.05]in group P compared with group I/R.Parecoxib ameliorated I/R- induced lung damage. Conclusion Compared with I/R group, the more attenuation of pulmonary inflammation in Parecoxib group after lung I/R injury is associated with less neutrophil activation and decrease in production of the inflammatory cytokines. Key words: Parecoxib; Reperfusion injur; Lung; Tumor necrosis factor-α; Interleukin-1