Parecoxib Research Articles

Effect of parecoxib sodium combined with dexmedetomidine on postoperative levels of plasma excitatory aminoacid and beta-amyloid protein in jugular bulb venous of elderly patients

Objective To investigate the effect of parecoxib sodium combined with dexmedetomidine on postoperative levels of plasma excitatory aminoacid and beta-amyloid protein (β-AP) in jugular bulb venous of elderly patients. Methods A total of 135 patients of either sex, aged 65-79 yr, weighing 47-76 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective open reduction and internal fixation after tibial fracture and hip replacement, were divided into 3 groups (n=45 each) using a random number table: parecoxib sodium group (group P), dexmedetomidine group (group D) and parecoxib sodium combined with dexmedetomidine group (group PD). In group P, parecoxib sodium 40 mg (diluted to 5 ml in normal saline) was injected intravenously at 15 min before induction of anesthesia.In group D, dexmedetomidine was intravenously infused at a loading dose of 0.5 μg/kg over 15 min starting from 15 min before induction of anesthesia, followed by an infusion of 0.5 μg·kg-1·h-1 until the end of surgery.In group PD, parecoxib sodium 40 mg (diluted to 5 ml in normal saline) was intravenously injected at 15 min before induction of anesthesia, and dexmedetomidine was intravenously infused at a loading dose of 0.5 μg/kg over 15 min followed by an infusion of 0.5 μg·kg-1·h-1 until the end of surgery at the same time.At 15 min before induction of anesthesia (T0), at the end of surgery (T1) and at 24, 48 and 72 h after surgery (T2-4), jugular bulb venous blood samples were taken for determination of concentrations of glutamate and aspartate in plasma (by reversed phase high-performance liquid chromatography) and β-AP (by enzyme-linked immunosorbent assay). Cognitive function was assessed at 1 day before surgery and 7 days after surgery using a battery of neuropsychologic tests including Wechsler Memory Scale, Digit Span (Forward and Backward), visual recognition and associative learning, Wechsler Adult Intelligence Scale and Trail Making Test Part A. The occurrence of postoperative cognitive dysfunction was recorded at 7 days after surgery. Results Compared with P and D groups, the concentrations of plasma glutamate at T2-3, plasma aspartate at T2 and β-AP at T1 and incidence of postoperative cognitive dysfunction were significantly decreased in group PD (P< 0.05). Conclusion The mechanism by which parecoxib sodium combined with dexmedetomidine decreases the occurrence of POCD may be related to inhibiting the levels of excitatory aminoacid and β-AP in brain tissues of elderly patients. Key words: Cyclooxygenase inhibitors; Dexmedetomidine; Excitatory amino acids; Amyloid beta-protein; Cognition disorders; Aged

Efficacy of parecoxib sodium on postoperative shivering: meta-analysis of clinical trials.

ObjectiveTo evaluate the effect of parecoxib on preventing postoperative shivering.MethodsMain outcomes were the relative risk (odds ratio, OR) and 95% confidence interval (CI) relative to the incidence of shivering.ResultsFourteen trials with 1,175 patients were analyzed. The pooled evidence suggested that parecoxib sodium, given before anesthesia or postoperatively (only 4 cases), had the potential to prevent postoperative shivering (OR = 0.21, 95% CI, 0.16, 0.29). Compared with the placebo, parecoxib sodium significantly lowered the incidence of postoperative shivering as follows: mild shivering [OR = 0.51, 95% CI (0.35, 0.74)]; moderate shivering [OR = 0.28, 95% CI (0.18, 0.45)]; severe shivering [OR = 0.18, 95% CI (0.10, 0.33)]. Compared with placebo, there was no significant association of parecoxib sodium with restlessness [OR = 0.95, 95% CI (0.59, 1.52)] or nausea/vomiting [OR = 0.24, 95% CI (0.09, 0.66)]. In addition, pethidine rescue was used significantly more often in the control group than in the parecoxib sodium group [OR = 0.22, 95% CI (0.09, 0.53)].ConclusionsParecoxib sodium may be an effective strategy for preventing postoperative shivering.

Parecoxib sodium pretreatment reduces myoclonus after etomidate: A prospective, double-blind, randomized clinical trial .

Myoclonus induced by etomidate during induction of general anesthesia is a common phenomenon. This prospective, randomized, saline-controlled clinical study was performed to evaluate the effect of parecoxib sodium pretreatment on the incidence and severity of etomidate-induced myoclonus. 60patients, American Society of Anesthesiologists (ASA) physical status I or II, aged 20 to 60 years, who were scheduled to undergo elective laparoscopic cholecystectomy under general anesthesia, were allocated randomly into one of two groups to receive parecoxib sodium 40mg intravenous (group P, n=30) or the same volume of saline (group S, n=30) 30minutes before administration of etomidate (0.3mg/kg). Myoclonus was assessed on a scale of 0-3. Postoperative side effects were recorded. The two groups were comparable with regard to baseline characteristics. The incidence of myoclonus was significantly lower in the parecoxib sodium group (11/30; 37%) than in the saline group (21/30; 70%) (p<0.05). The severity of myoclonic movements was also significantly reduced by parecoxib sodium (p<0.05). There were no significant differences between the two groups with respect to postoperative side effects. Pretreatment with intravenous injection of parecoxib sodium 40mg significantly reduced the incidence and severity of etomidate-induced myoclonus without significant side effects. .

Effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy: A randomized double blinded controlled trial

Study objectiveTo evaluate effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy. DesignRandomized, double-blind study. SettingUniversity-affiliated teaching hospital. PatientsOne hundred and fifty-two elderly patients scheduled for shoulder arthroscopy. InterventionsAt 15min before the induction of anesthesia, 152 patients received intravenously parecoxib sodium 40mg and dexmedetomidine at a dose of 0.5μg/kg over 15min, followed by a continuous infusion at a rate of 0.5μg/kg/h until the end of surgery. Then all patients who received postoperative patient-controlled intravenous analgesia were divided 2 groups: sufentanil(0.04μg/kg/h, S group), sufentanil (0.04μg/kg/h) plus dexmedetomidine(0.06μg/kg/h) (SD group). MeasurementsThe mini–mental status examination score in SD group was significantly higher than S group at 1, 2 and 7days after surgery. The incidence of postoperative cognitive dysfunction during 7days after surgery in S and SD groups was respectively 17.1% and 6.7%. Compared with the S group, the visual analogue scale scores at rest and upon movement were significantly lower at 6, 14, 24, 36 and 48h after surgery in SD group; analgesia pump liquid amount during 24h after surgery and number of rescue analgesia during 48h after surgery were significantly lower in SD group. Jugular venous oxygen partial pressure and jugular venous oxygen saturation values in SD group were significantly higher than S group at postoperative 24h. The occurrence of nausea and vomiting within 48h after surgery in SD group were significantly lower than S group. We found no complications including respiratory depression and sinus bradycardia within 48h after surgery in all patients. ConclusionsParecoxib sodium pretreatment combined with dexmedetomidine could reduce the incidence of early postoperative cognitive dysfunction in elderly patients. This might be related to the improvement of postoperative analgesia effect and cerebral oxygen metabolism in patients.

Validated Stability-indicating RP-HPLC Method for the Determination of Parecoxib Sodium and Degradation Impurities in Bulk Drug

Background: Parecoxib sodium (PCX), the selective cyclooxygenase (COX)-2 inhibitor, has aroused great interests among researchers mainly because of its central role in analgesic and antiinflammatory effects in a wide range of perioperative or postoperative procedures. The aim of the current study was to develop and validate a precise, accurate, and specific HPLC method systematically which could accomplish the stability indicating of PCX bulk drug and qualitation and quantization for the formed main impurity under the stressed conditions. Keywords: HPLC-UV/DAD, parecoxib sodium, stability-indicating, degradation products, validation, titrimetric method.

Multimodal Pain Management for Laparoscopic Adnexal Surgery: A comparative cohort study

Objectives: To determine the morphine-sparing effect of multimodal pain management for laparoscopic surgery. Materials and Methods : A retrospective cohort study was carried out in 210 patients who underwent laparoscopic adnexal surgery from August 2008 to November 2013 at the Songklanagarind Hospital. The patients were divided into three groups (n = 70 each) according to analgesic management. Group I received parecoxib 40 mg intravenously 2 hours preoperatively with postoperative paracetamol/NSAIDs around the clock, Group II received parecoxib 40 mg intravenously 15-30 minutes preoperatively with postoperative paracetamol/NSAIDs as needed, and Group III received only postoperative paracetamol/NSAIDs as needed. Morphine or fentanyl was used during operation and morphine was used as needed for severe postoperative pain in all cases. Patients in each group were matched by the operation in the same time period. The consumption of analgesic agents during surgery and 24 hours postoperation, pain scores, and adverse events were evaluated. Results: Intraoperative morphine consumption was not different among the 3 groups. However, in the 24 hours postoperation, 40% of patients in Group I received morphine (mean 1.1 mg) compared to 68.6% in Group II (mean 6.1 mg) and 80% in Group III (mean 9.6 mg) (p < 0.01). Group I received more postoperative paracetamol/NSAIDs than both Group II and Group III (p < 0.01). Group I had 88.5% morphine-sparing effect compared to Group III and 82% compared to Group II. The pain scores were similar between the groups. Conclusions: Preemptive parecoxib and postoperative paracetamol/NSAIDs provide a significant morphine-sparing effect in laparoscopic adnexal surgery.

Application of multimodal analgesia in radical gastrectomy for gastric cancer patients: a prospective nonrandomized controlled study

To compare the postoperative analgesia efficacy, rehabilitation parameters and complication between multimodal analgesia and traditional analgesia after radical gastrectomy for gastric cancer patients. Patients with gastric cancer who underwent surgery in our hospital from October 2016 to December 2016 were enrolled in this prospective study. According to the non-randomized method, patients were assigned to multimodal analgesia group(n=32) and traditional analgesia group(n=33) in gastric cancer treatment team A and B in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. The treatment measures of group A were as follows: (1) The ratio of 1/1 diluted ropivacaine (100 mg, 10 ml) was infiltrated around the incision before abdomen closure, with incision sutured layer by layer. (2) Parecoxib sodium (40 mg) was injected intravenously every 12 hours after operation for 5 days. (3) Oxycodone-acetaminophen tablet was given orally on the first day or the second day after operation, 50 mg twice a day. (4) Patient-controlled analgesia was not used after operation. Patients in group B received direct suture of incision and patient-controlled analgesia. The pain score, postoperative rehabilitation and 30-day postoperative complications were collected and analyzed. Multimodal analgesia group had lower pain scores at 1 d (4.8±0.9), 2 d (4.3±1.0), 3 d (2.9±0.8), 4 d (2.4±0.7) and 5 d (1.7±0.7) after surgery, as compared to traditional analgesia group (5.9±0.9, P=0.000), (5.1±0.7, P=0.001), (3.9±0.8, P=0.000), (3.0±0.6, P=0.000), (2.6±0.7, P=0.000), with significant difference. Postoperative hospital stay [(8.2±1.6) days vs. (10.6±2.2) days, P=0.000], time to ambulation [(47.5±13.8) days vs. (66.2±16.8) days, P=0.000], time to first flatus [(76.4±25.2) days vs. (120.0±29.9) days, P=0.000], time to first defecate [(117.3±42.2) days vs. (159.7±30.7) days, P=0.000] and time to first fluid diet [(83.8±21.6) days vs. (141.9±33.9) days, P=0.000] in the multimodal analgesia group were significantly shorter than those in the traditional analgesia group. There was no significant difference between the two groups with respect to 30-day postoperative complication rate(9.4% vs. 9.1%, P=1.000). Multimodal analgesia can significantly reduce the postoperative pain and is beneficial to rehabilitation, meanwhile it does not increase the risk of postoperative complications. Multimodal analgesia is safe and effective for gastric cancer patients undergoing radical gastrectomy.

Clinical values of multimodal preventive analgesia in patients with partial hepatectomy for liver cancer

Objective: To investigate the clinical values of multimodal preventive analgesia in patients with partial hepatectomy for liver cancer. Methods: A perspective study was conducted to collect data of patients with liver cancer who underwent partial hepatectomy from March 2014 to March 2015.The 90 patients involved in the study were randomly divided into two groups as multimodal analgesia and control groups, and each group had 45 cases. In multimodal analgesia group, 40 mg parecoxib sodium was injected intravenously 30 minutes before anesthetic induction, and 0.375% ropivacaine 150 mg combined with dexamethasone 5 mg were applied to transversus abdominis plane block before closing abdomen.The patients in control group without above treatment. Patient controlled intravenous analgesia was used in all patients. Three days after surgery, 40 mg parecoxib sodium was injected intravenously, twice a day for all patients.Visual analogue scales (VAS) was used to evaluate postoperative pain, and postoperative adverse events were observed.The number of cases of postoperative ambulation (>6 h for every day), time of flatus and defecation, and duration of hospital stay were recorded in two groups.Pearson chi-square test was used to compare the rate or constituent ratio between two groups.Independent sample t test or Mann-Whitney U was used to analyzed the measurement data between two groups. Results: There were no difference between two groups in aging, gender, weight, body mass index, ASA classification, blood loss volume, time of operation(all P>0.05). The scores of VAS in multimodal analgesia group was significantly lower than that in control group(3.0±0.8 vs. 4.6±1.1, t=7.814, P<0.01 for day 1; 2.2±1.0 vs. 3.6±1.2, t=5.825, P<0.01 for day 2; 1.6±0.8 vs. 2.4±1.2, t=3.894, P<0.01 for day 3). The number of cases of postoperative ambulation(>6 h) in multimodal analgesia group was significantly more than that in control group (10 cases vs. 0 case, χ(2)=11.250, P<0.01 for day 1; 21 cases vs. 5 cases, χ(2)=13.846, P<0.01 for day 2; 28 cases vs. 17 cases, χ(2)=5.378, P =0.020 for day 3). The time of flatus and defecation, and duration of hospital stay were significantly shorter than that in control group((30.2±7.3) hours vs. (36.4±7.0)hours, t=4.115, P<0.01 for flatus; (50.9±5.2)hours vs. (60.7±7.3)hours, t=7.346, P<0.01 for defecation; (6.2±0.8)days vs. (9.6±1.1)days, t=16.615, P<0.01 for hospital stay). Conclusion: Multimodal preventive analgesia effectively alleviate the postoperative pain, benefits early ambulation, improves recovery of gastrointestinal function, and shortens duration of hospital stay in patients with partial hepatectomy for liver cancer.

Influence of Parecoxib combined with Morphine on delirium incidence in elderly patients

Objectives To investigate the influence of multimodel analgesia of Parecoxib combined with Morphine on delirium in elderly patients. Methods Patients aged 60-85 years scheduled for thoracic surgery, general surgery or orthopedic surgery were randomized into Parecoxib combined with Morphine group(PM group)or Morphine alone group(M group). All patients in two groups received the same regimen of Morphine for patient controlled intravenous analgesia(PCIA)after operation.Patients in PM group received the first dose of Parecoxib 40 mg at the end of surgery, and then received parecoxib 40 mg per dose at 12-hour interval until postoperative 72 hours.Patients in M group received normal saline instead of Parecoxib.Incidence rate of delirium was evaluated during 1st to 5th postoperative day(confusion assessment method for the intensive are unit). The visual analogue score(VAS), daily morphine consumption, presence of nausea and vomiting(PONV), Blood urea nitrogen, serum creatinine, alanine aminotransferase, aspartate aminotransferase, prothrombin time, activated partial throboplastin time, and international normallized ratios on 1st to 3rd postoperative day were recorded and compared between the two groups. Results The delirium incidence during 5 days after operation was 4.3%(11/257)in PM group, and 6.8%(17/250)in morphine alone group(P>0.05). From 1st to 3rd postoperative day, PM group versus M group showed that VAS was lower(P<0.01), consumption of Morphine was lower(P<0.05), incidence of PONV was lower(P<0.05). Conclusions Parecoxib combined with morphine used in the elderly patients improves postoperative analgesia, reduces morphine consumption and incidence of PONV, but has no significant effect on delirium incidence. Key words: Abortifacient agents, nonsteroidal; Delirium; Analgesia

Effect of Bupivacaine Local Infiltration Compared with Parecoxib Intravenous Administered in Post Surgical Pain Management Following Total Abdominal Hysterectomy

Objective: To compare effect of bupivacaine local infiltration with parecoxib intravenous administered for post surgical pain relief in woman undergoing abdominal hysterectomy. Materials and Methods: From August 2014 to January 2015, 42 patients scheduled for abdominal hysterectomy under general anesthesia were randomly allocated to 2 groups. Group P (n=21) were received 40 mg intravenous parecoxib and group B (n=21) were received 0.5% bupivacaine 20 mL intraoperative injection to incisional surgical site before the subcutaneous fat and skin were closed. All patients were received morphine patient-controlled analgesia (PCA) at ward. Main outcome measures: Pain scores, morphine consumption, sedation score and nausea or vomiting were assessed at 2, 6, 10, 14 and 26 hours after surgery. Antiemetic requirement, pruritus and satisfaction scores were evaluated at 26 hours after surgery. Results: No significant differences between 2 groups in age, BMI, surgical time and intraoperative dose of fentanyl were found. Pain scores at rest were significantly lower (p=0.045) in the P group at 2, 14 hours after surgery. There were no significant differences in pain scores during movement, morphine consumption, sedation score, nausea or vomiting, antiemetic requirement, pruritus and satisfaction scores between 2 groups. Conclusion: The use of parecoxib with PCA morphine in post operative analgesia reduced pain significantly when compared with bupivacaine at 2 and 14 hours after surgery.

Efficacy and safety of Postoperative Intravenous Parecoxib sodium Followed by ORal CElecoxib (PIPFORCE) post-total knee arthroplasty in patients with osteoarthritis: a study protocol for a multicentre, double-blind, parallel-group trial.

IntroductionTotal knee arthroplasty (TKA) has been regarded as a most painful orthopaedic surgery. Although many surgeons sequentially use parecoxib and celecoxib as a routine strategy for postoperative pain control after TKA, high quality evidence is still lacking to prove the effect of this sequential regimen, especially at the medium-term follow-up. The purpose of this study, therefore, is to evaluate efficacy and safety of postoperative intravenous parecoxib sodium followed by oral celecoxib in patients with osteoarthritis (OA) undergoing TKA. The hypothesis is that compared to placebo with opioids as rescue treatment, sequential use of parecoxib and celecoxib can achieve less morphine consumption over the postoperative 2 weeks, as well as better pain control, quicker functional recovery in the postoperative 6 weeks and less opioid-related adverse events during the 12-week recovery phase.Methods and analysisThis study is designed as a multicentre, randomised, double-blind, parallel-group and placebo-controlled trial. The target sample size is 246. All participants who meet the study inclusion and exclusion criteria will be randomly assigned in a 1:1 ratio to either the parecoxib/celecoxib group or placebo group. The randomisation and allocation will be study site based. The study will consist of three phases: an initial screening phase; a 6-week double-blind treatment phase; and a 6-week follow-up phase. The primary end point is cumulative opioid consumption during 2 weeks postoperation. Secondary end points consist of the postoperative visual analogue scale score, knee joint function, quality of life, local skin temperature, erythrocyte sedimentation rate, C reactive protein, cytokines and blood coagulation parameters. Safety end points will be monitored too.Ethics and disseminationEthics approval for this study has been obtained from the Ethics Committee, Peking Union Medical College Hospital, China (Protocol number: S-572) Study results will be available as published manuscripts and presentations at national and international meetings.Trial registration numberNCT02198924.

Comparison of analgesic effects of epidural Morphine versus lumbosacral plexus block in elderly patients undergoing hip joint replacement

Objective To compare the analgesic effects of epidural Morphine versus lumbosacral plexus block in patients undergoing hip joint replacement. Methods A total of 94 ASA Ⅰ~Ⅱ patients undergoing hip surgery with combined spinal epidural anesthesia(CSEA) were selected and randomized into 4 groups: Group M received a single epidural injection of 2 mg Morphine for analgesia, Group MN1 received an epidural injection of 1 mg Morphine combined with lumbosacral plexus block, Group MN2 received an epidural injection of 2 mg morphine combined with lumbosacral plexus block, and Group N received lumbosacral plexus block. All patients were administered intramuscular parecoxib for 3 days after surgery and, if the visual analogue scale(VAS)≥4, additional intramuscular tramadol. Patient-controlled intravenous analgesia(PCIA) was applied if pain relief was insufficient after Tramadol treatment. Postoperative analgesic effects, the ability to ambulate and side effects were monitored. Results VAS scores gradually increased in the 4 groups after surgery and were higher between the morning of the 1st day and the evening of the next day than at 4 hours after surgery in all the 4 groups. There were no significant differences in VAS scores between rest and exercise conditions in any of the 4 groups. Ambulatory VAS scores were lower in Groups MN1 and MN2 than in Groups M and N 6 hours after surgery, while resting VAS scores had no significant differences between the 4 groups. Resting and ambulatory VAS scores were both lower in Groups MN1 and MN2 than in Groups M and N 6 hours after surgery, while they had no significant differences between either Groups MN1 and MN2 or Groups M and N 4-8 hours after surgery. Resting and ambulatory VAS scores were lower in Groups M, MN1 and MN2 than in Group M on the morning of the day after surgery, and more patients in Group N needed early tramadol and PCIA for rescue analgesia. Muscle strength was lower in Groups MN1 and MN2 than in Groups M and N 4 hours and on the morning of the day after surgery. No significant differences between the groups were found in standing ability 6 hours after surgery and in motor activity on the morning of the day after surgery. The incidence of urinary retention was higher in Groups M and MN2 than in Groups MN1 and N, and was higher in Group MN1 than in Group N. The incidence of pruritus was higher in Groups M and MN2 than in Group N. There was no significant difference in Ramsay sedation scores and postoperative nausea and vomiting(PONV) between the groups. Conclusions Epidural morphine combined with lumbosacral plexus nerve block can provide better analgesic effects than a single dose of epidural morphine or lumbosacral plexus nerve block in elderly patients undergoing hip joint replacement. Although the synergy of the combination has certain influence on early muscle strength recovery, it does not affect early postoperative rehabilitation training. With the combined use of parecoxib and lumbosacral plexus nerve block, epidural injection of 1 mg and 2 mg morphine provides similar analgesic effects, but epidural injection of 2 mg morphine results in a higher incidence of urinary retention. Thus, a small dose of epidural morphine combined with lumbosacral plexus nerve block is recommended for postoperative analgesia in elderly patients receiving hip joint replacement. Key words: Analgesia, epidural; Arthroplasty, replacement, hip; Morphine; Lumbosacral

Simultaneous determination of parecoxib sodium and its active metabolite valdecoxib in rat plasma by UPLC-MS/MS and its application to a pharmacokinetic study after intravenous and intramuscular administration.

In this study, we developed and validated a new, rapid, specific and sensitive ultra-performance liquid chromatography-tandem mass spectrometric (UPLC-MS/MS) method to simultaneously determine parecoxib sodium (PX) and its active metabolite, valdecoxib (VX), in rat plasma. Plasma samples were prepared by plasma protein precipitation combined with a liquid-liquid extraction method. The separation was carried out on a Kinetex C18 column (2.1mm×50mm, 2.6μm) with a gradient elution using methanol (A) and a 2mM ammonium acetate aqueous solution (B). The analysis was performed in less than 3min with a flow rate of 0.2mL/min. Ketoprofen was used as an internal standard (IS). Mass spectrometric detection was conducted with a triple quadrupole detector equipped with electrospray ionization in the negative ion mode (ESI(-)) using multiple reaction monitoring (MRM). The calibration curves were linear over the concentration ranges of 5-4000ng/mL for PX and 5-2000ng/mL for VX with all correlation coefficients greater than 0.998. The intra- and inter-day relative standard deviations (RSD) for both analytes were within 15% and the accuracy was within 85-115% at all quality control levels. The mean extraction recoveries for all analytes obtained from three concentrations of QC plasma samples were more than 89.0% efficient. Selectivity, matrix effect, dilution integrity and stability were also validated. The method was successfully used to investigate the pharmacokinetics of PX and VX in rat plasma after intravenous and intramuscular administration of PX.

Effect of perioperative parecoxib sodium on postoperative pain control for transcatheter arterial chemoembolization for inoperable hepatocellular carcinoma: a prospective randomized trial

Pain is one of the most common side effects of transcatheter arterial chemoembolization (TACE) treatment. This study aimed to assess the analgesic effect of parecoxib sodium for postoperative pain control in patients with inoperable hepatocellular carcinoma (HCC) undergoing TACE. This randomized placebo-controlled prospective clinical study was conducted at a single cancer centre. Patients were randomly assigned to receive parecoxib sodium (experimental group; n = 60) or 0.9% sodium chloride (control group; n = 60) 1h before TACE and once every 12h for 2days after TACE. Pain level, morphine consumption, adverse events, and quality of life were evaluated and compared between the two groups. Pain scores, percentage distribution of pain categories, and morphine consumption were significantly lower in the experimental group than in the control group (P < 0.05). Fever score comparisons revealed significantly better body temperature balance in the experimental group than in the control group (P = 0.024). Quality-of-life scores in the experimental group were significantly better than those in the control group (P < 0.05). Our results demonstrate that the perioperative administration of parecoxib significantly improved its effectiveness in the control of postoperative pain after TACE. • Perioperative administration of parecoxib is effective for control of pain after TACE. • COX-2 inhibitors provide effective and safe pain control. • Parecoxib helps improve quality-of-life after TACE for patients with inoperable hepatocellular carcinoma.

Impact of parecoxib on hospital discharge: retrospective analysis of Brazilian health insurance

ABSTRACT BACKGROUND AND OBJECTIVES: Adequate postoperative pain and renal colic control is critical for patients' recovery and to decrease hospitalization costs and the use of resources. So, this study aimed at evaluating hospitalization time of patients treated with parecoxib sodium versus other non-steroid anti-inflammatory drugs to manage postoperative pain of appendectomy or fractures and renal colic. METHODS: This is a retrospective data analysis of Brazilian private hospitals medical bills, including patients treated with non-steroid anti-inflammatory drugs to decrease post-appendectomy pain (n=1618), post orthopedic fracture pain (n=2858 and renal colic (n=6555), between January and June 2014. Mean hospitalization time was evaluated according to each group of drugs. Mean difference among groups was calculated by the Kruskal-Wallis method. RESULTS: Mean hospitalization time for patients submitted to appendectomy was 1.95 days with parecoxib versus 2.20 with other non-steroid anti-inflammatory drugs (p= 0.006). For patients submitted to orthopedic fracture surgery, mean time was 1.75 days with parecoxib versus 1.93 days with other anti-inflammatory drugs (p=0.008). Parecoxib has also significantly decreased hospitalization time for renal colic as compared to other drugs (25.2h versus 32.9h; p<0.001). CONCLUSION: Parecoxib sodium has provided shorter hospitalization time with possible decrease in use of resources and costs and should be considered a choice for such painful conditions.

Preventive effect of low-dose sufentanil combined with parecoxib sodium for hyperalgesia of remifentanil anesthesia after postoperative

Objective To explore preventive effect of low-dose sufentanil combined with parecoxib sodium for hyperalgesia of remifentanil anesthesia after postoperative. Methods A total of 120 patients undergoing elective abdominal surgery under general anesthesia was randomly divided into three groups that were given intraoperative remifentanil infusion. At the 30 minutes before surgery, group A were given intravenous sufentanil 0.1 μg/kg combined with 40 mg parecoxib sodium, group B were given intravenous sufentanil 0.2 μg/kg combined with 40 mg parecoxib sodium, and group C were given normal saline 5 ml. Postoperative recovery time, extubation time, postoperative 1, 2, 6, 12, and 24 h visual analog scale (Visual Analogue Scale/Score, VAS) score, and after 24 h additional analgesia number of cases and the restless occurrence of three groups were compared. Results Awakening time and extubation time of group B was significantly longer than groups A and C [(10.9±1.3)min vs (8.6±0.6)min, (8.2±0.7)min; (14.0±2.1)min vs (10.7±2.2)min, ( 10.8±1.2)min, all P 0.05). Conclusions Low dose sufentanil together with parecoxib sodium can inhibit after-remifentanil-induced hyperalgesia, and will not appear awakening time and extubation time delays and safe. Key words: Sufentanil/AD; Cyclooxygenase 2 inhibitors/AD; Fentanyl/TU; Anesthesia; Hyperalgesia/PC

Parecoxib sodium reduces the need for opioids after tonsillectomy in children: a double-blind placebo-controlled randomized clinical trial.

Postoperative pain is a common phenomenon after pediatric tonsillectomy. This prospective randomized double-blind placebo-controlled clinical trial was performed to evaluate the analgesic efficacy of intravenous parecoxib sodium in children undergoing tonsillectomy. Sixty children (American Society of Anesthesiologists physical status I-III, aged three to seven years, and scheduled to undergo elective tonsillectomy under general anesthesia) were randomly allocated into one of two groups to receive intravenous parecoxib sodium 1 mg·kg(-1) (Group P, n = 30) or the same volume of saline (Group S, n = 30) just after induction of general anesthesia. Between-group comparisons were made for the number of patients requiring rescue morphine, total number of doses of postoperative rescue morphine, time to first rescue analgesic, postoperative pain and sedation scores, and adverse effects. Rescue morphine was given to more children in Group S (25/30, 83%) than in Group P (17/30, 57%) [relative risk (RR), 1.5; 95% confidence interval (CI), 1.0 to 2.1; P = 0.024]. The mean (SD) time to first rescue analgesic was shorter in Group S than in Group P [132 (54) min vs 193 (78) min, respectively; mean difference, 61; 95% CI, 26.6 to 96.1; P = 0.001]. The median (interquartile range [IQR]) Children's Hospital of Eastern Ontario Pain Scale scores in the postanesthesia care unit were lower in Group P than in Group S (7 [5-8] vs 9 [8-11], respectively; P = 0.001). The incidence of postoperative nausea and vomiting (PONV) was higher in Group S than in Group P [11/30 (37%) vs 4/30 (13%), respectively; RR, 2.8; 95% CI, 1.0 to 7.7; P = 0.037]. A single intravenous injection of parecoxib sodium 1 mg·kg(-1) after anesthesia induction is an effective method for the control of postoperative pain. It provides a morphine-sparing effect, prolongs the time to first rescue analgesic, and reduces PONV in children undergoing tonsillectomy.

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

Paclitaxel-induced lung injury and its amelioration by parecoxib sodium

To investigate the mechanism of paclitaxel-induced lung injury and its amelioration by parecoxib sodium. In this study, rats were randomly divided into: the control group (Con); the paclitaxel chemotherapy group (Pac); the paclitaxel+ parecoxib sodium intervention group (Pac + Pare); and the parecoxib sodium group (Pare). We observed changes in alveolar ventilation function, alveolar-capillary membrane permeability, lung tissue pathology and measured the levels of inflammatory cytokines and cyclooxygenase-2 (Cox-2) in lung tissue, the expression of tight junction proteins (Zo-1 and Claudin-4). Compared with the Con group, the lung tissue of the Pac group showed significantly increased expression of Cox-2 protein (p < 0.01), significant lung tissue inflammatory changes, significantly increased expression of inflammatory cytokines, decreased expression of Zo-1 and Claudin-4 proteins (p < 0.01), increased alveolar-capillary membrane permeability (p < 0.01), and reduced ventilation function (p < 0.01). Notably, in Pac + Pare group, intraperitoneal injection of parecoxib sodium led to decreased Cox-2 and ICAM-1 levels and reduced inflammatory responses, the recovered expression of Zo-1 and Claudin-4, reduced level of indicators reflecting the high permeability state, and close-to-normal levels of ventilation function. Intervention by the Cox-2-specific inhibitor parecoxib sodium can block this damage.