Lack of analgesic effect of parecoxib following laparoscopic cholecystectomy

• Published in: Acta anaesthesiologica Scandinavica Vol. 50; no. 8; pp. 1027 - 1032
• Main Authors: Puolakka, P. A. E., Puura, A. I. E., Pirhonen, R. A., Ranta, A. U., Autio, V., Lindgren, L., Rorarius, M. G. F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2006; Blackwell
• Subjects: Adult; Ambulatory Surgical Procedures; Analgesia; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cholecystectomy, Laparoscopic; cyclo-oxygenase-2 inhibitor; Double-Blind Method; Female; Fentanyl - administration & dosage; Humans; Isoxazoles - administration & dosage; Male; Medical sciences; Middle Aged; non-steroidal anti-inflammatory drug; Pain, Postoperative - drug therapy; parecoxib; Prospective Studies; visceral pain; Cholecystectomy; Prostaglandin-endoperoxide synthase; non-steroidal anti- inflammatory drug; Enzyme; Enzyme inhibitor; cyclo-oxygenase-2 inhibitor; Cyclooxygenase 2 inhibitor; Non steroidal antiinflammatory agent; visceral pain; Analgesic; Pain; Anesthesia; Parecoxib; Oxidoreductases
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2006.01116.x

Background:  The cyclo‐oxygenase‐2 inhibitor, parecoxib, can be administered parenterally. The recommended dose for post‐operative use is 40 mg twice daily, which may not be the appropriate dose for the treatment of visceral pain. We studied the effect of a single dose of parecoxib of either 40 or 80 mg in laparoscopic cholecystectomy, and its effect on opioid‐induced side‐effects. Methods:  Seventy‐three patients scheduled for elective laparoscopic cholecystectomy were enrolled in this prospective, randomized, double‐blind study. Patients were randomized into three groups: a placebo‐treated control group, a 40‐mg parecoxib‐treated group (P40) and an 80‐mg parecoxib‐treated group (P80). We recorded the cumulative fentanyl consumption during the first 20 h post‐operatively by patient‐controlled analgesia equipment, the pain scores during rest, coughing and mobilization (visual analogue scale, 0–10), the worst pain during the first 2 h post‐operatively and in the following 18 h, and the side‐effects by questionnaire. Results:  No significant differences in fentanyl consumption between the three groups could be detected. The worst pain experienced between 2 and 20 h post‐operatively on the ward was significantly lower in the P80 group than in the control group. Conclusion:  The recommended dose of parecoxib, 40 mg, is not effective for the treatment of pain during the early post‐operative period after laparoscopic cholecystectomy. Doubling the dose to 80 mg seems to improve the results.