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Tytuł:
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Effects of parecoxib after pancreaticoduodenectomy: A single center randomized controlled trial.
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Autorzy:
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Liu G; Department of General Surgery, Peking University First Hospital, Beijing, 100034, China.
Ma Y; Department of General Surgery, Peking University First Hospital, Beijing, 100034, China.
Chen Y; Department of General Surgery, Peking University First Hospital, Beijing, 100034, China.
Zhuang Y; Department of General Surgery, Peking University First Hospital, Beijing, 100034, China.
Yang Y; Department of General Surgery, Peking University First Hospital, Beijing, 100034, China. Electronic address: .
Tian X; Department of General Surgery, Peking University First Hospital, Beijing, 100034, China. Electronic address: .
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Źródło:
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International journal of surgery (London, England) [Int J Surg] 2021 Jun; Vol. 90, pp. 105962. Date of Electronic Publication: 2021 Apr 29.
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Typ publikacji:
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Journal Article; Randomized Controlled Trial
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Język:
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English
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Imprint Name(s):
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Publication: 2023- : [Philadelphia] : Wolters Kluwer Health, Inc.
Original Publication: London : Surgical Associates Ltd., c2004-
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MeSH Terms:
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Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use
Cyclooxygenase 2 Inhibitors/*therapeutic use
Isoxazoles/*therapeutic use
Pain, Postoperative/*prevention & control
Pancreaticoduodenectomy/*adverse effects
Analgesia, Patient-Controlled ; Analgesics, Opioid/administration & dosage ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Cyclooxygenase 2 Inhibitors/adverse effects ; Double-Blind Method ; Female ; Humans ; Isoxazoles/adverse effects ; Male ; Middle Aged ; Morphine/administration & dosage ; Pain Management ; Pain Measurement ; Pain, Postoperative/etiology
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Contributed Indexing:
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Keywords: Analgesia; Efficacy; Pancreaticoduodenectomy; Parecoxib; Safety
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Substance Nomenclature:
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0 (Analgesics, Opioid)
0 (Anti-Inflammatory Agents, Non-Steroidal)
0 (Cyclooxygenase 2 Inhibitors)
0 (Isoxazoles)
76I7G6D29C (Morphine)
9TUW81Y3CE (parecoxib)
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Entry Date(s):
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Date Created: 20210501 Date Completed: 20210706 Latest Revision: 20210823
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Update Code:
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20240105
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DOI:
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10.1016/j.ijsu.2021.105962
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PMID:
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33932589
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Background: Parecoxib, a selective cyclooxygenase-2 inhibitor, is a potential alternative analgesic to reduce opioid consumption after Pancreaticoduodenectomy (PD). Further, the safety and efficacy of long-term use of parecoxib for patients after PD remain a major concern.
Materials and Methods: In this single-center, randomized clinical trial, 134 patients undergoing open PD were randomized into the parecoxib group (group P) and control group (group C) at a 1:1 ratio. Besides a routine patient-controlled epidural analgesia (PCEA) until 3 days postoperatively for both groups, patients in group P (n = 68) received parecoxib (40 mg, intravenously, Q 12 h) for the first 5 postoperative days and were encouraged to receive opioid analgesics to control severe pain as needed. Patients in group C (n = 66) received on-demand opioid analgesics (pethidine or morphine) postoperatively. The primary outcomes included the effectiveness of parecoxib in controlling pain (measured using the visual analog scale (VAS)) and reduction of opioid use (measured as accumulated doses). Secondary outcomes included the postoperative recovery process, rate of postoperative complications, and the anti-inflammatory effect of parecoxib.
Results: The VAS scores were not significantly different between the two groups. The number of doses of opioids for patients in group P (3.2 ± 0.3 doses) was significantly lower than in group C (8.5 ± 0.4 doses) (p = 0.0007). The incidence of opioid-related side effects was significantly lower in group P than in group C (p = 0.001). There were no significant differences in postoperative complications or readmission rates between the two groups. The postoperative time to first pass flatus, time to first mobilization out of bed, and time of removal of nasogastric tube in group P were significantly shorter than those in group C (P < 0.05). The postoperative serum IL-6 levels of patients in group P were significantly lower than those in group C at each time point (P < 0.05).
Conclusions: Parecoxib effectively controls pain after PD. Prophylactic analgesia using parecoxib for up to 5 days after PD is safe, feasible, and can provide the same optimal pain control as opioids without adverse effects.
(Copyright © 2021. Published by Elsevier Ltd.)
Comment in: Int J Surg. 2021 Jun;90:105976. (PMID: 34004372)
Comment in: Int J Surg. 2021 Jul;91:105992. (PMID: 34116254)
