Effects of parecoxib on morphine analgesia after gynecology tumor operation: a randomized trial of parecoxib used in postsurgical pain management

Abstract

Background: The analgesic efficacy of parecoxib in postsurgical pain management has been confirmed in minimally invasive surgery. However, little is known about its effects used in combination with opioids and about its potential for opioid-sparing effects in complex operations. This study was performed to investigate the influence of parecoxib on morphine analgesia after gynecological tumor surgery.

Methods: Eighty patients undergoing gynecological tumor resection were randomized to receive either intravenous parecoxib at a dose of 40 mg (Group P, n = 40) followed by 40 mg every 12 h for 48 h or saline as a control (Group C, n = 40) 30 min before induction of anesthesia, followed by saline at the same time points after the operation. All patients had access to patient-controlled analgesia with intravenous morphine. Patients were assessed with respect to pain score (visual analog scale from 0-10), cumulative morphine requirement, satisfaction score, and side effects at 2, 6, 12, 24, and 48 h after surgery.

Results: A total of 79 patients were evaluated. The cumulative dose of morphine administered at each time point was lower in Group P than in Group C (P < 0.05), at 2 h (3.81 ± 0.35 versus 4.13 ± 0.45; P = 0.01), 6 h (16.20 ± 1.49 versus 19.60 ± 0.35; P < 0.001), 12 h (26.29 ± 2.75 versus 32.49 ± 2.42; P < 0.001), 24 h (41.72 ± 2.70 versus 49.97 ± 4.53; P < 0.001), and 48 h (60.06 ± 4.00 versus 65.68 ± 3.23; P < 0.001). Compared with Group C, Group P had significantly lower visual analog scale scores at rest and with movement, respectively, at 2 h (4.2, P < 0.001 and 5.0, P < 0.001), 6 h (3.6, P < 0.001 and 4.5, P < 0.001), 12 h (3.0, P = 0.017 and 4.0, P < 0.001), 24 h (2.1, P < 0.001 and 3.4, P < 0.001), and 48 h (1.8, P < 0.001 and 2.6, P < 0.001). The satisfaction score was higher in Group P than in Group C (8.6 ± 0.3 versus 6.8 ± 0.7, P < 0.001). There were no significant differences in side effects between the two groups (P > 0.05).

Conclusions: The use of parecoxib with patient-controlled analgesic morphine in postoperative analgesia resulted in comprehensive enhancement of the analgesic efficacy, reducing the opioid requirement and increasing patient satisfaction after gynecological tumor surgery.

Keywords: Cumulative dose; Parecoxib; Postoperative analgesia; Postsurgical pain management; Visual analog scale.