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Parecoxib Increases Muscle Pain Threshold and Relieves Shoulder Pain After Gynecologic Laparoscopy: A Randomized Controlled Trial


Parecoxib Increases Muscle Pain Threshold and Relieves Shoulder Pain After Gynecologic Laparoscopy: A Randomized Controlled Trial

Hufei Zhang et al. J Pain Res.


Objectives: Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT.

Materials and methods: The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery.

Results: Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P<0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07-0.382; P<0.001) and the intensity of bilateral shoulder pain (both P<0.01).

Conclusion: Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologic laparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP.

Keywords: laparoscopic surgery; nonsteroidal anti-inflammatory drugs; pain threshold; sensitization; shoulder pain.


Figure 1
Figure 1
Observation points for pressure pain threshold assessment.
Figure 2
Figure 2
Flowchart of randomization and group allocation. Abbreviation: BMI, body mass index.
Figure 3
Figure 3
The correlations between VAS score and preoperative PPT levels at three observation sites in the control group. Notes: The Spearman correlation test was used to calculate correlation coefficient and statistical significance. (A) Levator scapulae, (B) supraspinatus, and (C) flexor carpi ulnaris. Abbreviations: VAS, visual analog scale; PPT, pressure pain threshold.
Figure 4
Figure 4
Changes in PPT. Notes: (A) The PPT levels at each observation site before and after surgery in the two groups are shown. Data were expressed as mean ± standard deviation. Results were compared with unpaired Student’s t-test. *P<0.01, #P<0.05 vs presurgery; **P<0.01 vs group C. (B) After surgery, the change of PPT at each observation site in the two groups is shown. The change of PPT (%) = (PPT levelpostsurgery − PPT levelpresurgery)/PPT levelpresurgery ×100. The boxes represent the median and the 25 and 75 percentile values, and the bars represent the maximal and minimal values. Results were compared with Mann–Whitney U test and one-way analysis of variance with Dunnett posttest (site C was control point). $P<0.01, +P <0.05 vs site C; **P<0.01 vs group C. A, levator scapulae; B, supraspinatus; C, flexor carpi ulnaris. Abbreviation: PPT, pressure pain threshold.

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