Preventive effects of perioperative parecoxib on post-discectomy pain.
BACKGROUND
Cyclooxygenase inhibitor treatment is viewed increasingly critical because of safety considerations, and there are several open questions on their optimal use.


METHODS
In a randomized placebo-controlled study in 320 patients undergoing discectomy, we administered parecoxib 40 mg either perioperatively (before operation and after operation), after operation (first dose given in the evening after surgery), or before operation (single parecoxib dose given 45 min before surgery). We measured the main outcome variables: average pain score, morphine consumption, and opioid-related symptom distress at 25, 49, and 73 h after surgery.


RESULTS
Perioperative parecoxib significantly (i) improved the pain score compared with both placebo and postoperative parecoxib, (ii) decreased morphine consumption, and (iii) reduced the opioid-related symptom distress score. Neither a single preoperative dose nor postoperative parecoxib (first dose given in the evening after surgery) significantly improved morphine's analgesic effectiveness.


CONCLUSIONS
Perioperative parecoxib compared with postoperative parecoxib improves post-discectomy pain and results in a reduction in adverse effects associated with opioid therapy. Postoperative parecoxib, or a single pre-incisional parecoxib dose, does not significantly improve post-discectomy pain or opioid side-effects up to 3 days after surgery.
Riest
G
G
Klinik für Anästhesiologie und Intensivmedizin, Universitaetsklinikum Essen, Germany.
Peters
J
J
Weiss
M
M
Dreyer
S
S
Klassen
P D
PD
Stegen
B
B
Bello
A
A
Eikermann
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage*; D017586:Diskectomy; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011229:Preanesthetic Medication; D011446:Prospective Studies
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D016861:Cyclooxygenase Inhibitors; D007555:Isoxazoles; D009020:Morphine; C409945:parecoxib