Effect of paracetamol and coxib with or without dexamethasone after laparoscopic cholecystectomy.
BACKGROUND
Pain after laparoscopic cholecystectomy (LCC) is multifactorial. Effective post-operative pain control is necessary in LCC performed as day-case surgery. We studied the efficacy of paracetamol or valdecoxib with or without dexamethasone after LCC.


METHODS
One hundred sixty patients were randomized to four groups of 40 patients. Groups 1 and 3 received parecoxib 40 mg intravenously (IV) during surgery and valdecoxib 40 mg x 1 per os (PO) for 7 post-operative days. Groups 2 and 4 received paracetamol 1 g x 4 IV during surgery and 1 g x 4 PO for 7 days. In addition, Groups 3 and 4 were given dexamethasone 10 mg IV intra-operatively. Propofol and remifentanil were used during surgery. The patients were given oxycodone 0.05 mg/kg IV in phase 1 post-anaesthesia care unit (PACU 1) or 0.15 mg/kg PO in phase 2 post-anaesthesia care unit (PACU 2) as needed to keep visual analogue scale <3/10. The patients were supplied with the study drugs for 7 post-operative days.


RESULTS
Pain intensity, nausea and the need of oxycodone in phase 1 PACU were similar in all groups. Dexamethasone reduced the need of oral oxycodone in phase 2 PACU (7.0 +/- 1.0 mg vs. 9.1 +/- 1.0 mg, P<0.05). Pain intensity was similar in all groups at home. More patients in the parecoxib/valdecoxib groups needed rescue medication on the 1st post-operative day (P<0.001) than paracetamol-treated patients.


CONCLUSIONS
Paracetamol was as effective as parecoxib/valdecoxib for pain after LCC. Dexamethasone decreased the need of oxycodone in phase 2 PACU. The effect of dexamethasone was similar in paracetamol and parecoxib/valdecoxib patients.
Tiippana
E
E
Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Helsinki University Hospital, Helsinki, Finland. elina.tiippana@hus.fi
Bachmann
M
M
Kalso
E
E
Pere
P
P
D000082:Acetaminophen / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002985:Clinical Protocols; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011446:Prospective Studies; D013449:Sulfonamides / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D000096926:Benzenesulfonamides
D000082:Acetaminophen; D018712:Analgesics, Non-Narcotic; D000893:Anti-Inflammatory Agents; D016861:Cyclooxygenase Inhibitors; D003907:Dexamethasone; D007555:Isoxazoles; D010098:Oxycodone; D013449:Sulfonamides; C406224:valdecoxib; D000096926:Benzenesulfonamides