title: Preemptive analgesia reduces pain after radical axillary lymph node dissection.
abstract: BACKGROUND
  Analyzing prospective data of our melanoma patients, we registered a suboptimal pain score under mobilization after radical axillary lymph node dissection (RALND). We performed a randomized, double blinded clinical trial to investigate the effects of a preemptive Parecoxib analgesic during the perioperative course.
  
  
  METHODS
  Between October 2006 and December 2007, 32 patients with stage III/IV melanoma underwent therapeutic RALND and were randomized into two groups. Patients received intravenously 40 mg Parecoxib or 0.9% normal saline solution 2 h before RALND. The postoperative treatment and analgetic regime was defined in the study protocol. Main outcome criterion was the pain under mobilization at the first postoperative morning registered via a visual analogue score. Minor criteria were the postoperative complications, fatigue, amount of analgesics, and the day of discharge.
  
  
  RESULTS
  Patients receiving a preemptive analgesic had a better outcome after RALND. The pain after mobilization was significantly decreased at the first postoperative morning (P = 0.04). Patients had less fatigue as well (P = 0.05) and the amount of pain medication in the treatment group was reduced (P = 0.04).
  
  
  CONCLUSIONS
  Preemptive application of Parecoxib enhances outcome after RALND. A preemptive analgesic with Parecoxib in the perioperative management after RALND of melanoma patients can be recommended.
authors.affiliation: Department of General, Visceral, Thoracic, and Vascular Surgery, Medical Faculty of the Humboldt University, Berlin, Germany. heiko.neuss@charite.de
authors.forename: Heiko
authors.initials: H
authors.lastname: Neuss
authors.forename: Gerold
authors.initials: G
authors.lastname: Koplin
authors.forename: Oliver
authors.initials: O
authors.lastname: Haase
authors.forename: Christian
authors.initials: C
authors.lastname: Reetz
authors.forename: Julian W
authors.initials: JW
authors.lastname: Mall
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D001365:Axilla; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005221:Fatigue / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D019990:Perioperative Care; D011446:Prospective Studies
chemical_list: D000700:Analgesics; D052246:Cyclooxygenase 2 Inhibitors; D007555:Isoxazoles; C409945:parecoxib