title: Multiple-, but not single-, dose of parecoxib reduces shoulder pain after gynecologic laparoscopy.
abstract: BACKGROUND
  The aim of this study was to investigate effect of single- and multiple-dose of parecoxib on shoulder pain after gynecologic laparoscopy.
  
  
  METHODS
  126 patients requiring elective gynecologic laparoscopy were randomly allocated to three groups. Group M (multiple-dose): receiving parecoxib 40mg at 30min before the end of surgery, at 8 and 20hr after surgery, respectively; Group S (single-dose): receiving parecoxib 40mg at 30min before the end of surgery and normal saline at the corresponding time points; Group C (control): receiving normal saline at the same three time points. The shoulder pain was evaluated, both at rest and with motion, at postoperative 6, 24 and 48hr. The impact of shoulder pain on patients' recovery (activity, mood, walking and sleep) was also evaluated. Meanwhile, rescue analgesics and complications were recorded.
  
  
  RESULTS
  The overall incidence of shoulder pain in group M (37.5%) was lower than that in group C (61.9%) (difference=-24.4%; 95% CI: 3.4~45.4%; P=0.023). Whereas, single-dose regimen (61.0%) showed no significant reduction (difference with control=-0.9%; 95% CI: -21.9~20.0%; P=0.931). Moreover, multiple-dose regimen reduced the maximal intensity of shoulder pain and the impact for activity and mood in comparison to the control. Multiple-dose of parecoxib decreased the consumption of rescue analgesics. The complications were similar among all groups and no severe complications were observed.
  
  
  CONCLUSIONS
  Multiple-, but not single-, dose of parecoxib may attenuate the incidence and intensity of shoulder pain and thereby improve patients' quality of recovery following gynecologic laparoscopy.
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Hufei
authors.initials: H
authors.lastname: Zhang
authors.forename: Haihua
authors.initials: H
authors.lastname: Shu
authors.forename: Lu
authors.initials: L
authors.lastname: Yang
authors.forename: Minghui
authors.initials: M
authors.lastname: Cao
authors.forename: Jingjun
authors.initials: J
authors.lastname: Zhang
authors.forename: Kexuan
authors.initials: K
authors.lastname: Liu
authors.forename: Liangcan
authors.initials: L
authors.lastname: Xiao
authors.forename: Xuyu
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage* / Q000627:therapeutic use; D010535:Laparoscopy / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology; D020069:Shoulder Pain / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D007555:Isoxazoles; C409945:parecoxib
keywords: Shoulder pain; laparoscopic surgery; nonsteroidal anti-inflammatory drugs; postoperative pain