title: Comparing parecoxib and ketorolac as preemptive analgesia in patients undergoing posterior lumbar spinal fusion: a prospective randomized double-blinded placebo-controlled trial.
abstract: BACKGROUND
  Poor postoperative pain control is frequently associated with complications and delayed discharge from a hospital. Preemptive analgesia is one of the methods suggested for reducing postoperative pain. Opioids are effective for pain control, but there known addictive properties make physicians cautious about using them. Parecoxib and ketorolac are potent non-opioid NSAIDs that are attractive alternative drugs to opioids to avoid opioid-related side effects. However, there are no good head-to-head comparisons between these two drugs in the aspect of preemptive analgesic effects in lumbar spinal fusion surgery. This study aimed to compare the efficacy in terms of postoperative pain control and safety of parecoxib with ketorolac as preemptive analgesia in posterior lumbar spinal fusion patients.
  
  
  METHODS
  A prospective, double-blinded randomized controlled trial was carried out in patients undergoing posterior lumbar spinal fusion, who were randomized into 3 groups (n = 32). Parecoxib, ketorolac or a placebo was given to each patient via injection around 30 minutes prior to incision. The efficacy of postoperative pain control was assessed by a verbal numerical rating score (0-10). And various postoperative things were monitored for analysis, such as total opioid consumption, complications, and estimated blood loss.
  
  
  RESULTS
  Both the ketorolac and parecoxib groups showed significantly better early postoperative pain reduction at the postanesthesia care unit (PACU) than the control group (p < 0.05). There were no differences between the pain scores of ketorolac and parecoxib at any time points. Complications and bleeding were not significantly different between all three groups.
  
  
  CONCLUSIONS
  Preemptive analgesia using both ketorolac and parecoxib showed a significantly better early postoperative pain control in the PACU than the control group in patients undergoing lumbar spinal fusion.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01859585. Registered 15 May 2013.
authors.affiliation: Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Hat Yai, 90110, Thailand. koopongs@hotmail.com.
authors.forename: Koopong
authors.initials: K
authors.lastname: Siribumrungwong
authors.affiliation: Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Hat Yai, 90110, Thailand. chulin_c@hotmail.com.
authors.forename: Julin
authors.initials: J
authors.lastname: Cheewakidakarn
authors.affiliation: Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Hat Yai, 90110, Thailand. boonsin.b@psu.ac.th.
authors.forename: Boonsin
authors.initials: B
authors.lastname: Tangtrakulwanich
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkla, Hat Yai, 90110, Thailand. snimmaanrat@yahoo.com.
authors.forename: Sasikaan
authors.initials: S
authors.lastname: Nimmaanrat
mesh_terms: D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D004415:Dyspepsia / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D007555:Isoxazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D020910:Ketorolac / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013123:Spinal Fusion / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007555:Isoxazoles; C409945:parecoxib; D020910:Ketorolac