Effect of Parecoxib as an Adjunct to Patient-Controlled Epidural Analgesia after Abdominal Hysterectomy: A Multicenter, Randomized, Placebo-Controlled Trial.
OBJECTIVE
This multicenter, randomized, placebo-controlled study evaluated the efficacy and side effects of parecoxib during patient-controlled epidural analgesia (PCEA) after abdominal hysterectomy.


METHODS
A total of 240 patients who were scheduled for elective abdominal hysterectomy under combined spinal-epidural anesthesia received PCEA plus postoperative intravenous parecoxib 40 mg or saline every 12 h for 48 h after an initial preoperative dose of parecoxib 40 mg or saline. An epidural loading dose of a mixture of 6 mL of 0.25% ropivacaine and 2 mg morphine was administered 30 min before the end of surgery, and PCEA was initiated using 1.25 mg/mL ropivacaine and 0.05 mg/mL morphine with a 2-mL/h background infusion and 2-mL bolus with a 15-min lockout. The primary end point of this study was the quantification of the PCEA-sparing effect of parecoxib.


RESULTS
Demographic data were similar between the two groups. Patients in the parecoxib group received significantly fewer self-administrated boluses (0 (0, 3) vs. 7 (2, 15), P < 0.001) and less epidural morphine (5.01 ± 0.44 vs. 5.95 ± 1.29 mg, P < 0.001) but experienced greater pain relief compared with the control group (P < 0.001). Patient global satisfaction was higher in the parecoxib group than the control group (P < 0.001). Length of hospitalization (9.50 ± 2.1, 95% CI 9.12~9.88 vs. 10.41 ± 2.6, 95% CI 9.95~10.87, P = 0.003) and postoperative vomiting (17% vs. 29%, P < 0.05) were also reduced in the parecoxib group. There were no serious adverse effects in either group.


CONCLUSIONS
Our data suggest that adjunctive parecoxib during PCEA following abdominal hysterectomy is safe and efficacious in reducing pain, requirements of epidural analgesics, and side effects.


BACKGROUND
ClinicalTrials.gov (NCT01566669).
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Wei-Feng
WF
Liu
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Hai-Hua
HH
Shu
Department of Anesthesiology, GuangDong General Hospital and GuangDong Academy of Medical Sciences, Guangzhou, China.
Guo-Dong
GD
Zhao
Department of Anesthesiology, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Shu-Ling
SL
Peng
Department of Anesthesiology, NanFang Hospital, Guangzhou, China.
Jin-Fang
JF
Xiao
Health Management (Examination) Center, GuangDong General Hospital and GuangDong Academy of Medical Sciences, Guangzhou, China.
Guan-Rong
GR
Zhang
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Ke-Xuan
KX
Liu
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Wen-Qi
WQ
Huang
D000293:Adolescent; D000328:Adult; D000577:Amides / Q000008:administration & dosage; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007555:Isoxazoles / Q000008:administration & dosage*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy; D000077212:Ropivacaine; D055815:Young Adult
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D052246:Cyclooxygenase 2 Inhibitors; D007555:Isoxazoles; D009020:Morphine; D000077212:Ropivacaine; C409945:parecoxib