Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial.
OBJECTIVE
Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT.


METHODS
The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery.


RESULTS
Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (allP<0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07-0.382;P<0.001) and the intensity of bilateral shoulder pain (bothP<0.01).


CONCLUSIONS
Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologic laparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP.
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou.
Hufei
H
Zhang
Department of Anesthesiology, Shenzhen Hospital, University of Hong Kong, Shenzhen.
Xinhe
X
Liu
Department of Obstetrics and Gynecology.
Hongye
H
Jiang
Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Zimeng
Z
Liu
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou.
Xu-Yu
XY
Zhang
Department of Obstetrics and Gynecology.
Hong-Zhe
HZ
Xie
laparoscopic surgery; nonsteroidal anti-inflammatory drugs; pain threshold; sensitization; shoulder pain
Pain. 2011 Jun;152(6):1289-97
21396775
Acta Anaesthesiol Belg. 2006;57(4):373-9
17236639
Exp Brain Res. 2010 May;202(4):915-25
20186400
Eur J Anaesthesiol. 2015 Oct;32(10):735-41
26295750
Obstet Gynecol. 1993 Dec;82(6):951-4
8233271
Clin J Pain. 2010 Nov-Dec;26(9):798-806
20842013
Pharmacology. 2007;80(4):244-8
17622776
Pain. 2004 Mar;108(1-2):148-53
15109518
PLoS One. 2009 Oct 05;4(10):e7340
19806210
Anesthesiology. 2005 Sep;103(3):613-8
16129988
J Oral Maxillofac Surg. 2003 Sep;61(9):1030-7
12966478
Pain. 2016 Aug;157(8):1634-44
27007068
Int J Med Sci. 2012;9(9):757-65
23136538
Hum Reprod. 2002 May;17(5):1334-42
11980761
Obstet Gynecol. 2008 May;111(5):1155-60
18448749
Anesthesiology. 2005 Feb;102(2):409-15
15681959
Pain. 2001 Feb 15;90(3):261-9
11207398
Nat Rev Rheumatol. 2010 Oct;6(10):599-606
20664523
Surg Endosc. 2011 Jan;25(1):23-7
20589515
Crit Care. 2002 Aug;6(4):335-41
12225610
J Pain. 2010 Dec;11(12):1295-304
20494623
Exp Ther Med. 2013 Jul;6(1):275-279
23935760
Am J Obstet Gynecol. 2014 Oct;211(4):360.e1-8
24732001
Pain Med. 2011 Jan;12(1):72-8
21143767
Burns. 2014 Jun;40(4):759-71
24290856
Best Pract Res Clin Anaesthesiol. 2007 Mar;21(1):65-83
17489220