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Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid-related adverse effects

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Abstract:

Background: 

Opioids are associated with numerous adverse effects. It is unclear if reduced postoperative opioid consumption lowers the incidence and severity of opioid-related adverse effects. This analysis – from a multicenter, randomized, double-blind trial – tested if the reduction of opioid consumption among patients who received intravenous preoperative parecoxib 40 mg, followed by oral valdecoxib 40 mg qd postoperatively, in Days 1–4 after outpatient laparoscopic cholecystectomy surgery, reduced opioid-related symptoms. Methods: 

Patients received intravenous fentanyl for pain before discharge, and oral acetaminophen 500 mg hydrocodone 5 mg q 4–6 h prn postdischarge for up to 7 days postsurgery. Patients also received intravenous parecoxib 40 mg administered 30–45 min preoperatively, and valdecoxib 40 mg qd up to Day 4 and prn Days 5–7 postsurgery, or placebo. Patients completed an opioid-related Symptoms Distress Scale (SDS) questionnaire every 24 h for 7 days. Opioid use was converted to morphine-equivalent doses (MEDs). Clinically meaningful events (CMEs) for 12 opioid-related symptoms were assessed by three ordinal measures: frequency, severity, and bothersomeness. Reduction of CMEs on Day 1 and number of patient-days with CMEs on Days 1–4 were examined. Results: 

Cumulative MEDs on Day 0, Day 1, and Days 1–4 were significantly lower in the parecoxib/valdecoxib group compared with the placebo group (P < 0.001). At the end of Day 1, parecoxib/valdecoxib-treated patients had significantly lower SDS scores (P < 0.02), a significantly reduced incidence of CMEs (P < 0.05), and significantly fewer patient-days with CMEs in Days 1–4 than placebo patients (P < 0.05). Patients in the parecoxib/valdecoxib group were less likely to have CMEs for multiple symptoms than those in the placebo group (P < 0.001). Conclusions: 

Treatment with parecoxib and valdecoxib significantly reduced the cumulative MED requirements, the incidence of opioid-related adverse effects, and patient-days with CMEs.

Keywords: Laparoscopic cholecystectomy; opioid sparing; parecoxib; valdecoxib

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1399-6576.2004.00495.x

Affiliations: 1: Department of Anesthesiology, Duke University Medical Center, Durham, NC, 2: Department of Anesthesiology and Pain Management, University of Texas South-western Medical Center, Dallas, TX, 3: Pfizer Global Pharmaceuticals, New York, NY

Publication date: October 1, 2004

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