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Parecoxib vs. lornoxicam in the treatment of postoperative pain after laparoscopic cholecystectomy: a prospective randomized placebo-controlled trial

Published online by Cambridge University Press:  29 August 2006

A. Papadima ,
E. E. Lagoudianakis ,
P. T. Antonakis ,
M. Pattas ,
F. Kremastinou ,
V. Katergiannakis ,
A. Manouras  and
L. Georgiou
A. Papadima
Affiliation:
Hippocrateion Hospital, Athens Medical School, Department of Anesthesiology, Athens, Greece
E. E. Lagoudianakis
Affiliation:
Hippocrateion Hospital, Athens Medical School, First Department of Propaedeutic Surgery, Athens, Greece
P. T. Antonakis
Affiliation:
Hippocrateion Hospital, Athens Medical School, First Department of Propaedeutic Surgery, Athens, Greece
M. Pattas
Affiliation:
Hippocrateion Hospital, Athens Medical School, First Department of Propaedeutic Surgery, Athens, Greece
F. Kremastinou
Affiliation:
Hippocrateion Hospital, Athens Medical School, Department of Anesthesiology, Athens, Greece
V. Katergiannakis
Affiliation:
Hippocrateion Hospital, Athens Medical School, First Department of Propaedeutic Surgery, Athens, Greece
A. Manouras
Affiliation:
Hippocrateion Hospital, Athens Medical School, First Department of Propaedeutic Surgery, Athens, Greece
L. Georgiou
Affiliation:
Hippocrateion Hospital, Athens Medical School, Department of Anesthesiology, Athens, Greece
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Abstract

Summary

Background and objective: Non-steroidal anti-inflammatory drugs are considered as an effective treatment of postoperative pain after laparoscopic cholecystectomy. COX-2 inhibitors are newer drugs having less adverse effects. Data supporting their efficacy postoperatively in comparison to older non-steroidal anti-inflammatory drugs are scarce. Our study is a prospective, randomized, double-blinded, placebo-controlled trial comparing the efficacy of lornoxicam vs. parecoxib for the management of pain after laparoscopic cholecystectomy. Materials and methods: We enrolled 76 patients, ASA I and II, scheduled for elective laparoscopic cholecystectomy. The patients were randomized to receive before induction parecoxib 40 mg i.v., lornoxicam 8 mg i.v. or placebo. Pain at rest and on movement was assessed using a visual analogue scale at 0, 6, 12 h postoperatively. Total meperidine consumption and adverse effects were also recorded. Results: At 12 h, visual analogue scale scores at rest and on movement were significantly lower with parecoxib and lornoxicam compared with control ( P = 0.047). The percentage of patients needing meperidine and the average dose of meperidine administered was significantly lower with parecoxib and lornoxicam compared with control (P < 0.001 and P = 0.018). There was no difference between parecoxib and lornoxicam. One patient receiving lornoxicam vomited. Conclusions: Parecoxib 40 mg i.v. and lornoxicam 8 mg i.v. were equianalgesic and both were more efficacious than placebo for the management of pain after laparoscopic cholecystectomy.

Keywords

SURGERY, abdominalLORNOXICAMPARECOXIBPAIN ACUTE AND POSTOPERATIVECHOLECYSTECTOMY LAPAROSCOPIC
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 154 - 158
Copyright
2007 European Society of Anaesthesiology

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References

Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 2001; 90: 261–269.Google Scholar
Joshi GP, Viscusi ER, Gan TJet al. Effective treatment of laparoscopic cholecystectomy pain with intravenous followed by oral COX-2 specific inhibitor. Anesth Analg 2004; 98: 336–342.Google Scholar
Ng A, Temple A, Smith G, Emembolu J. Early analgesic effects of parecoxib versus ketorolac following laparoscopic sterilization: a randomized controlled trial. Br J Anaesth 2004; 92: 846–849.Google Scholar
Barden J, Edwards JE, McQuay HJ, Moore RA. Oral valdecoxib and injected parecoxib for acute postoperative pain: a quantitative systematic review. BMC Anesthesiol 2003; 3: 1.Google Scholar
Gan TJ, Joshi GP, Zhao SZ, Hanna DB, Cheung RY, Chen C. Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid-related adverse effects. Acta Anaesthesiol Scand 2004; 48: 1194–1207.Google Scholar
Simon LS, Weaver AL, Graham DYet al. Anti-inflammatory and upper gastrointestinal effects of celecoxib in rheumatoid arthritis: a randomized controlled trial. JAMA 1999; 282: 1921–1928.Google Scholar
Goldstein JL, Correa P, Zhao WWet al. Reduced incidence of gastroduodenal ulcers with celecoxib, a novel cyclooxygenase-2 inhibitor, compared to naproxen in patients with arthritis. Am J Gastroenterol 2001; 96: 1019–1027.Google Scholar
Harris SI, Stoltz RR, LeComte D, Hubbard RC. Parecoxib sodium demonstrates gastrointestinal safety comparable to placebo in healthy subjects. J Clin Gastroenterol 2004; 38: 575–580.Google Scholar
Leese PT, Recker DP, Kent JD. The COX-2 selective inhibitor, valdecoxib, does not impair platelet function in the elderly: results of a randomized controlled trial. J Clin Pharmacol 2003; 43: 504–513.Google Scholar
Leese PT, Talwalker S, Kent JD, Recker DP. Valdecoxib does not impair platelet function. Am J Emerg Med 2002; 20: 275–281.Google Scholar
Gan TJ, Joshi GP, Viscusi Eet al. Preoperative parenteral parecoxib and follow-up oral valdecoxib reduce length of stay and improve quality of patient recovery after laparoscopic cholecystectomy surgery. Anesth Analg 2004; 98: 1665–1673.Google Scholar
Stichtenoth DO, Frolich JC. The second generation of COX-2 inhibitors: what advantages do the newest offer? Drugs 2003; 63: 33–45.Google Scholar
McMurray RW, Hardy KJ. Cox-2 inhibitors: today and tomorrow. Am J Med Sci 2002; 323: 181–189.Google Scholar
Balfour JA, Fitton A, Barradell LB. Lornoxicam. A review of its pharmacology and therapeutic potential in the management of painful and inflammatory conditions. Drugs 1996; 51: 639–657.Google Scholar
Bombardier C, Laine L, Reicin Aet al. VIGOR Study Group. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med 2000; 343: 1520–1528.Google Scholar
Meagher EA. Cardiovascular and renovascular implications of COX-2 inhibition. Curr Pharm Des 2004; 10: 603–611.Google Scholar
Nussmeier NA, Whelton AA, Brown MTet al. Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. N Engl J Med 2005; 352: 1081–1091.Google Scholar
Krotz F, Schiele TM, Klauss V, Sohn HY. Selective COX-2 inhibitors and risk of myocardial infarction. J Vasc Res 2005; 42: 312–324.Google Scholar
Slappendel R, Weber EW, Benraad B, Dirksen R, Bugter ML. Does ibuprofen increase perioperative blood loss during hip arthroplasty? Eur J Anaesthesiol 2002; 19: 829–831.Google Scholar
Møiniche S, Rømsing J, Dahl JB, Tramèr MR. Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg 2003; 96: 68–77.Google Scholar
Desikan SR, Meena NG. Do non-steroidal anti-inflammatory drugs increase the risk of bleeding after tonsillectomy? Arch Dis Child 2004; 89: 493–494.Google Scholar
Noveck RJ, Hubbard RC. Parecoxib sodium, an injectable COX-2-specific inhibitor, does not affect unfractionated heparin-regulated blood coagulation parameters. J Clin Pharmacol 2004; 44: 474–480.Google Scholar