Parecoxib in the treatment of postoperative pain after lumbar discectomy - a prospective randomized double blind trial
Abstract
Background: Parecoxib sodium, the cyclo-oxygenase-2-inhibitor, can be administered parenterally. This study examined the analgesic efficacy and opioid-sparing effectiveness of intraoperative administration of parecoxib (40 mg) in degenerative lumbar spine disease patients.
The second target of the study was to evaluate possible adverse effects of this therapy. Methods: This was a prospective, randomized, double-blind, placebo controlled study.
Thirty patients scheduled for elective lumbar discectomy were randomized to receive parecoxib 40 mg (n= 15) or placebo (n= 15) during operation. Pain at rest was assessed using a visual analogue scale (VAS) preoperatively and 40 minutes and 120 minutes postoperatively.
Total piritramid consumption and adverse effects were also recorded. Results: At 40 min and 120 min, visual analogue scale was unchanged with parecoxib compared to preoperative value (VASparecoxib preop = 3.4 +- 2.3; VASparecoxib 40 = 3.2 +- 2.2; VASparecoxib 120 = 3.3 +- 2.6).
There was a significant increase of pain visual analogue score postoperatively in the placebo group (VASplacebo preop = 3.2 +- 1.8; VASplacebo 40 = 4.3 +- 1.6; VASplacebo 120 = 4.3 +- 2.4). Patients in the parecoxib group received less piritramid than patients in the control group (0.9 +- 1.6 applications per patient vs. 2.8 +- 1.5).
Ten patients (66, 7%) with parecoxib did not even require any additional piritramid treatment. Time to first piritramid application was longer in parecoxib group (666 minutes) compared to placebo group (490 minutes).
There were no cardiovascular adverse events, bleeding, or wound infections in either group. Conclusions: Single dose of parecoxib 40 mg intraoperatively has been shown to be effective for postoperative pain management after lumbar spine surgery.
This therapy is safe without any adverse events.