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

被引:98
作者
Gan, TJ [1 ]
Joshi, GP
Zhao, SZ
Hanna, DB
Cheung, RY
Chen, C
机构
[1] Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 USA
[2] Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, Dallas, TX USA
[3] Pfizer Global Pharmaceut, New York, NY USA
关键词
laparoscopic cholecystectomy; opioid sparing; parecoxib; valdecoxib;
D O I
10.1111/j.1399-6576.2004.00495.x
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
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.
引用
收藏
页码:1194 / 1207
页数:14
相关论文
共 41 条
[1]   Adjunctive analgesia with intravenous propacetamol does not reduce morphine-related adverse effects [J].
Aubrun, F ;
Kalfon, F ;
Mottet, P ;
Bellanger, A ;
Langeron, O ;
Coriat, P ;
Riou, B .
BRITISH JOURNAL OF ANAESTHESIA, 2003, 90 (03) :314-319
[2]   Efficacy and safety of valdecoxib in treating the signs and symptoms of rheumatoid arthritis: a randomized, controlled comparison with placebo and naproxen [J].
Bensen, W ;
Weaver, A ;
Espinoza, L ;
Zhao, WW ;
Riley, W ;
Paperiello, B ;
Recker, DP .
RHEUMATOLOGY, 2002, 41 (09) :1008-1016
[3]  
Bensen WG, 2000, J RHEUMATOL, V27, P1876
[4]   Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. [J].
Bombardier, C ;
Laine, L ;
Reicin, A ;
Shapiro, D ;
Burgos-Vargas, R ;
Davis, B ;
Day, R ;
Ferraz, MB ;
Hawkey, CJ ;
Hochberg, MC ;
Kvien, TK ;
Schnitzer, TJ ;
Weaver, A .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 343 (21) :1520-1528
[5]  
Camu Frederic, 2002, Am J Ther, V9, P43, DOI 10.1097/00045391-200201000-00009
[6]   POSTOPERATIVE NAUSEA AND VOMITING AFTER-DISCHARGE FROM OUTPATIENT SURGERY CENTERS [J].
CARROLL, NV ;
MIEDERHOFF, P ;
COX, FM ;
HIRSCH, JD .
ANESTHESIA AND ANALGESIA, 1995, 80 (05) :903-909
[7]  
Chang VT, 2000, CANCER-AM CANCER SOC, V88, P1175, DOI 10.1002/(SICI)1097-0142(20000301)88:5<1175::AID-CNCR30>3.0.CO
[8]  
2-N
[9]   Valdecoxib, a cyclooxygenase-2-specific inhibitor, is effective in treating primary dysmenorrhea [J].
Daniels, SE ;
Talwalker, S ;
Torri, S ;
Snabes, MC ;
Recker, DP ;
Verburg, KM .
OBSTETRICS AND GYNECOLOGY, 2002, 100 (02) :350-358
[10]   A double-blind, randomized comparison of intramuscularly and intravenously administered parecoxib sodium versus ketorolac and placebo in a post-oral surgery pain model [J].
Daniels, SE ;
Grossman, EH ;
Kuss, ME ;
Talwalker, S ;
Hubbard, RC .
CLINICAL THERAPEUTICS, 2001, 23 (07) :1018-1031