Preoperative intravenous parecoxib reduces length of stay on ambulatory laparoscopic cholecystectomy

Background: The complexity of pain after laparoscopic cholecystectomy (LC) needs multi-module analgesia. Opioids are widely used for perioperative pain but associated with numerous adverse effects. We investigated the effect of parecoxib administrated preoperatively and postoperatively for analgesia after ambulatory laparoscopic cholecystectomy. Methods: 120 patients scheduled for ambulatory LC with general anesthesia were randomly assigned to three groups: group A received 40 mg parecoxib injection 30-45 min before anesthesia induction and 4 ml saline injection when gallbladder was removed; group B received 4 ml saline injection 30-45 min before anesthesia induction and 40 mg parecoxib injection when gallbladder was removed; group C received 4 ml saline injection 30-45 min before anesthesia induction and the time when gallbladder was removed. We recorded the time achieve to modified Aldrete's score > 9 in the post-anesthesia care unit (PACU) and modified Post-Anesthetic Discharge Scoring System (PADSS) > 9 in ambulatory unit. The visual analog scale (VAS) was used to assess the degree of the postoperative pain in the first 24 h, and the numbers of patients who need additional analgesic and postoperative adverse effects were also recorded. Results: Patients of group A had a shorter length of stay (LOS) in PACU compared to these of group B and group C (32.4 +/- 7.2 min vs. 39.1 +/- 10.4 min and 42.2 +/- 7.6 min, P < 0.05). Patients of group A also had a shorter discharge time compared to these of group B and group C (148.4 +/- 39.3 min vs. 187.9 +/- 47.7 min and 223.4 +/- 52.5 min, P < 0.05). Moreover, patients of group A experienced reduced pain intensity, less postoperative side effect, and less additional analgesic requirement. Conclusion: Preoperative administration of parecoxib for postoperative analgesia provided significant effect on reducing PACU length of stay (LOS) and discharge time, and improving patient outcome after ambulatory LC. (C) 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.