Preincisional Versus Postincisional Administration of Parecoxib in Colorectal Surgery: Effect on Postoperative Pain Control and Cytokine Response. A Randomized Clinical Trial

Background Preincisional pain management aims at reducing pain and inflammatory response. We investigated whether preincisional parecoxib administration reduces pain, opioid requirements, and cytokine production after surgery for colonic cancer. Methods Forty one patients whose American Society of Anesthesiologists (ASA) status was I H and who were scheduled for colorectal cancer surgery were randomly divided in two groups according to the timing of parecoxib administration: Group PRE (preincisional) received parecoxib 40 mg intravenously 30 min before skin incision and group POST (postincisional) received the same dose 30 min after skin incision. Postoperative analgesia involved the administration of patient-controlled analgesia (PCA) morphine to all patients. We recorded verbal rating scale (VRS) scores and morphine consumption at I, 6, 18, and 24 h after surgery and blood levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-a alpha) 30 min before skin incision, at peritoneal closure, and 24 h postoperatively. Results The VRS scores were similar between groups. Although morphine consumption was significantly lower in group PRE at 6, 18 and 24 h postoperatively (p = 0.044, p = 0.02, p < 0.001, respectively) morphine-related adverse effects did not differ between the two groups. The serum IL-6 was significantly (p = 0.042) elevated from the baseline value 24 h postoperatively in group POST. Conclusions Preincisional parecoxib administration compared to postincisional administration reduced postoperative morphine consumption, but without affecting morphine-related adverse effects and attenuated IL-6 production 24 h after surgery for colorectal cancer.