Multiple-, but not single-, dose of parecoxib reduces shoulder pain after gynecologic laparoscopy

Hufei Zhang, Haihua Shu, Lu Yang, Minghui Cao, Jingjun Zhang, Kexuan Liu, Liangcan Xiao, Xuyu Zhang, Hufei Zhang, Haihua Shu, Lu Yang, Minghui Cao, Jingjun Zhang, Kexuan Liu, Liangcan Xiao, Xuyu Zhang

Abstract

Background: The aim of this study was to investigate effect of single- and multiple-dose of parecoxib on shoulder pain after gynecologic laparoscopy.

Methods: 126 patients requiring elective gynecologic laparoscopy were randomly allocated to three groups. Group M (multiple-dose): receiving parecoxib 40mg at 30min before the end of surgery, at 8 and 20hr after surgery, respectively; Group S (single-dose): receiving parecoxib 40mg at 30min before the end of surgery and normal saline at the corresponding time points; Group C (control): receiving normal saline at the same three time points. The shoulder pain was evaluated, both at rest and with motion, at postoperative 6, 24 and 48hr. The impact of shoulder pain on patients' recovery (activity, mood, walking and sleep) was also evaluated. Meanwhile, rescue analgesics and complications were recorded.

Results: The overall incidence of shoulder pain in group M (37.5%) was lower than that in group C (61.9%) (difference=-24.4%; 95% CI: 3.4~45.4%; P=0.023). Whereas, single-dose regimen (61.0%) showed no significant reduction (difference with control=-0.9%; 95% CI: -21.9~20.0%; P=0.931). Moreover, multiple-dose regimen reduced the maximal intensity of shoulder pain and the impact for activity and mood in comparison to the control. Multiple-dose of parecoxib decreased the consumption of rescue analgesics. The complications were similar among all groups and no severe complications were observed.

Conclusions: Multiple-, but not single-, dose of parecoxib may attenuate the incidence and intensity of shoulder pain and thereby improve patients' quality of recovery following gynecologic laparoscopy.

Keywords: Shoulder pain; laparoscopic surgery; nonsteroidal anti-inflammatory drugs; postoperative pain.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flowchart of randomization and group allocation

References

    1. Chapron C, Fauconnier A, Goffinet F, Bréart G, Dubuisson JB. Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis. Hum Reprod. 2002;17:1334–42.
    1. Harrell AG, Heniford BT. Minimally invasive abdominal surgery: lux et veritas past, present, and future. Am J Surg. 2005;190:239–43.
    1. Bijen CB, Vermeulen KM, Mourits MJ, de Bock GH. Costs and effects of abdominal versus laparoscopic hysterectomy: systematic review of controlled trials. PLoS One. 2009;4:e7340.
    1. Compeau C, McLeod NT, Ternamian A. Laparoscopic entry: a review of Canadian general surgical practice. Can J Surg. 2011;54:315–20.
    1. Phelps P, Cakmakkaya OS, Apfel CC, Radke OC. A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial. Obstet Gynecol. 2008;111:1155–60.
    1. Chang SH, Lee HW, Kim HK, Kim SH, Kim DK. An evaluation of perioperative pregabalin for prevention and attenuation of postoperative shoulder pain after laparoscopic cholecystectomy. Anesth Analg. 2009;109:1284–6.
    1. Dixon JB, Reuben Y, Halket C, O'Brien PE. Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery. Obes Surg. 2005;15:1111–7.
    1. Shin HY, Kim SH, Lee YJ, Kim DK. The effect of mechanical ventilation tidal volume during pneumoperitoneum on shoulder pain after a laparoscopic appendectomy. Surg Endosc. 2010;24:2002–7.
    1. Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg. 2000;87:1161–5.
    1. Koivusalo AM, Kellokumpu I, Lindgren L. Gasless laparoscopic cholecystectomy: comparison of postoperative recovery with conventional technique. Br J Anaesth. 1996;77:576–80.
    1. Vezakis A, Davides D, Gibson JS, Moore MR, Shah H, Larvin M, McMahon MJ. Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy. Surg Endosc. 1999;13:890–3.
    1. Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. Lancet. 1991;338:1569–70.
    1. Ng A, Swami A, Smith G, Robertson G, Lloyd DM. Is intraperitoneal levobupivacaine with epinephrine useful for analgesia following laparoscopic cholecystectomy? A randomized controlled trial. Eur J Anaesthesiol. 2004;21:653–7.
    1. Alexander JI. Pain after laparoscopy. Br J Anaesth. 1997;79:369–78.
    1. Alanoglu Z, Ateş Y, Orbey BC, Türkçapar AG. Preoperative use of selective COX-II inhibitors for pain management in laparoscopic nissen fundoplication. Surg Endosc. 2005;19:1182–7.
    1. Crocker S, Paech M. Preoperative rectal indomethacin for analgesia after laparoscopic sterilisation. Anaesth Intensive Care. 1992;20:337–40.
    1. Van EE R, Hemrika DJ, van der Linden CT. Pain relief following day-case diagnostic hysteroscopy-laparoscopy for infertility: a double-blind randomized trial with preoperative naproxen versus placebo. Obstet Gynecol. 1993;82:951–4.
    1. Edwards ND, Barclay K, Catling SJ, Martin DG, Morgan RH. Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenac. Anaesthesia. 1991;46:1077–80.
    1. Sandhu T, Paiboonworachat S, Ko-iam W. Effects of preemptive analgesia in laparoscopic cholecystectomy: a double-blind randomized controlled trial. Surg Endosc. 2011;25:23–7.
    1. Jabbour-Khoury SI, Dabbous AS, Gerges FJ, Azar MS, Ayoub CM, Khoury GS. Intraperitoneal and intravenous routes for pain relief in laparoscopic cholecystectomy. JSLS. 2005;9:316–21.
    1. Phinchantra P, Bunyavehchevin S, Suwajanakorn S, Wisawasukmongchol W. The preemptive analgesic effect of celecoxib for day-case diagnostic laparoscopy. J Med Assoc Thai. 2004;87:283–8.
    1. Dembo G, Park SB, Kharasch ED. Central nervous system concentrations of cyclooxygenase-2 inhibitors in humans. Anesthesiology. 2005;102:409–15.
    1. Mehta V, Johnston A, Cheung R, Bello A, Langford RM. Intravenous parecoxib rapidly leads to COX-2 inhibitory concentration of valdecoxib in the central nervous system. Clin Pharmacol Ther. 2008;83:430–5.
    1. Koppert W, Wehrfritz A, Körber N, Sittl R, Albrecht S, Schüttler J, Schmelz M. The cyclooxygenase isozyme inhibitors parecoxib and paracetamol reduce central hyperalgesia in humans. Pain. 2004;108:148–53.
    1. Rundshagen I, Hardt T, Cortina K, Pragst F, Fritzsche T, Spies C. Narcotrend-assisted propofol/remifentanil anaesthesia vs clinical practice: does it make a difference? Br J Anaesth. 2007;99:686–93.
    1. Beauregard L, Pomp A, Choinière M. Severity and impact of pain after day-surgery. Can J Anaesth. 1998;45:304–11.
    1. Mendoza TR, Chen C, Brugger A, Hubbard R, Snabes M, Palmer SN, Zhang Q, Cleeland CS. Lessons learned from a multiple-dose post-operative analgesic trial. Pain. 2004;109:103–9.
    1. Whitley E, Ball J. Statistics review 4: sample size calculations. Crit Care. 2002;6:335–41.
    1. McGrath B, Elgendy H, Chung F, Kamming D, Curti B, King S. Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5,703 patients. Can J Anaesth. 2004;51:886–91.
    1. Akaraviputh T, Leelouhapong C, Lohsiriwat V, Aroonpruksakul S. Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy: a prospective, randomized study. World J Gastroenterol. 2009;15:2005–8.
    1. Papadima A, Lagoudianakis EE, Antonakis PT, Pattas M, Kremastinou F, Katergiannakis V, Manouras A, Georgiou L. Parecoxib vs. lornoxicam in the treatment of postoperative pain after laparoscopic cholecystectomy: a prospective randomized placebo-controlled trial. Eur J Anaesthesiol. 2007;24:154–8.
    1. Puolakka PA, Puura AI, Pirhonen RA, Ranta AU, Autio V, Lindgren L, Rorarius MG. Lack of analgesic effect of parecoxib following laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2006;50:1027–32.
    1. Abdulla S, Eckhardt R, Netter U, Abdulla W. A randomized, double-blind, controlled trial on non-opioid analgesics and opioid consumption for postoperative pain relief after laparoscopic cholecystectomy. Acta Anaesthesiol Belg. 2012;63:43–50.
    1. Ratchanon S, Phaloprakarn C, Traipak K. Pain control in laparoscopic gynecologic surgery with/without preoperative (preemptive) parecoxib sodium injection: a randomized study. J Med Assoc Thai. 2011;94:1164–8.
    1. Bunyavejchevin S, Prayoonwech C, Sriprajittichai P. Preemptive Analgesic Efficacy of Parecoxib vs Placebo in Infertile Women Undergoing Diagnostic Laparoscopy: Randomized Controlled Trial. J Minim Invasive Gynecol. 2012 [Epub ahead of print]
    1. Schulte-Steinberg H, Weninger E, Jokisch D, Hofstetter B, Misera A, Lange V, Stein C. Intraperitoneal versus interpleural morphine or bupivacaine for pain after laparoscopic cholecystectomy. Anesthesiology. 1995;82:634–40.
    1. Yuan JJ, Yang DC, Zhang JY, Bible R Jr, Karim A, Findlay JW. Disposition of a specific cyclooxygenase-2 inhibitor, valdecoxib, in human. Drug Metab Dispos. 2002;30:1013–21.
    1. Joshi GP. Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiol Clin North America. 2005;23:185–202.
    1. Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, Wei HB. Laparoscopic versus open appendectomy for acute appendicitis: a meta analysis. Surg Endosc. 2011;25:1199–208.
    1. Basse L, Jakobsen DH, Bardram L, Billesbølle P, Lund C, Mogensen T, Rosenberg J, Kehlet H. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg. 2005;241:416–23.
    1. Zheng MH, Feng B, Lu AG, Li JW, Wang ML, Mao ZH, Hu YY, Dong F, Hu WG, Li DH, Zang L, Peng YF, Yu BM. Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma. World J Gastroenterol. 2005;11:323–6.
    1. White PF, Sacan O, Tufanogullari B, Eng M, Nuangchamnong N, Ogunnaike B. Effect of short-term postoperative celecoxib administration on patient outcome after outpatient laparoscopic surgery. Can J Anaesth. 2007;54:342–8.
    1. Nussmeier NA, Whelton AA, Brown MT, Joshi GP, Langford RM, Singla NK, Boye ME, Verburg KM. Safety and efficacy of the cyclooxygenase-2 inhibitors parecoxib and valdecoxib after noncardiac surgery. Anesthesiology. 2006;104:518–26.
    1. Mehlisch DR, Desjardins PJ, Daniels S, Hubbard RC. Single doses of parecoxib sodium intravenously are as effective as ketorolac in reducing pain after oral surgery. J Oral Maxillofac Surg. 2003;61:1030–7.
    1. Karim A, Laurent A, Qian J, Kuss M, Hubbard R. Single dose tolerability and pharmacokinetics of parecoxib sodium, a COX-2 specific inhibitor, following intravenous administration. San Francisco, California: Proceedings of the 2000 American Society of Anesthesiologists Annual Meeting, October 14-18. 2000;2000:A–945.
    1. Akinci SB, Ayhan B, Aycan IO, Tirnaksiz B, Basgul E, Abbasoglu O, Aypar U, Sayek I. The postoperative analgesic efficacy of intraperitoneal tramadol compared to normal saline or intravenous tramadol in laparoscopic cholecystectomy. Eur J Anaesthesiol. 2008;25:375–81.

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