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BJA Advance Access originally published online on December 13, 2007
British Journal of Anaesthesia 2008 100(2):256-262; doi:10.1093/bja/aem345
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Preventive effects of perioperative parecoxib on post-discectomy pain

G. Riest1, J. Peters1, M. Weiss1, S. Dreyer1, P. D. Klassen2, B. Stegen1, A. Bello3 and M. Eikermann1,*

1 Klinik für Anästhesiologie und Intensivmedizin
2 Klinik für Neurochirurgie, Universitaetsklinikum Essen, Germany
3 Pfizer Inc., New York, USA

* Corresponding author: Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114-2696, USA. E-mail: meikermann{at}partners.org

Background: Cyclooxygenase inhibitor treatment is viewed increasingly critical because of safety considerations, and there are several open questions on their optimal use.

Methods: In a randomized placebo-controlled study in 320 patients undergoing discectomy, we administered parecoxib 40 mg either perioperatively (before operation and after operation), after operation (first dose given in the evening after surgery), or before operation (single parecoxib dose given 45 min before surgery). We measured the main outcome variables: average pain score, morphine consumption, and opioid-related symptom distress at 25, 49, and 73 h after surgery.

Results: Perioperative parecoxib significantly (i) improved the pain score compared with both placebo and postoperative parecoxib, (ii) decreased morphine consumption, and (iii) reduced the opioid-related symptom distress score. Neither a single preoperative dose nor postoperative parecoxib (first dose given in the evening after surgery) significantly improved morphine’s analgesic effectiveness.

Conclusions: Perioperative parecoxib compared with postoperative parecoxib improves post-discectomy pain and results in a reduction in adverse effects associated with opioid therapy. Postoperative parecoxib, or a single pre-incisional parecoxib dose, does not significantly improve post-discectomy pain or opioid side-effects up to 3 days after surgery.

Keywords: analgesics non-opioid; analgesics opioid, morphine; pain, mechanism; pain, postoperative


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