BJA Advance Access originally published online on December 16, 2005
British Journal of Anaesthesia 2006 96(2):171-178; doi:10.1093/bja/aei298
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Single dose parecoxib significantly improves ventilatory function in early extubation coronary artery bypass surgery: a prospective randomized double blind placebo controlled trial
1 South Yorkshire Cardiothoracic Unit, Sheffield Teaching Hospitals NHS Foundation Trust, The Northern General Hospital, Herries Road, Sheffield S5 7AU, UK. 2 Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
* Corresponding author: Department of Anaesthesia, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK. E-mail: richard.marks{at}sth.nhs.uk
Background. Parecoxib, a cyclo oxygenase-2 inhibiting non-steroidal anti-inflammatory drug, has been widely used for postoperative analgesia. Our aim was to quantify the benefit of a single dose after coronary artery bypass grafting.
Methods. The investigation was carried out as a randomized double blind placebo controlled study. A single i.v. dose of parecoxib 40 mg or placebo was given at closure of sternotomy. No opioid other than morphine was given in the first 24 postoperative hours. Pain was assessed using both a Visual Analogue Score (1–10), and the amount of morphine used via a morphine patient controlled analgesia pump. Creatinine clearance was measured before and after operation from 24 h urine collections. After a global announcement by Pfizer that paracoxib was ‘contraindicated in patients with ischaemic heart disease’ further recruitment was suspended and the collected data from 40 patients were analysed.
Results. Twenty-one patients received parecoxib and 19 received placebo. Amongst those who received parecoxib, there was a highly significant sparing of rescue medication before tracheal extubation (P=0.004) compared with placebo, and an overall 35% morphine sparing effect during the first 6 h post extubation after correction for the variability in extubation time (P=0.037). Respiration, as measured by arterial carbon dioxide tension at the time of extubation, was significantly better in the parecoxib group (P=0.045). Significantly more furosemide was given for postoperative oliguria in those patients who received parecoxib (P=0.036). After correcting for differences in diuretic usage and fluid balance, parecoxib was associated with a significant increase in plasma creatinine (P=0.041).
Conclusion. A single dose of parecoxib has a significant opioid sparing effect in the first 6 h after coronary artery bypass grafting which resulted in significantly improved ventilation with mild elevation of plasma creatinine within normal limits.