Comparing parecoxib and ketorolac as preemptive analgesia in patients undergoing posterior lumbar spinal fusion: a prospective randomized double-blinded placebo-controlled trial

BMC Musculoskeletal Disorders

Sasikaan Nimmaanrat²  Boonsin Tangtrakulwanich¹  Julin Cheewakidakarn¹  Koopong Siribumrungwong¹ 

[1] Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkla 90110, Hat Yai, Thailand;Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkla 90110, Hat Yai, Thailand

关键词: Posterior lumbar fusion;    Preemptive analgesia;    Ketorolac;    Parecoxib;   

Others  :  1139076
DOI  :  10.1186/s12891-015-0522-5

 received in 2013-12-24, accepted in 2015-03-04,  发布年份 2015

【 摘 要 】

Background

Poor postoperative pain control is frequently associated with complications and delayed discharge from a hospital. Preemptive analgesia is one of the methods suggested for reducing postoperative pain. Opioids are effective for pain control, but there known addictive properties make physicians cautious about using them. Parecoxib and ketorolac are potent non-opioid NSAIDs that are attractive alternative drugs to opioids to avoid opioid-related side effects. However, there are no good head-to-head comparisons between these two drugs in the aspect of preemptive analgesic effects in lumbar spinal fusion surgery. This study aimed to compare the efficacy in terms of postoperative pain control and safety of parecoxib with ketorolac as preemptive analgesia in posterior lumbar spinal fusion patients.

Methods

A prospective, double-blinded randomized controlled trial was carried out in patients undergoing posterior lumbar spinal fusion, who were randomized into 3 groups (n = 32). Parecoxib, ketorolac or a placebo was given to each patient via injection around 30 minutes prior to incision. The efficacy of postoperative pain control was assessed by a verbal numerical rating score (0–10). And various postoperative things were monitored for analysis, such as total opioid consumption, complications, and estimated blood loss.

Results

Both the ketorolac and parecoxib groups showed significantly better early postoperative pain reduction at the postanesthesia care unit (PACU) than the control group (p < 0.05). There were no differences between the pain scores of ketorolac and parecoxib at any time points. Complications and bleeding were not significantly different between all three groups.

Conclusions

Preemptive analgesia using both ketorolac and parecoxib showed a significantly better early postoperative pain control in the PACU than the control group in patients undergoing lumbar spinal fusion.

Trial registration

ClinicalTrials.gov NCT01859585. Registered 15 May 2013.

【 授权许可】

   
2015 Siribumrungwong et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Fig. 4.

【 参考文献 】

• [1]Ready LB: Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med 1999, 24:499-505.
• [2]Pflug AE, Murphy TM, Butler SH, Tucker GT: The effects of postoperative peridural analgesia on pulmonary therapy and pulmonary complications. Anesthesiology 1974, 41:8-17.
• [3]Kehlet H, Wilmore DW: Multimodal strategies to improve surgical outcome. Am J Surg 2002, 183:631-41.
• [4]Marret E, Kurdi O, Zufferrey P, Bonnet F: Effect of nonsteroidal antiinflammatory drugs on patients controlled analgesia morphine side effects. Anesthesiology 2005, 102:1249-60.
• [5]Kehlet H, Dahl JB: The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg 1993, 77:1048-56.
• [6]White PF: The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg 2002, 94:577-85.
• [7]Ochroch EA, Mardini IA, Gottschalk A: What is the role of NSAIDs in pre-emptive analgesia? Drugs 2003, 63:2709-23.
• [8]Hubbard RC, Naumann TM, Traylor L, Dhadda S: Parecoxib sodium has opioid-sparing effects in patients undergoing total knee arthroplasty under spinal anaesthesia. Br J Anaesth 2003, 90:166-72.
• [9]Resman-Targoff BH: Ketorolac: a parenteral nonsteroidal antiinflammatory drug. DICP 1990, 24:1098-104.
• [10]Gillis JC, Brogden RN: Ketorolac. A reappraisal of its pharmacodynamics and pharmacokinetic properties and therapeutic use in pain management. Drugs 1997, 53:139-88.
• [11]Litvak KM, McEvoy GK: Ketorolac, an injectable nonnarcotic analgesic. Clin Pharm 1990, 9:921-35.
• [12]DeAndrade JR, Maslanka M, Reines HD, Howe D, Rasmussen GL, Cardea J, et al.: Ketorolac versus meperidine for pain relief after orthopaedic surgery. Clin Orthop Relat Res 1996, 325:301-12.
• [13]Etches RC, Warriner CB, Badner N, Buckley DN, Beattie WS, Chan VW, et al.: Continuous intravenous administration of ketorolac reduces pain and morphine consumption after total hip or knee arthroplasty. Anesth Analg 1995, 81:1175-80.
• [14]DeAndrade JR, Maslanka M, Maneatis T, Bynum L, Burchmore M: The use of ketorolac in the management of postoperative pain. Orthopedics 1994, 17:157-66.
• [15]Barber FA, Gladu DE: Comparison of oral ketorolac and hydrocortisone for pain relief after anterior cruciate ligament reconstruction. Arthroscopy 1998, 14:605-12.
• [16]Cassinelli EH, Dean CL, Garcia RM, Furey CG, Bohlman HH: Ketorolac use for postoperative pain management following lumbar decompression surgery: a prospective, randomized, double-blinded, placebo-controlled trial. Spine (Phila Pa 1976) 2008, 12:1313-7.
• [17]Chen LC, Elliott RA, Ashcroft DM: Systematic review of the analgesic efficacy and tolerability of COX-2 inhibitors in post-operative pain control. J Clin Pharm Ther 2004, 29:215-29.
• [18]Cicconetti A, Bartoli A, Ripari F, Ripari A: Cox-2 selective inhibitors: a literature review of analgesic efficacy and safety in oral-maxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004, 97:139-46.
• [19]Gajraj NM, Joshi GP: Role of cyclooxygenase-2 inhibitors in postoperative pain management. Anesthesiol Clin North Am 2005, 23:49-72.
• [20]Romsing J, Moiniche S: A systematic review of COX-2 inhibitors compared with traditional NSAIDs, or different COX-2 inhibitors for postoperative pain. Acta Anesthesiol Scand 2004, 48:525-46.
• [21]Straube S, Derry S, McQuay HJ, Moore RA: Effect of preoperative Cox-II-selective NSAIDs (coxibs) on postoperative outcomes: a systematic review of randomized studies. Acta Anaesthesiol Scand 2005, 49:601-13.
• [22]Joshi W, Connelly NR, Reuben SS, Wolckenhaar M, Thakkar N: An evaluation of the safety and efficacy of administering rofecoxib for postoperative pain management. Anesth Analg 2003, 97:35-8.
• [23]Desjardins PJ, Traylor L, Hubbard RC: Analgesic efficacy of preoperative parecoxib sodium in an orthopedic pain model. J Am Podiatr Med Assoc 2004, 94:305-14.
• [24]Gan TJ, Joshi GP, Zhao SZ, Hanna DB, Cheung RY, Chen C: Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid-related adverse effects. Acta Anaesthesiol Scand 2004, 48:1194-207.
• [25]Joshi GP, Viscusi ER, Gan TJ, Minkowitz H, Cippolle M, Schuller R, et al.: Effective treatment of laparoscopic cholecystectomy pain with intravenous followed by oral COX-2 specific inhibitor. Anesth Analg 2004, 98:336-42.
• [26]Khalil MW, Chaterjee A, Macbryde G, Sarkar PK, Marks RR: Single dose parecoxib significantly improves ventilatory function in early extraction coronary artery bypass surgery: a prospective randomized double blind placebo controlled trial. Br J Anesth 2006, 96:171-8.
• [27]Kranke P, Morin AM, Roewer N, Eberhart LH: Patients’ global evaluation of analgesia and safety of injected parecoxib for postoperative pain: a quantitative systematic review. Anesth Analg 2004, 99:797-806.
• [28]Malan TP Jr, Gordon S, Hubbard R, Snabes M: The cyclooxygenase-2-specific inhibitor parecoxib sodium is as effective as 12 mg of morphine administered intramuscularly for treating pain after gynecologic laparotomy surgery. Anesth Analg 2005, 100:454-60.
• [29]Mehlisch DR, Desjardins PJ, Daniels S, Hubbard RC: The analgesic efficacy of intramuscular parecoxib sodium in postoperative dental pain. J Am Dent Assoc 2004, 135:1578-90.
• [30]Ng A, Temple A, Smith G, Emembolu J: Early analgesic effects of parecoxib versus ketorolac following laparoscopic sterilization: a randomized controlled trial. Br J Anaesth 2004, 92:846-9.
• [31]Nussmeier NA, Whelton AA, Brown MT, Joshi GP, Langford RM, Singla NK, et al.: Safety and efficacy of the cyclooxygenase-2 inhibitors parecoxib and valdecoxib after noncardiac surgery. Anesthesiology 2006, 104:518-26.
• [32]Ong CK, Lirk P, Seymour RA, Jenkins BJ: The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 2005, 100:757-73.
• [33]Moher D, Schulz KF, Altman DG: The CONSORT statement: revised recommendations for improving the quality of reports or parallel-group trials. Lancet 2001, 357:1191-4.
• [34]Woolf CJ, Wall PD: Morphine-sensitive and morphine-insensitive actions of C-fiber input on the rat spinal cord. Neurosci Lett 1986, 64:221-5.
• [35]Kissin I: Preemptive analgesia. Anesthesiology 2000, 93:1138-43.
• [36]Sekar C, Rajasekaran S, Kannan R, Reddy S, Shetty TA, Pithwa YK: Preemptive analgesia for postoperative pain relief in lumbosacral spine surgeries: a randomized controlled trial. Spine J 2004, 4:261-4.
• [37]Ersavli DT, Gurbet A, Bekar A, Uckunkaya N, Bilgin H: Effects of perioperatively administered bupivacaine and bupivacaine-methylprednisolone on pain after lumbar discectomy. Spine (Phila Pa 1976) 2006, 19:2221-6.
• [38]Yukawa Y, Kato F, Ito K, Terashima T, Horie Y: A prospective randomized study of preemptive analgesia for postoperative pain in the patients undergoing posterior lumbar interbody fusion: continuous subcutaneous morphine, continuous epidural morphine, and diclofenac sodium. Spine (Phila Pa 1976) 2005, 30:2357-61.
• [39]Jirarattanaphochai K, Thienthong S, Sriraj W, Jung S, Pulnitiporn A, Lertsinudom S, et al.: Effect of parecoxib on postoperative pain after lumbar spine surgery: a bicenter, randomized, double-blinded, placebo-controlled trial. Spine (Phila Pa 1976) 2008, 33:132-9.
• [40]Gandhi K, Baratta JL, Heitz JW, Schwenk ES, Vaghari B, Viscusi ER: Acute pain management in the postanesthesia care unit. Anesthesiol Clin 2012, 30:1-15.
• [41]Cashman J, Mcanulty G: Nonsteroidal anti-inflammatory drugs in perisurgical pain management. Mechanisms of action and rationale for optimal use. Drugs 1995, 49:51-70.
• [42]Moniche S, Romsing J, Dahl JB, Tramèr MR: Nonsteroidal anti-inflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg 2003, 96:68-77.
• [43]Dimar JR 2nd, Ante WA, Zhang YP, Glassman SD: The effects of nonsteroidal anti-inflammatory drugs on posterior spinal fusions in the rat. Spine (Phila Pa 1976) 1996, 21:1870-6.
• [44]Deguchi M, Rapoff AJ, Zdeblick TA: Posterolateral fusion for isthmic spondylolisthesis in adults: analysis of fusion rate and clinical results. J Spinal Disord 1998, 11:459-64.
• [45]Li Q, Zhang Z, Cai Z, Li Q, Zhang Z, et al.: High-dose ketorolac affects adult spinal fusion: a meta-analysis of the effect of perioperative nonsteroidal anti-inflammatory drugs on spinal fusion. Spine (Phila Pa 1976) 2011, 36:461-8.
• [46]Reuben SS, Connelly NR: Postoperative analgesic effects of celecoxib or rofecoxib after spinal fusion surgery. Anesth Analg 2000, 91:1221-5.
• [47]Pradhan BB, Tatsumi RL, Gallina J, Kuhns CA, Wang JC, Dawson EG: Ketorolac and spinal fusion: does the perioperative use of ketorolac really inhibit spinal fusion? Spine (Phila Pa 1976) 2008, 33:2079-82.
• [48]Cheer SM, Gao KL: Parecoxib (Parecoxib sodium). Drugs 2001, 61:1133-41.