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. 2016 May;8(5):880-7.
doi: 10.21037/jtd.2016.03.45.

Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy

Xiao-Min Ling  1 , Fang Fang  1 , Xiao-Guang Zhang  1 , Ming Ding  1 , Qiu-A-Xue Liu  1 , Jing Cang  1
Affiliations

Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy

Xiao-Min Ling et al. J Thorac Dis. 2016 May.

Abstract

Background: Thoracotomy results in severe postoperative pain potentially leading to chronic pain. We investigated the potential benefits of intravenous parecoxib on postoperative analgesia combined with thoracic epidural analgesia (TEA).

Methods: Eighty-six patients undergoing thoracic surgery were randomized into two groups. Patient-controlled epidural analgesia (PCEA) was used until chest tubes were removed. Patients received parecoxib (group P) or placebo (group C) intravenously just 0.5 h before the operation and every 12 h after operation for 3 days. The intensity of pain was measured by using a visual analogue scale (VAS) and recorded at 2, 4, 8, 24, 48, 72 h after operation. The valid number of PCA, the side effects and the overall satisfaction to analgesic therapy in 72 h were recorded. Venous blood samples were taken before operation, the 1(st) and 3(rd) day after operation for plasma cortisol, adrenocorticotropic hormone (ACTH), interleukin-6 and tumor necrosis factor-α level. The occurrence of residual pain was recorded using telephone questionnaire 2 and 12 months after surgery.

Results: Postoperative pain scores at rest and on coughing were significantly lower with the less valid count of PCA and greater patient satisfaction in group P (P<0.01). Adverse effect and the days fit for discharge were comparable between two groups. The cortisol levels in placebo group were higher than parecoxib group at T2. The level of ACTH both decreased in two groups after operation but it was significantly lower in group P than that in group C. There were no changes in plasma IL-6 and TNF-α levels before and after analgesia at T1 and T2 (P>0.05). The occurrence of residual pain were 25% and 51.2% separately in group P and C 3 months postoperatively (P<0.05).

Conclusions: Intravenous parecoxib in multimodal analgesia improves postoperative analgesia provided by TEA, relieves stress response after thoracotomy, and may restrain the development of chronic pain.

Keywords: Epidural analgesia; parecoxib; postoperative analgesia; thoracotomy.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interests to declare.

Figures

Figure 1
Figure 1
Diagram showing the flow of the patients enrolled in the study. Eighty-six patients were included before surgery and 83 ones analysed for early parameters.
Figure 2
Figure 2
Postoperative VAS score at rest and on coughing. VAS scores were significantly lower in group P than group C in 72 h after surgery. VAS, visual analogue scale.
Figure 3
Figure 3
Plasma concentration changes of cortisol. The cortisol concentration was significantly lower in group P than group C on day 1 and day 3 after operation.
Figure 4
Figure 4
Plasma concentration changes of ACTH. In two groups, plasma concentration of ACTH both significantly reduced postoperatively, especially in patients treated with parecoxib. ACTH, adrenocorticotropic hormone.
See this image and copyright information in PMC

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