A Randomized Controlled Trial Comparing Preoperative Celecoxib vs Etoricoxib Combined with Paracetamol for Postoperative Pain Management after Total Abdominal Hysterectomy
Keywords:
analgesia, celecoxib, etoricoxib, hysterectomy, postoperative painAbstract
Background: Preemptive multimodal analgesia, particularly using COX-2 inhibitors combined with paracetamol, may effectively reduce postoperative pain and morphine consumption following abdominal hysterectomy. The study aims to compare the efficacy of preoperative celecoxib or etoricoxib combined with paracetamol in reducing postoperative pain and morphine use. Methods: A randomized controlled trial was conducted in 63 patients undergoing abdominal hysterectomy. Participants were randomized into three groups: celecoxib 400 mg and paracetamol 500 mg, etoricoxib 90 mg and paracetamol 500 mg and a control group receiving no preoperative medication. Pain scores were assessed using the numerical rating scale (NRS) at 1, 4, 8, and 24 h, postoperatively. Morphine consumption within 24 h was recorded. Statistical analysis included ANOVA, Kruskal-Wallis, and Chi-square tests. Results: Morphine consumption within 24 h differed significantly among groups (P=0.016), with the etoricoxib group using the least (3.4 ± 2.9 mg) significantly lower than the control group (P=0.012). The celecoxib group did not differ significantly from the control (P=0.220). Pain scores were not significantly different among the groups. Conclusion: Preoperative etoricoxib combined with paracetamol significantly reduces postoperative morphine use and is suitable as part of a multimodal analgesia strategy.
References
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534-40.
Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11:1859-71.
Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline. J Pain. 2016;17:131-57.
Kehlet H, Dahl JB. The value of multimodal or balanced analgesia in postoperative pain treatment. Anesth Analg. 1993;77:1048-56.
Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009;22:588-93.
Davies NM, McLachlan AJ, Day RO, Williams KM. Clinical pharmacokinetics and pharmacodynamics of celecoxib: a selective cyclo-oxygenase-2 inhibitor. Clin Pharmacokinet. 2000;38:225-42.
Patrignani P, Capone ML, Tacconelli S. Clinical pharmacology of etoricoxib: a novel selective COX2 inhibitor. Expert Opin Pharmacother. 2003;4:265-84.
Stephan AS. The role of COX-2 inhibitors in the treatment of postoperative pain. J Cardiovasc Pharmacol. 2006;47(Suppl):S82-6.
Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology. 2002;96:
-41.
Ong CKS, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal anti-inflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110:1170-9.
Remy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Curr Opin Anaesthesiol. 2006;19:562-5.
Chau-in W, Thienthong S, Pulnitiporn A, Tantanatewin W, Prasertcharoensuk W, Sriraj W. Prevention of postoperative pain after abdominal hysterectomy by single dose etoricoxib. J Med Assoc Thai. 2008;91:68-73.
Boonriong T, Tangtrakulwanich B, Glabglay P, Nimmaanrat S. Comparing etoricoxib and celecoxib for preemptive analgesia for acute postoperative pain in patients undergoing arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial. BMC Musculoskelet Disord. 2010;11:246.
McNicol ED, Ferguson MC, Haroutounian S, Carr DB, Schumann R. Single dose intravenous paracetamol or intravenous propacetamol for postoperative pain. Cochrane Database Syst Rev. 2016;2016:CD007126.
Arponrat P, Kongdan Y, Luecha A. Effect of preoperative parecoxib on postoperative pain in major gynecologic surgery: a randomized double-blind controlled trial. J Med Assoc Thai. 2015;98:790-6.
Yang S, Xiao W, Wang S, et al. Parecoxib shortens the duration of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy. Front Pharmacol. 2019;10:689.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright
Copyright of all articles published in the Thai Journal of Anesthesiology is held by the Thai Journal of Anesthesiology, the Royal College of Anesthesiologists of Thailand. Submission of a manuscript constitutes the authors' agreement that, upon acceptance for publication, copyright of the work is transferred to the Journal. The content and any opinions expressed in published articles are the sole responsibility of the authors and do not necessarily reflect the views of the editorial board or the Royal College of Anesthesiologists of Thailand.
Licensing
All articles are published open access under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). Under this license, anyone may copy and redistribute published articles in any medium or format for non-commercial purposes, provided that appropriate credit is given to the authors and to the Thai Journal of Anesthesiology as the original source of publication, a link to the license is included, and the material is not modified in any way. Requests for commercial use or for adaptation of published material should be directed to the editorial office.
Authors' Rights
Although copyright is held by the Journal, authors retain the right to reuse their own published material in their future scholarly works, theses and dissertations, teaching, and academic presentations, and to deposit the final published version (PDF) in institutional or subject repositories or on personal and institutional websites, without embargo, provided that the Thai Journal of Anesthesiology is clearly acknowledged as the original place of publication.
