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Hu CY, Wang JH, Chen TY, Wang PK. Associations of parecoxib and other variables with recovery and safety outcomes in total knee arthroplasty: insights from a retrospective cohort study. Front Surg 2024; 10:1308221. [PMID: 38239668 PMCID: PMC10794493 DOI: 10.3389/fsurg.2023.1308221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024] Open
Abstract
Background Early mobilization post-total knee arthroplasty (TKA) significantly affects patient outcomes. While parecoxib is known to reduce postoperative pain and morphine use with a favorable safety profile, its impact on mobilization timing post-TKA remains uncertain. This retrospective study aims to assess parecoxib's influence on postoperative mobilization timing in TKA patients without compromising safety. Methods This study included unilateral TKA patients treated for primary knee osteoarthritis under general anesthesia. We divided the study period into two intervals, 2007-2012 and 2013-2018, to evaluate temporal differences. Both the control group and parecoxib group received standard postoperative oral analgesics and as-needed intramuscular morphine. The control group did not receive parecoxib, while the parecoxib group did. Primary outcomes compared postoperative complications and mobilization timing between groups, with secondary outcomes including length of hospital stay (LOS), Visual Analog Scale (VAS) scores for pain, as-needed morphine use, and postoperative nausea/vomiting. Results Parecoxib did not increase postoperative complications. Unmatched comparison with patients in controlled group found that patients in parecoxib group had significantly shortened mobilization time (2.2 ± 1.1 vs. 2.7 ± 1.6 days, P < 0.001) and LOS (6.7 ± 2.5 vs. 7.2 ± 2.1 days, P = 0.01). Multivariate analysis linked parecoxib use with faster mobilization (β = -0.365, P < 0.001) but not LOS. Males showed increased mobilization time and LOS compared to females during the period of 2007-2018, but gender had no significant association with LOS during the period of 2013-2018. The 2013-2018 period saw significant reductions in both mobilization time and LOS. Use of a tourniquet and local infiltration analgesia showed no significant impact. ASA classification 1-2 was positively associated with faster mobilization but not LOS. Longer operation times were linked to delayed mobilization and increased LOS. Conclusion In this study, intravenous parecoxib injection, female gender, and shorter OP time had consistent positive association with shorter time to mobilization after individual multivariate analysis in 2 different period. The use of parecoxib had consistent no significant association with LOS. Only shorter OP time was consistent positive associated with shorter LOS.
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Affiliation(s)
- Ching-Yuan Hu
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tsung-Ying Chen
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Po-Kai Wang
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Li XY, Zhang L, Ding YM, Wang CX, Qiu Y. Effects of fascia iliaca compartment block as an adjunctive management to parecoxib for pain control after total hip arthroplasty. Medicine (Baltimore) 2022; 101:e29688. [PMID: 35905228 PMCID: PMC9333507 DOI: 10.1097/md.0000000000029688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This retrospective study investigated the effects of fascia iliaca compartment block (FICB) as an adjunctive management to parecoxib for pain control after total hip arthroplasty (THA). METHODS A total of 72 patient records of THA were included in this retrospective study. All patients received parecoxib and were allocated to either the treatment group (n = 36) or the control group (n = 36). In addition, patients in the treatment group underwent FICB. The primary outcome was pain intensity measured using a resting and moving visual analog scales (VASs). The secondary outcomes were inflammatory factors (interleukin 6 and C-reactive protein) and occurrence rate of adverse events. RESULTS Patients in the treatment group had better outcomes in the resting VAS (12 hours, P < .01; 24 hours, P < .01; 36 hours, P = .01; 72 hours, P = .03), moving VAS (12 hours, P < .01; 24 hours, P < .01; 36 hours, P = .02; 72 hours, P = .02), serum interleukin 6 (P < .01), and C-reactive protein (P < .01) than those in the control group at different time points. In addition, there were no significant differences in the occurrence rate of adverse events. CONCLUSION The findings of this study demonstrated that the effects of FICB as an adjunctive management to parecoxib are superior to those of parecoxib alone for pain control after THA.
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Affiliation(s)
- Xiao-yan Li
- Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Liang Zhang
- Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yu-mei Ding
- Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Cai-xia Wang
- Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yi Qiu
- Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- *Correspondence: Yi Qiu, Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University, No.1, Yingfang Road, Hohhot, 010010, China (e-mail: )
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Ma M, Fan AY, Liu Z, Yang LQ, Huang JM, Pang ZY, Yin F. Baohuoside I Inhibits Osteoclastogenesis and Protects Against Ovariectomy-Induced Bone Loss. Front Pharmacol 2022; 13:874952. [PMID: 35571086 PMCID: PMC9092047 DOI: 10.3389/fphar.2022.874952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
Bone-resorbing osteoclasts are essential for skeletal remodelling, and the hyperactive formation and function of osteoclasts are common in bone metabolic diseases, especially postmenopausal osteoporosis. Therefore, regulating the osteoclast differentiation is a major therapeutic target in osteoporosis treatment. Icariin has shown potential osteoprotective effects. However, existing studies have reported limited bioavailability of icariin, and the material basis of icariin for anti-osteoporosis is attributed to its metabolites in the body. Here, we compared the effects of icariin and its metabolites (icariside I, baohuoside I, and icaritin) on osteoclastogenesis by high-content screening followed by TRAP staining and identified baohuoside I (BS) with an optimal effect. Then, we evaluated the effects of BS on osteoclast differentiation and bone resorptive activity in both in vivo and in vitro experiments. In an in vitro study, BS inhibited osteoclast formation and bone resorption function in a dose-dependent manner, and the elevated osteoclastic-related genes induced by RANKL, such as NFATc1, cathepsin K, RANK, and TRAP, were also attenuated following BS treatment. In an in vivo study, OVX-induced bone loss could be prevented by BS through interrupting the osteoclast formation and activity in mice. Furthermore, mechanistic investigation demonstrated that BS inhibited osteoclast differentiation by ameliorating the activation of the MAPK and NF-kB pathways and reducing the expression of uPAR. Our study demonstrated that baohuoside I could inhibit osteoclast differentiation and protect bone loss following ovariectomy.
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Affiliation(s)
- Min Ma
- Department of Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ao-Yuan Fan
- Department of Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zheng Liu
- Department of Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li-Qing Yang
- Department of Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jun-Ming Huang
- Department of Orthopaedic, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhi-Ying Pang
- Department of Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Feng Yin
- Department of Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China.,Shanghai Clinical Research Centre for Ageing and Medicine, Shanghai, China
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Protti ÍF, Rodrigues DR, Fonseca SK, Alves RJ, de Oliveira RB, Maltarollo VG. Do Drug-likeness Rules Apply to Oral Prodrugs? ChemMedChem 2021; 16:1446-1456. [PMID: 33471444 DOI: 10.1002/cmdc.202000805] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/12/2021] [Indexed: 12/21/2022]
Abstract
This paper describes a comparative analysis of the physicochemical and structural properties of prodrugs and their corresponding drugs with regard to drug-likeness rules. The dataset used in this work was obtained from the DrugBank. Sixty-five pairs of prodrugs/drugs were retrieved and divided into the following categories: carrier-linked to increase hydrophilic character, carrier-linked to increase absorption, and bioprecursors. We compared the physicochemical properties related to drug-likeness between prodrugs and drugs. Our results show that prodrugs do not always follow Lipinski's Rule of 5, especially as we observed 15 prodrugs with more than 10 hydrogen bond acceptors and 18 with a molecular weight greater than 500 Da. This fact highlights the importance of extending Lipinski's rules to encompass other parameters as both strategies (filtering of drug-like chemical libraries and prodrug design) aim to improve the bioavailability of compounds. Therefore, critical reasoning is fundamental to determine whether a structure has drug-like properties or could be considered a potential orally active compound in the drug-design pipeline.
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Affiliation(s)
- Ícaro F Protti
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627 Pampulha, Belo Horizonte, MG, BR 31270-901, Brazil
| | - Daniel R Rodrigues
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627 Pampulha, Belo Horizonte, MG, BR 31270-901, Brazil
| | - Sofia K Fonseca
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627 Pampulha, Belo Horizonte, MG, BR 31270-901, Brazil
| | - Ricardo J Alves
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627 Pampulha, Belo Horizonte, MG, BR 31270-901, Brazil
| | - Renata B de Oliveira
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627 Pampulha, Belo Horizonte, MG, BR 31270-901, Brazil
| | - Vinícius G Maltarollo
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627 Pampulha, Belo Horizonte, MG, BR 31270-901, Brazil
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Cheng L, Le Y, Yang H, Zhou X. The effect of dexamethasone on pain control after thyroid surgery: a meta-analysis of randomized controlled trials. Eur Arch Otorhinolaryngol 2020; 278:1957-1964. [PMID: 32804272 DOI: 10.1007/s00405-020-06245-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/24/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The effect of dexamethasone on postoperative pain after thyroid surgery remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexamethasone versus placebo on postoperative pain after thyroid surgery. METHODS We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through May 2020 for randomized controlled trials (RCTs) assessing the effect of dexamethasone versus placebo on postoperative pain after thyroid surgery. This meta-analysis is performed using the random-effect model. RESULTS Eight RCTs involving 734 patients are included in the meta-analysis. Overall, compared with control group for thyroid surgery, dexamethasone shows significantly reduced pain scores (SMD = - 0.82; 95% CI - 1.08 to - 0.56; P < 0.00001), number of required analgesics (OR = 0.18; 95% CI 0.11-0.31; P < 0.00001), analgesic consumption (SMD = - 0.38; 95% CI - 0.63 to - 0.13; P = 0.003), nausea and vomiting (OR = 0.38; 95% CI 0.17-0.86; P = 0.02), as well as rescue antiemetics (OR = 0.40; 95% CI 0.20-0.79; P = 0.008). CONCLUSIONS Perioperative dexamethasone is effective to reduce the pain, nausea and vomiting after thyroid surgery.
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Affiliation(s)
- Lian Cheng
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Department of General Surgery (Thyroid Surgery), Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Yuan Le
- Hospital of Traditional Chinese Medicine affiliated to Southwest Medical University, Luzhou, 646000, China
| | - Hui Yang
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Department of General Surgery (Thyroid Surgery), Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
| | - Xiangyu Zhou
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Department of General Surgery (Thyroid Surgery), Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
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Xu T, Dong B, Wu X, Shi C, Huang L, Yang H. WITHDRAWN: Dexamethasone effect on postoperative pain of thyroid surgery: A meta-analysis of randomized controlled trials. Am J Otolaryngol 2020. [DOI: 10.1016/j.amjoto.2020.102669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Baboli KM, Liu H, Poggio JL. Opioid-free postoperative analgesia: Is it feasible? Curr Probl Surg 2020; 57:100794. [DOI: 10.1016/j.cpsurg.2020.100794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/28/2022]
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Huang JM, Lv ZT, Zhang B, Jiang WX, Nie MB. Intravenous parecoxib for early postoperative cognitive dysfunction in elderly patients: evidence from a meta-analysis. Expert Rev Clin Pharmacol 2020; 13:451-460. [PMID: 32077347 DOI: 10.1080/17512433.2020.1732815] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Inflammation plays a key role in the etiology and pathology of postoperative cognitive dysfunction (POCD). Cyclooxygenase (COX)-2 inhibitor parecoxib is used for the treatment of acute pain due to its potent anti-inflammatory and analgesic effects. Herein, we evaluated the efficacy and safety of parecoxib on early POCD in geriatric patients. OBJECTIVE This study was performed to evaluate the efficacy and safety of parecoxib for early postoperative cognitive dysfunction (POCD) in elderly patients. METHODS Comprehensive literature search based on six electronic databases was applied to retrieve all related randomized controlled trials (RCTs). Two independent reviewers screened each article for eligibility according to the predetermined inclusion criteria. The Cochrane's Tool was applied to evaluate the methodological quality of included studies. RevMan 5.3 was used to conduct meta-analysis. RESULTS Eight RCTs comprising a total of 1106 subjects prepared for orthopedic surgical operation were selected. All the identified RCTs were conducted in China. The methodological qualities of included studies were judged to be medium to high. The integrated data showed that perioperative intravenous parecoxib could remarkably reduce the incidence of POCD with improved Mini-Mental State Examination (MMSE) score. Parecoxib could significantly reduce the concentrations of interleukin-6, but results regarding the changes in tumor necrosis factor-alpha, C-reactive protein, and S100β levels remained inconsistent. CONCLUSION Perioperative parecoxib administration is effective in reducing the incidence of POCD and improving the MMSE score compared with control. However, the beneficial effect of parecoxib has been tested only in the Chinese population. Future RCTs in western countries with larger-scale and more comprehensive neurological tests are needed.
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Affiliation(s)
- Jun-Ming Huang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Zheng-Tao Lv
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Bin Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
| | - Wen-Xiu Jiang
- Department of Otorhinolaryngology, Fudan University Eye Ear Nose and Throat Hospital, Fudan University , Shanghai, China
| | - Ming-Bo Nie
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
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Zhang X, Zhu J, Ye B, Yashengaili A, Xu L, Li X. Combination of Epidural Blockade and Parecoxib in Enhanced Recovery After Gastrointestinal Surgery. J INVEST SURG 2020; 34:716-720. [PMID: 31960719 DOI: 10.1080/08941939.2019.1690601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigation effects of the combination use of epidural blockade and parecoxib in postoperative recovery of colorectal cancer (CRC) patients. METHODS The present prospective single-blinded study included 186 CRC patients who received radical resection during April 2016 to December 2017. All patients were randomized into 3 different groups, the epidural blockade group, the combined-group with both epidural blockade and pre-intravenous injection of parecoxib, and the control group. The mean operative time, bleeding volume, the first out of bed activity time and hospital stay time were recorded. The mini-mental state examination (MMSE) score and Ramsay score were measured for cognitive function and the Visual Analog Score (VAS) was determined for the pain condition. RESULTS The surgery time for the control group was significantly shorter than the other 2 groups (P < 0.05). The VAS scores were significantly lower in both the combined group and the epidural blockade group when compared with the control group and were dramatically lower in the combined group than the others 2 groups (all P < 0.05). The first out of bed activity time and hospital stay time were the shortest in the combined group, and the control group had the longest time (all P < 0.05). Both the Ramsay and MMSE scores were the highest in the combination group than other groups (all P < 0.05) and no significant difference was observed between the epidural blockade group and the control. CONCLUSION The combination of epidural blockade and parecoxib could enhance the recovery process, as well as reduce the pain for the CRC patients.
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Affiliation(s)
- Xuerong Zhang
- Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jun Zhu
- Department of Clinic, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | | | | | - Lei Xu
- Xinjiang Medical University, Urumqi, China
| | - Xuebin Li
- Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Du X, Song F, Zhang X, Ma S. Protective efficacy of combined use of parecoxib and dexmedetomidine on postoperative hyperalgesia and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients. Acta Cir Bras 2019; 34:e201900905. [PMID: 31800679 PMCID: PMC6889861 DOI: 10.1590/s0102-865020190090000005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/04/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose: To investigate efficacy of combined use of parecoxib and dexmedetomidine on
postoperative pain and early cognitive dysfunction after laparoscopic
cholecystectomy for elderly patients. Methods: The present prospective randomized controlled study included a total of 80
patients who underwent laparoscopic cholecystectomy surgery during January
2016 to November 2017 in our hospital. All patients were randomly divided
into 4 groups, the parecoxib group, the dexmedetomidine group, the parecoxib
and dexmedetomidine combined group, and the control group. Demographic data
and clinical data were collected. Indexes of heart rate (HR), mean arterial
pressure (MAP), levels of jugular venous oxygen saturation (SjvO2) and
jugular venous oxygen pressure (PjvO2) were recorded at different time
points before and during the surgery. The mini-mental state examination
(MMSE) score, Ramsay score and Visual Analogue Score (VAS) were
measured. Results: Levels of both SjvO2 and PjvO2 were significantly higher in parecoxib group,
dexmedetomidine group and the combined group than the control group.
Meanwhile, levels of both SjvO2 and PjvO2 in the combined group were the
highest. VAS scores were significantly lower in the combined group than all
other groups, and total patient controlled intravenous analgesia (PCIA)
pressing times within 48 h after surgery were the lowest in the combined
group. Both Ramsay and MMSE scores were the highest in the combined group
compared with other groups, while were the lowest in the control group. Conclusion: The combined use of parecoxib and dexmedetomidine could reduce the
postoperative pain and improve the postoperative sedation and cognitive
conditions of patients after laparoscopic cholecystectomy.
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Affiliation(s)
- Xiaoxuan Du
- MD, Department of Anesthesiology, the Sixth Affiliated Hospital of the Sixth Clinical Medical School, Xinjiang Medical University, Tianshan District, Urumqi, XinJiang, China. Design of the study, technical procedures, manuscript writing
| | - Feng Song
- MD, Department of Anesthesiology, the Sixth Affiliated Hospital of the Sixth Clinical Medical School, Xinjiang Medical University, Tianshan District, Urumqi, XinJiang, China. Technical procedures, analysis of data, critical revision
| | - Xueqiang Zhang
- MM, Department of Anesthesiology, the Sixth Affiliated Hospital of the Sixth Clinical Medical School, Xinjiang Medical University, Tianshan District, Urumqi, XinJiang, China. Technical procedures, analysis of data, critical revision
| | - Shanshan Ma
- MM, Department of Anesthesiology, the Sixth Affiliated Hospital of the Sixth Clinical Medical School, Xinjiang Medical University, Tianshan District, Urumqi, XinJiang, China. Technical procedures, analysis of data, critical revision
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冯 金, 李 卡, 冯 缓, 韩 蔷, 高 敏, 许 瑞. [Efficacy of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative analgesia in patients undergoing pancreaticoduodenectomy]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:830-835. [PMID: 31340917 PMCID: PMC6765552 DOI: 10.12122/j.issn.1673-4254.2019.07.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the effect of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative pain management in patients undergoing pancreaticoduodenectomy. METHODS This randomized controlled trial was conducted among 98 patients undergoing pancreaticoduodenectomy in the Department of Biliary Surgery of West China Hospital between March, 2017 and August, 2018. The patients were randomized to receive perioperative analgesia with local infiltration anesthesia with ropivacaine combined with multimodal analgesia with parecoxib (experimental group, n=50) or postoperative analgesia with dizosin (control group, n=48). The regimens for intraoperative anesthesia and postoperative pain relief were identical in the two groups. The differences in NRS pain score, use of pain relief agents, the incidences of adverse reactions to analgesia and wound infection, and the time to first ambulation and first flatus passage after the operation were compared between the two groups. RESULTS At 12, 24 h, 48 h, 72 h and 7 days after the operation, the patients in the experimental group had significantly lower NRS scores (P < 0.05) than those in the control group. The rate of use of rescue analgesics was significantly lower in the experimental group than in the control group (32% vs 66.67%, P < 0.05); the rate of tramadol hydrochloride use was also significantly lower in the experimental group (P < 0.05). Compared with those in the control group, the patients in the experimental group showed a significantly lower total incidence of adverse reactions (22% vs 54.17%, P < 0.05) as well as a lower incidence of nausea and vomiting (P < 0.05), an earlier time of first ambulation and first flatus passage after the operation (P < 0.05), and a shorter postoperative hospital stay (P < 0.05). CONCLUSIONS In patients undergoing pancreaticoduodenectomy, local infiltration of ropivacaine combined with multimodal analgesia with ropivacaine can effectively relieve perioperative pain, reduce the use of relief analgesics, lower the incidence of adverse reactions, and promote the recovery after the surgery.
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Affiliation(s)
- 金华 冯
- 四川大学 华西医院胆道外科,四川 成都 610041Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China
| | - 卡 李
- 四川大学 华西护理学院,四川 成都 610041West China Nursing College, Sichuan University, Chengdu 610041, China
| | - 缓 冯
- 四川大学 华西医院胆道外科,四川 成都 610041Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China
| | - 蔷 韩
- 四川大学 华西医院胆道外科,四川 成都 610041Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China
| | - 敏 高
- 四川大学 华西医院胆道外科,四川 成都 610041Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China
| | - 瑞华 许
- 四川大学 华西医院胆道外科,四川 成都 610041Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China
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Qiu J, Xie M, Qu R. The Influence of Etoricoxib on Pain Control for Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech 2019; 29:150-154. [PMID: 30855399 DOI: 10.1097/sle.0000000000000635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The efficacy of etoricoxib on pain control for laparoscopic cholecystectomy remains controversial. We conduct a systematic review and meta-analysis to explore the impact of etoricoxib on pain intensity after laparoscopic cholecystectomy. MATERIALS AND METHODS We searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2018 for randomized controlled trials assessing the effect of etoricoxib versus placebo on pain management after laparoscopic cholecystectomy. This meta-analysis was performed using the random-effect model. RESULTS Four randomized controlled trials involving 351 patients are included in the meta-analysis. Overall, compared with control group for laparoscopic cholecystectomy, etoricoxib has no important impact on pain scores within 4 hours [mean difference (MD)=-1.48; 95% confidence interval (CI)=-3.54 to 0.58; P=0.16] and 8 hours (MD=-0.65; 95% CI=-1.43 to 0.12; P=0.10), but can significantly decrease pain intensity within 12 hours (MD=-1.16; 95% CI=-1.93 to -0.38; P=0.003) and 24 hours (MD=-1.10; 95% CI=-1.98 to -0.22; P=0.01), as well as postoperative analgesic consumption (standard MD=-1.21; 95% CI=-2.19 to -0.23; P=0.02), with no increase in nausea and vomiting (risk ratio=0.68; 95% CI=0.42-1.10; P=0.11), and headache (risk ratio=0.96; 95% CI=0.44-2.09; P=0.92). CONCLUSIONS Etoricoxib can substantially reduce pain intensity in patients with laparoscopic cholecystectomy.
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Affiliation(s)
- Jin Qiu
- Departments of Aneshesiology
| | | | - Ronglan Qu
- ICU, ChongQing Traditional Chinese Medicine Hospital, Jiangbei District, Chongqing, China
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Du X, Gu J. The efficacy and safety of parecoxib for reducing pain and opioid consumption following total knee arthroplasty: A meta-analysis of randomized controlled trials. Int J Surg 2018; 59:67-74. [DOI: 10.1016/j.ijsu.2018.09.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 11/28/2022]
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