Efficacy and Safety of Injected Parecoxib Sodium for Acute Postoperative Pain: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Xiaoqian ¹ , SUN Jiehao ² ,  MA Hong ¹

1. Department of Anesthesiology, the First Affiliated Hospital, China Medical University, Shenyang 110001, China2. Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical College, Whenzhou 325000, China;

Corresponding author：

MA Hong, Email: shirley037305@hotmail.com

Keywords：

Parecoxib sodium; Pain; Cyclooxygenase-2 inhibitor; Meta-analysis

DOI：

10.7507/1672-2531.20090156

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Objective 　To systematically evaluate the efficacy and safety of injected cyclooxygenase-2 inhibitor for acute postoperative pain.
Methods 　We electronically searched PubMed, EBSCO, Springer, Ovid and CNKI databases from 1999 through Jan. 2009 to identify randomized controlled trials (RCTs) about cyclooxygenase-2 inhibitor or parecoxib sodium for acute postoperative pain. The methodological quality of included RCTs were assessed, and the data was extracted by two reviewers independently according to the Cochrane Handbook. The homogeneous RCTs were pooled using RevMan software, and the non-homogeneous studies evaluted using descriptive qualitative analysis.
Results 　Seven RCTs involving 1939 patients met the inclusion criteria. The results of meta-analyses showed that: ① Efficacy: The comparison of PCA combined parecoxib sodium (successively injected less than 3 days) i.v. with PCA alone: after 24, 48, and 72 hours of the initial dose of parecoxib 40 mg i.v., the percentage of the patients’ global evaluation of study medication (PGESM) described effective (excellent and good) was higher than that of the control group [RR (95%CI) were 1.41 (1.13, 1.75), 1.25 (1.15, 1.35), and 1.30 (1.21, 1.40) respectively]; the percentage of the PGESM described ineffective (fair and poor) was lower than that of the control group [RR (95%CI) were 0.43 (0.26, 0.72), 0.44 (0.34, 0.57), and 0.33 (0.23, 0.48) respectively]. ② Safety: Combination of PCA with parecoxib sodium could lessen the incidence of postoperative fever (RR=0.34, 95%CI 0.22 to 0.53) and nausea and vomiting (RR=0.69, 95%CI 0.57 to 0.83), but not statistically decrease of respiratory depression (RR=0.84, 95%CI 0.38 to 1.83), pruritus (RR=0.91, 95%CI 0.54 to 1.52), and headache (RR=0.77, 95%CI 0.47 to 1.28).
Conclusion 　The combination of PCA with parecoxib sodium successively injected less than 3 days can significantly increase the scores of PGESM, and does not increase the incidence of adverse effects or postoperative complications, and also has the advantage of decreasing postoperative fever, nausea and vomiting.

Citation： LI Xiaoqian,SUN Jiehao,MA Hong. Efficacy and Safety of Injected Parecoxib Sodium for Acute Postoperative Pain: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2009, 09(8): 887-892. doi: 10.7507/1672-2531.20090156 Copy

1.	Bensen WG, Fiechtner JJ, McMillen JI, et al. Treatment of osteoarthritis with celecoxib, a cyclooxygenase-2 inhibitor: a randomized controlled trial. Mayo Clin Proc, 1999; 74: 1095-1105.
2.	Gierse JK, McDonald JJ, Hauser SD, et al. A single amino acid difference between cyclooxygenase-1 (COX-1) and -2 (COX-2) reverses the selectivity of COX-2 specific inhibitors. J Biol Chem, 1996, 271(26): 15810-15814.
3.	Apfelbaum JL, Desjardins PJ, Brown MT, et al. Multiple-day efficacy of parecoxib sodium treatment in postoperative bunionectomy pain. Clin J Pain, 2008, 24(9): 784-792.
4.	Michael C, Artur J, Kotarski J, et al. Parecoxib sodium administered over several days reducespain after gynecologic surgery via laparotomy. J Clin Anesth, 2007, 19: 448-455.
5.	Viscusi ER, Gimbel JS, Halder AM, et al. A multiple-day regimen of parecoxib sodium 20 mg twice daily provides pain relief after total hip arthroplasty. Anesth Analg, 2008, 107(2): 652-660.
6.	Tang J, Li S, White PF, et al. Effect of parecoxib, a novel intravenous cyclooxygenase type-2 inhibitor, on the postoperative opioid requirement and quality of pain control. Anesthesiology, 2002, 96(6): 1305-1309.
7.	Malan TP, Marsh G, Hakki SI, et al. Parecoxib sodium, a parenteral cyclooxygenase-selective inhibitor, improves morphine analgesia and is opioid-sparing following total hip arthroplasty. Anesthesiology, 2003, 98: 950-957.
8.	Jirarattanaphochai K, Thienthong S, Sriraj W, et al. Effect of parecoxib on postoperative pain after lumbar spine surgery. Spine, 2008, 33: 132-139.
9.	Hubbard RC, Naumann TM, Traylor L, et al. Parecoxib sodium has opioid-sparing effects in patients undergoing total knee arthroplasty under spinal anaesthesia. Br J Anaesth, 2003, 90(2): 166-172.
10.	Barton SF, Langeland FF, Snabes MC, et al. Efficacy and safety of intravenous parecoxib sodium in relieving acute post-operative pain following gynecologic laparotomy surgery. Anesthesiology, 2002, 97: 306-314.
11.	Mehlisch DR, Desjardins PJ, Daniels S, et al. The analgesic efficacy of intramuscular parecoxib sodium in postoperative dental pain. J Am Dent Assoc, 2004, 135(11): 1578-1590.
12.	Gan TJ, Joshi GP, Zhao SZ, et al. 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(9): 1194-1207.
13.	Leykin Y, Casati A, Rapotec A, et al. Comparison of parecoxib and proparacetamol in endoscopic nasal surgery patients. Yonsei Med J, 2008, 49: 383-388.

1. Bensen WG, Fiechtner JJ, McMillen JI, et al. Treatment of osteoarthritis with celecoxib, a cyclooxygenase-2 inhibitor: a randomized controlled trial. Mayo Clin Proc, 1999; 74: 1095-1105.
2. Gierse JK, McDonald JJ, Hauser SD, et al. A single amino acid difference between cyclooxygenase-1 (COX-1) and -2 (COX-2) reverses the selectivity of COX-2 specific inhibitors. J Biol Chem, 1996, 271(26): 15810-15814.
3. Apfelbaum JL, Desjardins PJ, Brown MT, et al. Multiple-day efficacy of parecoxib sodium treatment in postoperative bunionectomy pain. Clin J Pain, 2008, 24(9): 784-792.
4. Michael C, Artur J, Kotarski J, et al. Parecoxib sodium administered over several days reducespain after gynecologic surgery via laparotomy. J Clin Anesth, 2007, 19: 448-455.
5. Viscusi ER, Gimbel JS, Halder AM, et al. A multiple-day regimen of parecoxib sodium 20 mg twice daily provides pain relief after total hip arthroplasty. Anesth Analg, 2008, 107(2): 652-660.
6. Tang J, Li S, White PF, et al. Effect of parecoxib, a novel intravenous cyclooxygenase type-2 inhibitor, on the postoperative opioid requirement and quality of pain control. Anesthesiology, 2002, 96(6): 1305-1309.
7. Malan TP, Marsh G, Hakki SI, et al. Parecoxib sodium, a parenteral cyclooxygenase-selective inhibitor, improves morphine analgesia and is opioid-sparing following total hip arthroplasty. Anesthesiology, 2003, 98: 950-957.
8. Jirarattanaphochai K, Thienthong S, Sriraj W, et al. Effect of parecoxib on postoperative pain after lumbar spine surgery. Spine, 2008, 33: 132-139.
9. Hubbard RC, Naumann TM, Traylor L, et al. Parecoxib sodium has opioid-sparing effects in patients undergoing total knee arthroplasty under spinal anaesthesia. Br J Anaesth, 2003, 90(2): 166-172.
10. Barton SF, Langeland FF, Snabes MC, et al. Efficacy and safety of intravenous parecoxib sodium in relieving acute post-operative pain following gynecologic laparotomy surgery. Anesthesiology, 2002, 97: 306-314.
11. Mehlisch DR, Desjardins PJ, Daniels S, et al. The analgesic efficacy of intramuscular parecoxib sodium in postoperative dental pain. J Am Dent Assoc, 2004, 135(11): 1578-1590.
12. Gan TJ, Joshi GP, Zhao SZ, et al. 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(9): 1194-1207.
13. Leykin Y, Casati A, Rapotec A, et al. Comparison of parecoxib and proparacetamol in endoscopic nasal surgery patients. Yonsei Med J, 2008, 49: 383-388.

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Efficacy and Safety of Injected Parecoxib Sodium for Acute Postoperative Pain: A Meta-analysis

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