Essex Margaret Noyes, Xu Hao, Parsons Bruce, Xie Li, Li Chunming
Global Medical Affairs, Pfizer, New York, NY, USA.
Department of General Surgery, Jiangsu Province Hospital, Nanjing, China.
Int J Gen Med. 2017 Sep 28;10:319-327. doi: 10.2147/IJGM.S143837. eCollection 2017.
Parecoxib provides analgesia following a variety of surgeries, including minor gastrointestinal procedures. To our knowledge, there is no data on parecoxib following major gastrointestinal surgery. This study assessed the efficacy and opioid-sparing effects of parecoxib following major gastrointestinal surgeries.
Patients in this analysis were a subset from a large, randomized, double-blind, placebo-controlled trial of parecoxib following noncardiac surgeries and consisted of those undergoing a variety of major gastrointestinal surgeries via laparotomy. Pain, pain interference with function, supplemental opioid utilization, opioid-related symptoms, and Patient/Physician Global Evaluation of Study Medication were compared between placebo and parecoxib groups in the 2-3 days following surgery.
Significantly (<0.001) lower pain scores were observed in the parecoxib group (n=111), relative to placebo (n=126), on Day 2 (-33%) and Day 3 (-35%). Pain interference with function scores was also significantly (<0.001) lower among patients receiving parecoxib compared with placebo on Day 2 (-29%) and Day 3 (-36%). At 24, 48, and 72 hours, the cumulative amount of supplemental morphine consumed was 45%, 41%, and 40% less in patients receiving parecoxib compared with placebo (all <0.001). The risk of experiencing ≥1 opioid-related symptoms was also significantly lower with parecoxib than with placebo on Day 2 (relative risk=0.75; <0.001). Specifically, the risks of fatigue and drowsiness were significantly (both <0.05) lower in patients receiving parecoxib compared to those receiving placebo. Patient and Physician Global Evaluation of Study Medication scores were significantly better in the parecoxib group than in the placebo group (<0.001).
This study is the first to demonstrate that multiple-dose parecoxib, initiated upon recovery from anesthesia, provides analgesia and opioid-sparing effects following a variety of major gastrointestinal surgeries employing laparotomy.
帕瑞昔布在包括小型胃肠道手术在内的多种手术后可提供镇痛作用。据我们所知，尚无关于大型胃肠道手术后使用帕瑞昔布的数据。本研究评估了大型胃肠道手术后帕瑞昔布的疗效及节省阿片类药物的作用。
本分析中的患者是一项关于非心脏手术后使用帕瑞昔布的大型随机、双盲、安慰剂对照试验的一个子集，包括那些通过剖腹术接受各种大型胃肠道手术的患者。在术后2至3天，比较安慰剂组和帕瑞昔布组之间的疼痛、疼痛对功能的干扰、补充阿片类药物的使用、阿片类药物相关症状以及患者/医生对研究药物的整体评估。
在第2天（降低33%）和第3天（降低35%），帕瑞昔布组（n = 111）的疼痛评分相对于安慰剂组（n = 126）显著更低（<0.001）。在第2天（降低29%）和第3天（降低36%），接受帕瑞昔布的患者疼痛对功能的干扰评分相对于安慰剂组也显著更低（<0.001）。在24、48和72小时时，接受帕瑞昔布的患者补充吗啡的累积消耗量比安慰剂组分别少45%、41%和40%（均<0.001）。在第2天，出现≥1种阿片类药物相关症状的风险，帕瑞昔布组也显著低于安慰剂组（相对风险 = 0.75；<0.001）。具体而言，接受帕瑞昔布的患者出现疲劳和嗜睡的风险显著低于接受安慰剂的患者（均<0.05）。帕瑞昔布组患者和医生对研究药物的整体评估评分显著优于安慰剂组（<0.001）。
本研究首次表明，麻醉苏醒后开始使用的多剂量帕瑞昔布，在采用剖腹术的各种大型胃肠道手术后可提供镇痛作用并具有节省阿片类药物的效果。
