Effective Treatment of Laparoscopic Cholecystectomy Pain with Intravenous Followed by Oral COX-2 Specific Inhibitor

Girish P. Joshi, Eugene R. Viscusi, Tong J. Gan, Harold Minkowitz, Mark Cippolle, Rienhard Shuller, Raymond Y. Cheung, John G. Fort

Research output: Contribution to journalArticle

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Abstract

In his multicenter, double-blinded, randomized, placebo, controlled study we evaluated the analgesic and opioid-sparing efficacy of a preoperative dose of IV parecoxib followed by oral valdecoxib in treating pain associated with elective laparoscopic cholecystectomy. Patients were randomized to receive a single IV dose of parecoxib 40 mg (n = 134) or placebo (n = 129) 30-45 min before induction of anesthesia. Six to 12 h after the IV dose, the parecoxib group received a single oral dose of valdecoxib 40 mg, followed by valdecoxib 40 mg qd on postoperative days 1-4, then 40 mg qd prn days 5-7. The placebo IV group received oral placebo on an identical schedule. All patients were allowed supplemental IV fentanyl as needed during the first 4 h postoperatively (T0-240 min) followed by hydrocodone 5 mg/acetaminophen 500 mg (Vicodin®; 1-2 tablets orally every 4-6 h as needed). Patients taking parecoxib used 21% less fentanyl than those receiving placebo (P = 0.011). The mean area under the curve of pain intensity (PI) scores over time from T0-240 min was 55.2 for parecoxib and 61.2 for placebo (P = 0.083). At T180 and T240 min, mean PI score was 7.0 and 7.6 points lower in the parecoxib group, respectively (P < 0.02). Fewer patients on valdecoxib required supplemental analgesics (P < 0.05) after discharge. At T240 min and at day 7, Patient's and Physician's/Nurse's Global Evaluations were significantly better in the parecoxib/valdecoxib group (P < 0.05). Incidences of adverse events, adverse events causing withdrawal, and serious adverse events were less for parecoxib/valdecoxib than for placebo. The authors conclude that preoperative parecoxib is a valuable opioid-sparing adjunct to the standard of care for treating pain after laparoscopic cholecystectomy, and subsequent treatment with oral valdecoxib extends this clinical benefit.

Original languageEnglish (US)
Pages (from-to)336-342
Number of pages7
JournalAnesthesia and Analgesia
Volume98
Issue number2
StatePublished - Feb 2004

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Cyclooxygenase 2 Inhibitors
Laparoscopic Cholecystectomy
Pain
Placebos
Therapeutics
Fentanyl
Opioid Analgesics
Hydrocodone
parecoxib
Standard of Care
Acetaminophen
valdecoxib
Tablets
Area Under Curve
Analgesics
Appointments and Schedules
Anesthesia
Nurses
Physicians
Incidence

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Joshi, G. P., Viscusi, E. R., Gan, T. J., Minkowitz, H., Cippolle, M., Shuller, R., ... Fort, J. G. (2004). Effective Treatment of Laparoscopic Cholecystectomy Pain with Intravenous Followed by Oral COX-2 Specific Inhibitor. Anesthesia and Analgesia, 98(2), 336-342.

Effective Treatment of Laparoscopic Cholecystectomy Pain with Intravenous Followed by Oral COX-2 Specific Inhibitor. / Joshi, Girish P.; Viscusi, Eugene R.; Gan, Tong J.; Minkowitz, Harold; Cippolle, Mark; Shuller, Rienhard; Cheung, Raymond Y.; Fort, John G.

In: Anesthesia and Analgesia, Vol. 98, No. 2, 02.2004, p. 336-342.

Research output: Contribution to journalArticle

Joshi, GP, Viscusi, ER, Gan, TJ, Minkowitz, H, Cippolle, M, Shuller, R, Cheung, RY & Fort, JG 2004, 'Effective Treatment of Laparoscopic Cholecystectomy Pain with Intravenous Followed by Oral COX-2 Specific Inhibitor', Anesthesia and Analgesia, vol. 98, no. 2, pp. 336-342.
Joshi, Girish P. ; Viscusi, Eugene R. ; Gan, Tong J. ; Minkowitz, Harold ; Cippolle, Mark ; Shuller, Rienhard ; Cheung, Raymond Y. ; Fort, John G. / Effective Treatment of Laparoscopic Cholecystectomy Pain with Intravenous Followed by Oral COX-2 Specific Inhibitor. In: Anesthesia and Analgesia. 2004 ; Vol. 98, No. 2. pp. 336-342.
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