Mamat, Mohd Azmi
(2010)
Acute postoperative analgesia after
craniotomy : the analgesic and opiod
sparing effects of intra venous
parecoxib.
Masters thesis, Universiti Sains Malaysia.
Abstract
Acute post craniotomy pain was previously reported to be between moderate to severe.
Parecoxib is the only available intravenous COX II inhibitor which has great potential to treat
acute post craniotomy pain. It can avoid side effects of opiod as well as avoid potential
conventional NSAIDs side effect of postoperative hematoma. The main aim of this study is to determine analgesic efficacy and opiod sparing effect of
Parecoxib for acute pain post craniotomy. This was prospective, double blinded, randomized controlled trial involving 60 post elective
craniotomy patients. Patients were divided into two groups in which one group received
parecoxib and PCA morphine (n=30) and the other group received PCA morphine (n=30). IV
parecoxib 40 mg was given 2 hours prior to extubation and another dose after 12 hours. The
other group was given IV nonnal saline at same interval. PCA morphine was prepared as rescue
analgesia. Their pain intensity was assessed by Visual Analogue Scale at specific interval post
operatively for 24 hours. Total morphine consumption over 24 hours, opiod side effects and post
operative hematoma were also recorded. There was significant different in VAS at 2, 4, 16 and 24 hours post extubation between
parecoxib group and morphine group. Mean VAS at 2 hours was 2.2 ± 0.85 in parecoxib group
and 5.0 ± 0.94 in morphine group (p <0.001). At 4 hours, mean VAS was 2.0 ± 0.66 for
parecoxib group and 3.3 ± 1.2 for morphine group (p <0.001). VAS at 8 and 12 hours were not
siginificantly different (p > 0.05). At 16 hours mean VAS for parecoxib group was 1.1 ± 0.30
and 1.4 ± 0.49 for morphine group (p < 0.05). Mean VAS at 24 hours was 1.0 ± 0.32 in
parecoxib group and 1.4 ± 0.49 in morphine group (p< 0.001). Total morphine consumption was
significantly reduced in parecoxib group in which total consumption was 4.8 mg ± 2.68
compared to 9.0 mg ± 2.03 in morphine group (p <0.00 I ).The reduction in morphine
consumption was 46.6% indicating an opiod sparing effect of parecoxib. There was no
significant different in opiod side effects and postoperative hematoma. Parecoxib provided better analgesia and is opiod sparing effect in post craniotomy patients.
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