Analgesic effect and renal safety of preoperative intravenous parecoxib in patients undergoing nephrectomy

Objective To observe the preemptive analgesic efficacy of parecoxib on postsurgical pain management and to evaluate the effect of single dose of parecoxib 40 mg on renal function following nephrectomy.Methods In this study,60 patients undergoing nephrectomy under general anesthesia were randomly allocated to two groups:Parecoxib group received intravenous parecoxib 40 mg 20 minutes before incision,while control group received equivalent volume of 0.9%NaCl as placebo.All patients accepted patient-controlled intravenous analgesic(PCIA) pump with fentanyl immediately after extubation.The intensity of pain was measured by static and dynamic visual analogue scale(VAS) at 2,6,12 and 24 hours postoperatively.The fentanyl consumption,the number of delivered doses,the patient's pain relief(PR) and the patients' global evaluation of study medication(PGESM) at 12 and 24 hours after operation,also the incidence of opioid-type side effects were recorded and compared between the two groups.Renal safety evaluation included 24 h urinary volume and some results of clinical lab tests including Bun.Cr,β2-M and RPB,which were recorded preoperatively,the first and the third day after operation.Results The static VAS scores in the parecoxib group were significantly lower than that in the control group within the first 12 hours postoperatively(P0.05).The PR and PGESM demonstrated a greater level of satisfaction among patients taking parecoxib than those taking placebo(P 0.05 or P 0.01).The fentanyl consumption at 12 and 24 h after operation was significantly less than that in control group and was reduced by 26.9%and 21.4%respectively.However,a reduction in opioid-type side effects was not demonstrated in the parecoxib group.There were no serious renal dysfunctional events in both groups.Conclusion.This study shows that the preincisional administration of parecoxib with fentanyl PCIA after nephrectomy resulted in significantly improved postoperative analgesic management as defined by reduction in opioid requirement and renal safety.