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document
Parecoxib for analgesia after craniotomy . BACKGROUND Pain after craniotomy is often under-treated . Opiates carry distinct disadvantages . Non-steroidal anti-inflammatory drugs have an anti-platelet action and carry a bleeding risk . Cyclo-oxygenase 2 inhibitors such as parecoxib are not associated with a bleeding risk and would be welcome analgesics if shown to be effective . METHODS In a prospective double-blind , randomized , placebo-controlled study , we investigated the analgesic effect of a single dose of parecoxib 40 mg given at dural closure in 82 patients undergoing elective craniotomies . Remifentanil was used intraoperatively , and i.v . morphine was titrated to the requirement in the post-anaesthetic unit . On the ward , i.m . morphine 5 mg as required and regular acetaminophen was prescribed . Morphine use and visual analogue pain scores were recorded at 1 , 6 , 12 , and 24 h after surgery . RESULTS Parecoxib reduced pain scores at 6 h and morphine use at 6 and 12 h after operation . However , overall , it had only minimal impact on postoperative analgesia . We found a wide variability in analgesic requirements where 11 % of patients required no opioids and 16 % required more than 15 mg i.v . morphine 1 h after the surgery . CONCLUSIONS We found only limited evidence to support parecoxib as an analgesic after craniotomy .
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Intervention_Pharmacological
Parecoxib
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Intervention_Control
placebo-controlled
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Intervention_Pharmacological
parecoxib 40 mg
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Intervention_Pharmacological
Remifentanil
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Intervention_Pharmacological
morphine
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Intervention_Pharmacological
morphine 5 mg
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Intervention_Pharmacological
acetaminophen
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Intervention_Pharmacological
Morphine
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Outcome_Physical
reduced pain scores
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Outcome_Other
postoperative analgesia .
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Participant_Condition
analgesia after craniotomy .