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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2015, Vol. 9 Issue (4) : 496-507    https://doi.org/10.1007/s11684-015-0414-y
RESEARCH ARTICLE
Efficacy and safety of perioperative parecoxib for acute postoperative pain treatment in children: a meta-analysis
Xueshan Bu, Lei Yang, Yunxia Zuo()
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
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Abstract

Perioperative parecoxib administration reduces postoperative pain, opioid consumption, and adverse events in adult patients. However, the efficacy and safety of parecoxib in children remain unclear. This meta-analysis included related published studies to address this concern. Eight databases in the literature until February 2015 were systematically explored to identify randomized controlled trials (RCTs) comparing perioperative parecoxib administration and placebo/standard treatments for acute postoperative pain in children. Primary outcomes were postoperative pain scores and adverse events. The Face, Legs, Activity, Crying, Consolability scale was used to score pain in children younger than 6 years, whereas the Visual Analog Scale was used in children older than 6 years. Secondary outcomes were sedation scores (measured using the Ramsay scale), agitation scores (measured using the Sedation-Agitation Scale), and opioid consumption. The methodological quality of RCTs was independently assessed in accordance with the “Risk of bias” of Cochrane Collaboration. Data were analyzed using Review Manager 5.2. Twelve RCTs involving 994 patients met the inclusion criteria. Compared with children who received placebo treatment, those who received parecoxib demonstrated lower early (2 h) and later (12 h) postoperative pain scores; lower incidence rates of postoperative nausea, vomiting, and agitation; higher early (1 h) postoperative sedation scores; and lower agitation scores. Similarly, children who received parecoxib had lower early (2 h) and later (12 h) postoperative pain scores, lower incidence rates of postoperative nausea and vomiting, and lower early (1 h) postoperative sedation scores compared with those who received standard treatments; however, these children showed no significant difference in agitation scores. Unfortunately, data on the effect of parecoxib on opioid consumption were insufficient. Overall, these results suggested that perioperative parecoxib administration was associated with less acute postoperative pain and fewer adverse events compared with placebo or standard treatments. Parecoxib administration also resulted in less emergence agitation compared with placebo treatment and less excessive sedation concern compared with standard treatments. However, the long-term effects, effects on opioid consumption, and patient satisfaction of parecoxib administration warrant further investigation.

Keywords NSAID      cyclooxygenase 2 inhibitor      child      pain, postoperative      opioid      placebo     
Corresponding Author(s): Yunxia Zuo   
Just Accepted Date: 31 August 2015   Online First Date: 23 September 2015    Issue Date: 26 November 2015
 Cite this article:   
Xueshan Bu,Lei Yang,Yunxia Zuo. Efficacy and safety of perioperative parecoxib for acute postoperative pain treatment in children: a meta-analysis[J]. Front. Med., 2015, 9(4): 496-507.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-015-0414-y
https://academic.hep.com.cn/fmd/EN/Y2015/V9/I4/496
Fig.1  Study selection. RCT, randomized controlled trial.
References ASA Age (year) Surgery Intervention measures Sample size
T (parecoxib) C n T C
Lv et al.(2012) [20] I, II 4−8 Adenoidectomy 20 mg Placebo 120 60 60
Qin et al. (2011) [21] I 4−12 Limb fracture operation T1: 0.5 mg/kg; T2: 1.0 mg/kg; T3: 1.5 mg/kg Placebo 80 T1:19 T2:20 T3:21 20
Subramaniam et al. (2007) [22] I, II 7−14 Corneal suturing 20 mg for<35 kg and 40 mg for>35 kg with or without proparacaine Fentanyl, 2.0?μg/kg 90 T1:30 T2:30 30
Miao et al. (2012) [23] I, II 5−8 Endoscopic adenoidectomy and tonsillectomy 1.0 mg/kg C1: fentanyl, 1.0?μg/kg; C2: placebo 60 20 C1:20 C2:20
Li et al.(2011) [24] I, II 3−12 Lower abdominal operation 0.5 mg/kg C1: tramadol, 2.0?mg/kg; C2: placebo 90 30 C1:30 C2:30
Sun et al. (2014) [25] I, II 4−10 Tonsillectomy 0.5 mg/kg C1: dexmedetomidine, 0.5?μg/kg; C2: tramadol, 1.0?mg/kg; C3: placebo 120 30 C1:30 C2:30 C3:30
Ma et al. (2013) [26] I, II 4−12 Adenoid and tonsil surgery 1.0 mg/kg Fentanyl, 1.0?μg/kg 86 43 43
Li et al. (2011) [27] I, II 3−5 Upper limb orthopedic surgery 1.0 mg/kg C1: tramadol, 2.0?mg/kg; C2: placebo 90 30 C1:30 C2:30
Zhang et al. (2014) [28] I, II 1−10 Laparoscopic hernia repair 1.0 mg/kg C1: tramadol, 1.5?mg/kg; C2: placebo 60 20 C1:20 C2:20
Ye and Jiang (2013) [29] I 6−12 Strabotomy 0.5 mg/kg Tramadol, 1.5?mg/kg 60 30 30
Fan et al. (2013) [30] NS 2−8 Hypospadias 1.0 mg/kg Placebo 48 T1:16 T2:16 16
Yuan et al. (2010) [31] I, II 5−14 Orthopedic surgery T1: 0.5 mg/kg; T2:1.0 mg/kg+ tramadol 1 mg/kg Tramadol, 1.0 mg/kg 90 T1:30 T2:30 30
Tab.1  Characteristics of included studies
Fig.2  Quality of included RCTs.
Fig.3  Forest plot of meta-analysis of the effects of perioperative parecoxib administration on pain scores 2 h after surgery compared with placebo (a) and standard (b) treatments.
Fig.4  Forest plot of meta-analysis of the effects of perioperative parecoxib administration on pain scores 12 h after surgery compared with placebo (a) and standard (b) treatments.
Fig.5  Forest plot of meta-analysis of the effects of perioperative parecoxib administration on postoperative nausea and vomiting (a), pruritus (b), uroschesis (c), and agitation (d) compared with placebo treatment.
Fig.6  Forest plot of meta-analysis of the effects of perioperative parecoxib administration on postoperative nausea and vomiting, and pruritus compared with fentanyl (a, b) and tramadol (c, d) treatments.
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