Parecoxib 40mg powder for solution for injection vials

BACKGROUND: Postoperative pain after artificial joint replacement is intense and remains an unsolved problem. Some studies have shown that parecoxib can provide better analgesia in postoperative multimodal analgesia, however, doubts arise about whether its multimodal preemptive analgesia can reduce postoperative pain. OBJECTIVES: The purpose of this systematic review and meta-analysis was to evaluate the impact of preoperative injection of parecoxib on postoperative pain in patients undergoing artificial joint replacement. STUDY DESIGN: Systematic review and meta-analysis. SETTING: Embase, PubMed, Cochrane Library, CNKI, VIP, Wangfang databases were searched to identify relevant randomized controlled trials. The last search was in May 2022. METHODS: Randomized controlled trials of efficacy and adverse reactions of intra-operative and postoperative injection of parecoxib in artificial joint replacement were collected. The primary outcome was postoperative visual analog scale scores and the secondary outcomes included cumulative postoperative opioid consumption and incidence of adverse reactions. Using the Cochrane systematic review method to screen the studies, evaluate the quality of the included studies, and extract feature information, RevMan 5.4 software performs a meta-analysis of the corresponding research indicators. RESULTS: In total, nine studies were involved in the meta-analysis with 667 patients. The trial and control group were given the same dose of parecoxib or placebo at the same time point before and after surgery. The results showed that compared with the control group, the trial group is associated with substantially reduced visual analog scale scores in 24, 48 h at rest (P < 0.05), visual analog scale scores in 24, 48, 72 h at movement (P < 0.05), dose of opioid need in trial group is notably lower than that in control group (P < 0.05), but shows no obvious effect on visual analog scale scores in 72 h at rest, and adverse events (P > 0.05). LIMITATIONS: The major limitation of this meta-analysis relates to some low-quality studies. CONCLUSIONS: Our results support parecoxib multimodal preemptive analgesia in reducing postoperative acute pain in hip and knee replacement patients, and reduces cumulative opioid consumption without increasing the risk of adverse drug events. Its multimodal preemptive analgesia is safe and effective in hip and knee replacement. PROSPERO REGISTRATION: CRD42022379672.

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Objective: The aim of this study was to systematically review the efficacy and safety of parecoxib and flurbiprofen axetil for perioperative analgesia in children through Bayesian network meta-analysis. Methods: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI, VIP, and Wanfang Data databases on 18 July 2022 to obtain randomized controlled trials comparing perioperative parecoxib or flurbiprofen with placebo or standard treatment for pediatric analgesia. The outcomes were the postoperative pain score and the incidence of adverse events. The Gemtc package of R-4.0.3 and Stata 17.0 were used for Bayesian network meta-analysis. Results: We retrieved 942 articles and 49 randomized controlled trials involving 3,657 patients who met the inclusion criteria. Compared with children who received placebo treatment, those who received flurbiprofen axetil had lower pain sores at each time point within 24 h postoperatively, and those who received parecoxib had lower pain sores at each time point within 12 h postoperatively. Compared with children who received tramadol treatment, both the children who received flurbiprofen axetil or parecoxib had lower pain scores at 8 h postoperatively. The ranking results demonstrated that flurbiprofen axetil had significant superiority in reducing pain scores at 2, 4, and 12 h postoperatively, and parecoxib had significant superiority in reducing pain scores at 0, 0.5, 1, 6, 8, and 24 h postoperatively. In terms of safety, compared with children who received placebo, those who received flurbiprofen axetil or parecoxib had a lower incidence of total adverse events and postoperative agitation. Compared with tramadol, flurbiprofen axetil and parecoxib both significantly reduced the incidence of total adverse events and postoperative nausea and vomiting. Compared with flurbiprofen axetil or fentanyl, parecoxib significantly reduced the incidence of postoperative nausea and vomiting. The ranking results showed that parecoxib was advantageous in decreasing the incidence of total adverse events and postoperative nausea and vomiting. Conclusion: Flurbiprofen axetil was most effective at reducing pain scores at 2, 4, and 12 h postoperatively. Parecoxib had an advantage in terms of reducing pain scores at 0, 0.5, 1, 6, 8, and 24 h postoperatively, as well as the incidence of total adverse events and postoperative nausea and vomiting. Systematic trial registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=348886, PROSPERO (CRD42022348886).

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INTRODUCTION: Orthopedic procedures have been associated with increased pain, making perioperative analgesia a major clinical concern. We assessed the efficacy and safety of intravenous parecoxib administration during the perioperative period for postoperative pain relief after orthopedic surgery in adults. METHODS: PubMed, Cochrane Library, EMBASE, and clinicaltrial.gov were searched from inception to 23 August 2021 without language restrictions. Randomized controlled trials comparing intravenous parecoxib with placebo or another active treatment for acute postoperative pain in adults after orthopedic surgery were included. The primary outcomes were the pain scores and cumulative morphine consumption. The secondary outcomes included the proportion of patients requiring rescue analgesics and the incidence of adverse events. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered on the International Prospective Register of Systematic Reviews Registration (PROSPERO). RESULTS: Twenty-seven trials (n = 2840) from more than 20 countries involving six types of orthopedic surgery met the inclusion criteria. Compared with placebo, intravenous parecoxib administration led to reductions in postoperative resting pain scores at 6, 12, 24, and 48 h [mean difference (MD) -0.87, 95% confidence interval [CI] -1.71 to -0.03; MD -0.86, 95% CI -1.26 to -0.46; MD -0.57, 95% CI -0.84 to -0.31; MD -0.40, 95% CI -0.69 to -0.11, respectively], postoperative movement pain scores at 24 and 48 h (MD -0.66, 95% CI -1.14 to -0.19; MD -0.78, 95% CI -1.16 to -0.39, respectively), cumulative morphine consumption (MD -11.30 mg, 95% CI -14.79 to -7.81 mg), and the proportion of patients requiring rescue analgesia (relative risk 0.83, 95% CI 0.77-0.89). There was no difference in the incidence of adverse events between groups. CONCLUSION: Low to moderate evidence indicates that parecoxib might be an effective and safe analgesic in perioperative orthopedic settings. It relieves postoperative orthopedic pain while sparing opioid analgesic consumption without increasing the incidence of adverse events. PROSPERO REGISTRATION: CRD42021274939.

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Background There is no effective drug treatment for the organ failure (OF) caused by severe acute pancreatitis (SAP). Objective We aimed to evaluate the efficacy of cyclooxygenase-2 inhibitors (COX-2-Is) on the treatment of SAP and its safety. Design In this multicentre, double-blind, randomised, placebo-controlled, investigator-initiated trial, 348 patients with acute pancreatitis aged 18–75 years, &lt;1 week from onset of illness to admission, and Acute Physiology and Chronic Health Evaluation II Score ≥7 or modified Marshall Score ≥2, were randomly assigned (1:1) to the COX-2-Is group (parecoxib sequential with imrecoxib) or the placebo group. SAP occurrence, duration of OF, local complications, clinical outcomes and serum inflammatory mediators were measured. Results Compared with the placebo group, SAP occurrence was reduced by 20.7% (77.6% vs 61.5%, p=0.001) and the persistent OF duration in SAP was shortened by 2 days (p&lt;0.001) after COX-2-Is treatment. For patients enrolled within or after 48 hours from symptom onset, SAP occurrence was reduced by 23.8% (p=0.001) and 8.5% (p=0.202), and the persistent OF duration in SAP was shortened by 3 days (p=0.001) and 2 days (p=0.010) after COX-2-Is treatment, respectively. The occurrence of local complications in the COX-2-Is group was significantly lower than those in the placebo group, 33.7% vs 49.1%, p=0.004. The serum levels of inflammatory mediators and 30-day mortality (from 8.6% to 3.4%) were significantly reduced after COX-2-Is treatment, p&lt;0.05. The incidence of adverse events was similar between the two treatment groups. Conclusion Parecoxib sequential with imrecoxib was effective and well tolerated in reducing the occurrence and duration of SAP and local complications through suppression of systemic inflammatory response, leading to decreased morbidity.

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BACKGROUND: Hyperlipidemia has been implicated in the higher risk of developing postoperative delirium. Prostaglandin endoperoxide synthase-2 mediates neuroinflammatory processes in postoperative delirium. This study aims to investigate whether preoperative administration of parecoxib is more efficient than a placebo in averting postoperative delirium in patients with hyperlipidemia. MATERIALS AND METHODS: In this randomized, double-blind, superiority trial, participants with hyperlipidemia were randomized in a 1:1 ratio to receive parecoxib (40 mg parecoxib administered intravenously before anesthesia induction) or placebo (normal saline). The primary outcome was postoperative delirium incidence within three days, with a 5.4% difference set as the superiority threshold. Secondary outcomes were cumulative incidences of emergence delirium and prostaglandin endoperoxide synthase-2 levels, inflammatory cell counts, and pain score on postoperative day 1 and postoperative adverse events. RESULTS: This trial conducted between August 2023 and August 2024 at a tertiary hospital in China included 452 adults with hyperlipidemia, with 226 in the parecoxib group and 226 in the placebo group. The incidence of postoperative delirium in the parecoxib group was 13.72%, a reduction of 12.39% compared to the placebo group (hazard ratio, 0.491; 95% confidence interval: 0.318 to 0.759; P < 0.001). The parecoxib group also had a lower incidence of emergence delirium, prostaglandin endoperoxide synthase-2 levels, white blood cell counts and neutrophil, and pain scores on postoperative day 1. The occurrence of adverse events was comparable between the two groups. Prostaglandin endoperoxide synthase-2 expression levels, white blood cell counts, and pain scores mediated the reduction of postoperative delirium incidence by parecoxib. CONCLUSION: Parecoxib may help in reducing the hyperlipidemia-related postoperative delirium incidence. The effective anti-inflammatory activity of prostaglandin endoperoxide synthase-2 inhibition by parecoxib and postoperative pain control may be important mechanisms for preventing postoperative delirium.

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BACKGROUND AND AIM: The optimal strategy for the management of postoperative pain after total knee arthroplasty (TKA) remains challenging, while its treatment is crucial to increase patients' outcomes. This study aimed to investigate the effects of parecoxib as add-on therapy, in a standard postoperative pain management protocol, represented by the continuous femoral nervous block. We studied its influence on rehabilitation indices and pain scores in patients undergoing TKA. MATERIAL AND METHODS: This is a single-center, prospective, double-blind, randomized, placebo-controlled trial. All patients were operated with the use of subarachnoid anesthesia, and divided into two groups for postoperative analgesia. Both groups received a continuous femoral nerve block. One of the groups received intravenous parecoxib, while the other received a placebo. The primary investigated outcome was the range of motion (ROM). Recordings were noted at different times postoperatively. Bromage score (BS), visual analog scale (VAS), and the State-Trait Anxiety Inventory (STAI) were also studied. RESULTS: A total of 90 patients were included and analyzed. ROM was significantly better (p<0.001) and pain scores were significantly lower (p=0.007) in the parecoxib group. No statistically significant difference was found with regard to BS between the two groups. A significant correlation was found between ROM and VAS pain scores at 12 hours (p=0.02), while ROM was inversely correlated with STAI postoperatively. CONCLUSIONS: The use of intravenous parecoxib is effective in improving rehabilitation indices and provides decreased postoperative pain scores after TKA.

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Objective: This study aimed to clarify the effect of parecoxib sodium on the occurrence of postoperative delirium and to investigate its possible mechanism. Methods: A total of 80 patients who underwent elective hip arthroplasty in our hospital between December 2020 and December 2021 were selected and randomly divided into two groups: a parecoxib sodium group (group P, n = 40) and a control group (group C, n = 40). Patients in group P were intravenously injected with 40 mg of parecoxib sodium 30 min before anesthesia and at the end of the surgery. Patients in group C were intravenously injected with the same volume of normal saline at the same time points. The primary endpoint was the incidence of POD, and the secondary endpoints were the levels of inflammatory factors (tumor necrosis factor- α [TNF-α], interleukin [IL]-1β, IL-6, and IL-10), nerve injury-related factors (brain-derived neurotrophic factor [BDNF], S-100β protein, neuron-specific enolase [NSE], and neurofilament light chain [NfL]), and antioxidant factors (heme oxygenase-1 [HO-1]), as well as the Visual Analogue Scale (VAS) and Confusion Assessment Method-Chinese Reversion (CAM-CR) scores. Results: The incidence of POD was 10% in group P and 27.5% in group C. Intergroup comparison revealed that the levels of TNF-α, IL-1β, S-100β, NfL, and NSE were lower, and BDNF was higher, in group P than in group C at each postoperative time point. The levels of IL-6 were lower, and the levels of IL-10 and HO-1 were higher, in group P than in group C at 1 h and 1 day postoperatively ( p &amp;lt; 0.05). Three days after surgery, the differences in the levels of IL-6, IL-10, and HO-1 were not statistically significant between the two groups ( p &amp;gt; 0.05). The VAS and CAM-CR scores were lower at each postoperative time point in group P than in group C ( p &amp;lt; 0.05). Conclusion: Parecoxib sodium could reduce postoperative pain, decrease the plasma levels of inflammatory and nerve injury-related factors, upregulate HO-1 levels, and reduce the incidence of POD. The results of this study suggest that parecoxib sodium may reduce the occurrence of POD through the effects of anti-inflammation, analgesia, and antioxidants.

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