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1.
J Evid Based Med ; 17(1): 207-223, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38530771

RESUMEN

Postoperative gastrointestinal disorder (POGD) was a common complication after surgery under anesthesia. Strategies in combination with Traditional Chinese Medicine and Western medicine showed some distinct effects but standardized clinical practice guidelines were not available. Thus, a multidisciplinary expert team from various professional bodies including the Perioperative and Anesthesia Professional Committees of the Chinese Association of Integrative Medicine (CAIM), jointly with Gansu Province Clinical Research Center of Integrative Anesthesiology/Anesthesia and Pain Medical Center of Gansu Provincial Hospital of Traditional Chinese Medicine and WHO Collaborating Center for Guideline Implementation and Knowledge Translation/Chinese Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Center/Gansu Provincial Center for Medical Guideline Industry Technology/Evidence-based Medicine Center of Lanzhou University, was established to develop evidence-based guidelines. Clinical questions (7 background and 12 clinical questions) were identified through literature reviews and expert consensus meetings. Based on systematic reviews/meta-analyses, evidence quality was analyzed and the advantages and disadvantages of interventional measures were weighed with input from patients' preferences. Finally, 20 recommendations were developed through the Delphi-based consensus meetings. These recommendations included disease definitions, etiologies, pathogenesis, syndrome differentiation, diagnosis, and perioperative prevention and treatment.


Asunto(s)
Enfermedades Gastrointestinales , Medicina Integrativa , Humanos , Medicina Tradicional China , Enfermedades Gastrointestinales/prevención & control , Medicina Basada en la Evidencia
2.
J Am Coll Surg ; 230(4): 428-439, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32062006

RESUMEN

BACKGROUND: Kentucky has one of the highest mortality rates for colon cancer, despite dramatic improvements in screening. The National Comprehensive Cancer Network (NCCN) guidelines recommend operation and adjuvant chemotherapy for locally advanced (stage IIb/c and stage III) colon cancer (LACC). The purpose of this study was to determine the rate of nonadherence with current standard of care (SOC) and associated factors as possible contributors to mortality. METHODS: The Kentucky Cancer Registry database linked with administrative health claims was queried for individuals (20 years and older) diagnosed with LACC from 2007 to 2012. Bivariate and logistic regression of nonadherence was performed. Survival analysis was performed with Cox regression and Kaplan-Meier plots. RESULTS: A total of 1,404 patients with LACC were included. Approximately 42% of patients with LACC were noted to be nonadherent to SOC, with nearly all (95.7%) failing to receive adjuvant chemotherapy. After adjusting for all significant factors, we found the factors associated with nonadherence included the following: age older than 75 years, stage III colon cancer, high Charlson Comorbidity Index (3+), low poverty level, Medicaid coverage, and disability. Adherence to SOC is associated with a significant improvement in the 5-year survival rate compared with nonadherence (63.0% and 27.4%, respectively; p < 0.0001). CONCLUSIONS: Our study identified multiple factors associated with the failure of patients with LACC to receive SOC, particularly adjuvant chemotherapy, suggesting the need to focus on improving adjuvant chemotherapy compliance in specific populations. Nonadherence to LACC SOC is likely a major contributor to the persistently high mortality rates in Kentucky.


Asunto(s)
Neoplasias del Colon/mortalidad , Neoplasias del Colon/terapia , Adhesión a Directriz/estadística & datos numéricos , Nivel de Atención/estadística & datos numéricos , Adulto , Anciano , Quimioterapia Adyuvante/estadística & datos numéricos , Neoplasias del Colon/patología , Femenino , Humanos , Kentucky/epidemiología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Tasa de Supervivencia , Adulto Joven
3.
Eur J Anaesthesiol ; 36(8): 557-565, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30985537

RESUMEN

BACKGROUND: Acupressure therapy is associated with favourable efficacies on postoperative nausea, pain and sleep disturbance, although the quality of the evidence is generally low. No randomised clinical trial has yet assessed the effect of acupressure on postoperative quality of recovery (QoR). OBJECTIVE: The objective was to study acupressure efficacy on patient-reported postoperative recovery. DESIGN: We conducted a single centre, three-group, blind, randomised controlled, pragmatic trial assessing acupressure therapy on the PC6, LI4 and HT7 acupoints. PATIENTS: Postoperative patients expected to stay in hospital at least 2 days after surgery. INTERVENTIONS: In the acupressure group, pressure was applied for 6 min (2 min per acupoint), three times a day after surgery for a maximum of 2 postoperative days during the hospital stay. In the sham group, extremely light touch was applied to the acupoints. The third group did not receive any touch. MAIN OUTCOME MEASURES: The primary outcome was the change in the QoR, using the QoR-15 questionnaire, between postoperative days 1 and 3. Key secondary outcomes included patients' satisfaction, postoperative nausea and vomiting, pain score and opioid (morphine equivalent) consumption. Assessors for the primary and secondary endpoints were blind to the group allocation. RESULTS: Overall, 163 patients were randomised (acupressure n=55, sham n=53, no intervention n=55). The mean (SD) postoperative change in QoR-15 did not differ statistically (P = 0.27) between the acupressure, sham and no intervention groups: 15.2 (17.8), 14.2 (21.9), 9.2 (21.7), respectively. Patient satisfaction (on a 0 to 10 scale) was statistically different (P = 0.01) among these three groups: 9.1 (1.5), 8.4 (1.6) and 8.2 (2.2), respectively. Changes in pain score and morphine equivalent consumption were not significantly different between the groups. CONCLUSION: Two days of postoperative acupressure therapy (up to six treatments) did not significantly improve patient QoR, postoperative nausea and vomiting, pain score or opioid consumption. Acupressure, however, was associated with improved patient satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02762435.


Asunto(s)
Acupresión , Procedimientos Ortopédicos/efectos adversos , Dolor Postoperatorio/rehabilitación , Cuidados Posoperatorios/métodos , Náusea y Vómito Posoperatorios/rehabilitación , Anciano , Analgésicos Opioides/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Náusea y Vómito Posoperatorios/etiología , Resultado del Tratamiento
4.
Anesth Analg ; 126(6): 1883-1895, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29369092

RESUMEN

Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.


Asunto(s)
Consenso , Estado Nutricional/fisiología , Atención Perioperativa/normas , Investigación Cualitativa , Recuperación de la Función/fisiología , Sociedades Médicas/normas , Ayuno/fisiología , Humanos , Atención Perioperativa/tendencias , Sociedades Médicas/tendencias , Estados Unidos
5.
Front Med (Lausanne) ; 2: 87, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26734609

RESUMEN

Postoperative nausea and vomiting (PONV) is a complication affecting between 20 and 40% of all surgery patients, with high-risk patients experiencing rates of up to 80%. Recent studies and publications have shed light on the uses of alternative treatment for PONV through their modulation of endogenous opioid neuropeptides and neurokinin ligands. In addition to reducing PONV, hypnosis was reported to be useful in attenuating postoperative pain and anxiety, and contributing to hemodynamic stability. Music therapy has been utilized to deepen the sedation level and decrease patient anxiety, antiemetic and analgesic requirements, hospital length of stay, and fatigue. Isopropyl alcohol and peppermint oil aromatherapy have both been used to reduce postoperative nausea. With correct training in traditional Chinese healing techniques, acupuncture (APu) at the P6 acupoint has also been shown to be useful in preventing early PONV, postdischarge nausea and vomiting, and alleviating of pain. Electro-acupuncture (EAPu), as with APu, provided analgesic and antiemetic effects through release and modulation of opioid neuropeptides. These non-pharmacological modalities of treatment contribute to an overall patient wellbeing, assisting in physical and emotional healing.

6.
Curr Opin Anaesthesiol ; 27(6): 605-9, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25225824

RESUMEN

PURPOSE OF REVIEW: Postoperative nausea and vomiting (PONV) continues to be one of the most common postsurgical medical problems. An understanding of the pathophysiology of PONV and the pharmacological profiles of agents affecting receptors involved in emesis is necessary to effectively treat PONV. RECENT FINDINGS: Although serotonin receptor antagonists remain key in the multimodal approach to PONV management, new research developments involving antiemetics, such as neurokinin-1 antagonists, corticosteroids, dopamine antagonists, and cholinergic antagonists, have yielded valuable efficacy and safety information. SUMMARY: Proper management of PONV includes an evaluation of risk factors, a strategy for prophylaxis, and rescue antiemetic treatment if necessary. In high-risk patients, combination therapy is recommended in preventing PONV. Knowledge of antiemetic efficacy and safety may facilitate an increase in patient satisfaction, decreased negative health consequences, and reduced medical costs.


Asunto(s)
Acupuntura/métodos , Antieméticos/uso terapéutico , Terapia Combinada/métodos , Náusea y Vómito Posoperatorios/terapia , Antagonistas Colinérgicos/uso terapéutico , Quimioterapia Combinada/métodos , Humanos , Satisfacción del Paciente , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Factores de Riesgo , Antagonistas de la Serotonina/uso terapéutico
8.
Pain Pract ; 12(8): 610-9, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22304620

RESUMEN

BACKGROUND: Topical analgesics are important products in the armamentarium for pain relief. METHODS AND FINDINGS: This study compared a topical analgesic product containing menthol to the same product with the addition of oxygenated glycerol triesters (OGTs) (also called essential oxygen oil) in 66 healthy adult subjects with acute musculoskeletal pain. Patients were randomized in a single-center, double-blind study to receive mentholated cream (MC) only or MC containing OGTs. Patients self-reported their pain intensity, lifestyle limitations, and evaluation of the mobility of the painful joint or muscle at baseline and three times daily over a seven-day course on a 100-mm visual analog scale (VAS). Patients in both groups experienced statistically significant pain relief on Day 8 over baseline, with the MC plus OGT-treated group reporting statistically significantly greater pain relief than the MC group (P = 0.016). In addition, patients treated with the combination product experienced an incremental decrease in pain during each of the 7 days of treatment in addition, and they had lower VAS scores and greater lifestyle and mobility improvements than the MC group. Both products were well tolerated with no serious adverse events reported and no signs of significant skin reactions in either group. CONCLUSION: Based on this study, a MC containing OGTs is safe, effective, and provided significantly better pain relief than MC alone. The combination of oxygenated glycerol trimesters and MC provided significant pain relief and offered continued improvement in pain relief over time.


Asunto(s)
Analgésicos/administración & dosificación , Glicerol/administración & dosificación , Mentol/administración & dosificación , Dolor Musculoesquelético/tratamiento farmacológico , Aceites Volátiles/administración & dosificación , Crema para la Piel/uso terapéutico , Administración Tópica , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino
9.
Urology ; 79(1): 32-6, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22202544

RESUMEN

OBJECTIVE: To assess the effect of noise-cancelling headphones with or without music on patient pain and anxiety associated with routine, office-based transrectal ultrasound (TRUS)-guided prostate biopsy in a prospective randomized study. METHODS: Patients scheduled for prostate biopsy as a result of elevated prostate-specific antigen and/or abnormal digital rectal examination were prospectively enrolled and randomized into a control, noise-cancelling headphones, or music-headphones group. Patients completed pain and anxiety questionnaires and had their physiological parameters assessed before and after the procedure and compared across groups. RESULTS: Eighty-eight patients were enrolled. Pain scores increased from baseline across all study groups, with the lowest mean score in the music group. No appreciable change was noted in anxiety scores after the procedure between groups (P>.05). Although postbiopsy systolic blood pressure values remained comparable with baseline levels in all groups, postbiopsy diastolic blood pressure increased in the control and headphones groups (P=.062 and .088, respectively) but remained stable in the music group (P=.552) after biopsy, indicating lesser physiological response to anxiety and pain in this group. CONCLUSION: Music-induced attention shift during prostate biopsy may have a beneficial impact on procedural anxiety and pain perception, but no apparent effect was noted for use of headphones alone. Further studies are necessary to explore strategies to reduce perceived anxiety and pain in men undergoing prostate biopsy.


Asunto(s)
Ansiedad/prevención & control , Biopsia con Aguja/efectos adversos , Endosonografía/métodos , Musicoterapia/instrumentación , Dolor/prevención & control , Neoplasias de la Próstata/patología , Anciano , Ansiedad/etiología , Biopsia con Aguja/psicología , Dispositivos de Protección de los Oídos , Humanos , Masculino , Persona de Mediana Edad , Música , Ruido , Dolor/etiología , Dimensión del Dolor , Percepción del Dolor , Estudios Prospectivos , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Sensibilidad y Especificidad
10.
Anesthesiol Clin ; 28(2): 225-49, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20488392

RESUMEN

Postoperative nausea and vomiting (PONV) continues to be one of the most common complaints following surgery, occurring in more than 30% of surgeries, or as high as 70% to 80% in certain high-risk populations without prophylaxis. The 5-hydroxytryptamine type 3 (5-HT(3)) receptor antagonists continue to be the mainstay of antiemetic therapy, but newer approaches, such as neurokinin-1 antagonists, a longer-acting serotonin receptor antagonist, multimodal management, and novel techniques for managing high-risk patients are gaining prominence. The related problem of postdischarge nausea and vomiting (PDNV) has received increasing attention from health care providers. The issues of PONV and PDNV are especially significant in the context of ambulatory surgeries, which comprise more than 60% of the combined 56.4 million ambulatory and inpatient surgery visits in the United States. Because of the relatively brief period that ambulatory patients spend in health care facilities, it is particularly important to prevent and treat PONV and PDNV swiftly and effectively.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Antieméticos/uso terapéutico , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Acupresión/métodos , Terapia por Acupuntura/métodos , Benzamidas/uso terapéutico , Butirofenonas/uso terapéutico , Terapia Combinada/métodos , Glucocorticoides/uso terapéutico , Humanos , Neurotransmisores/uso terapéutico , Fenotiazinas/uso terapéutico , Náusea y Vómito Posoperatorios/etiología , Propofol/uso terapéutico , Factores de Riesgo
11.
Pain Physician ; 12(3): 685-8, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19461837

RESUMEN

BACKGROUND: Chronic pain is a debilitating problem with significant impact on healthcare utilization in the US. Many chronic pain patients use complementary or alternative medicine (CAM) in addition to standard pharmacologic therapy. OBJECTIVE: The aim of our study was to identify differences in the characteristics of usage of CAM for chronic pain control among several ethnic groups. DESIGN: We recruited 92 consecutive patients seeking treatment at the pain clinic and interviewed them using a questionnaire. RESULTS: The most common pain complaint was back pain (55.4%) and the mean pain duration for all chronic pain problems was 9.8 years. Approximately 81% of respondents were using or have used CAM before. The commonest CAM used by patients in our study included massage therapy, spiritual healing as well as the consumption of mineral and vitamin supplements. Sixty-three percent of them were satisfied with CAM treatment compared to 56% of patients who were satisfied with prescription therapy. However, there was no difference in the use of CAM among the different ethnic groups (P > 0.05). CONCLUSION: Our study demonstrates that CAM is used very frequently in patients with chronic pain. However, it did not show any ethnic or racial differences in CAM utilization.


Asunto(s)
Terapias Complementarias/psicología , Cultura , Manejo del Dolor , Dolor/etnología , Adulto , Anciano , Analgésicos/uso terapéutico , Dolor de Espalda/etnología , Dolor de Espalda/psicología , Dolor de Espalda/terapia , Enfermedad Crónica/etnología , Enfermedad Crónica/psicología , Enfermedad Crónica/terapia , Terapias Complementarias/métodos , Terapias Complementarias/estadística & datos numéricos , Suplementos Dietéticos/estadística & datos numéricos , Femenino , Humanos , Masculino , Masaje/psicología , Masaje/estadística & datos numéricos , Persona de Mediana Edad , Dolor/psicología , Clínicas de Dolor , Satisfacción del Paciente/etnología , Satisfacción del Paciente/estadística & datos numéricos , Grupos Raciales/psicología , Grupos Raciales/estadística & datos numéricos , Terapias Espirituales/psicología , Terapias Espirituales/estadística & datos numéricos , Encuestas y Cuestionarios , Vitaminas/uso terapéutico
12.
Anesth Analg ; 107(6): 2038-47, 2008 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19020156

RESUMEN

OBJECTIVE: The objective of this review was to evaluate the efficacy of acupuncture for treatment of chronic headache. METHODS: We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials investigating the use of acupuncture for chronic headache. Studies were included in which adults with chronic headache, including migraine, tension-type headache or both, were randomized to receive needling acupuncture treatment or control consisting of sham acupuncture, medication therapy, and other nonpharmacological treatments. We extracted the data on headache intensity, headache frequency, and response rate assessed at early and late follow-up periods. RESULTS: Thirty-one studies were included in this review. The majority of included trials comparing true acupuncture and sham acupuncture showed a trend in favor of acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture either at the early follow-up period (risk ratio [RR]: 1.19, 95% confidence interval [CI]: 1.08, 1.30) or late follow-up period (RR: 1.22, 95% CI: 1.04, 1.43). Combined data also showed acupuncture was superior to medication therapy for headache intensity (weighted mean difference: -8.54 mm, 95% CI: -15.52, -1.57), headache frequency (standard mean difference: -0.70, 95% CI: -1.38, -0.02), physical function (weighted mean difference: 4.16, 95% CI: 1.33, 6.98), and response rate (RR: 1.49, 95% CI: 1.02, 2.17). CONCLUSION: Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate.


Asunto(s)
Analgesia por Acupuntura , Trastornos de Cefalalgia/terapia , Analgesia por Acupuntura/efectos adversos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
13.
Anesth Analg ; 102(2): 581-4, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16428565

RESUMEN

We randomized 94 patients undergoing cesarean delivery with spinal anesthesia to receive transcutaneous acupoint electrical stimulation using the ReliefBand at the P6 point (active group) or an active ReliefBand applied to the dorsum of the wrist (sham control group). The ReliefBand was applied 30-60 min preoperatively and left in place for 24 h. There was no statistically significant difference between the active and sham control groups in the incidence of intraoperative/postoperative nausea (30% versus 43%/23% versus 41%), vomiting (13% versus 9%/26 versus 37%), need for rescue antiemetics (23% versus 18%/34% versus 39%), or complete response (55% versus 57%/51% versus 34%). There was also no difference between the two groups in nausea scores, number of vomiting episodes, or patient satisfaction with postoperative nausea and vomiting management.


Asunto(s)
Anestesia Obstétrica , Anestesia Raquidea , Cesárea , Electroacupuntura/instrumentación , Náusea y Vómito Posoperatorios/prevención & control , Puntos de Acupuntura , Adulto , Antieméticos/uso terapéutico , Femenino , Humanos , Complicaciones Intraoperatorias/prevención & control , Satisfacción del Paciente , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Embarazo
14.
Anesth Analg ; 99(4): 1070-1075, 2004 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-15385352

RESUMEN

In this study we evaluated the efficacy of electro-acupoint stimulation, ondansetron versus placebo for the prevention of postoperative nausea and vomiting (PONV). Patients undergoing major breast surgery under general anesthesia were randomized into active electro-acupoint stimulation (A), ondansetron 4 mg IV (O), or sham control (placement of electrodes without electro-acupoint stimulation; placebo [P]). The anesthetic regimen was standardized. The incidence of nausea, vomiting, rescue antiemetic use, pain, and patient satisfaction with management of PONV were assessed at 0, 30, 60, 90, 120 min, and at 24 h. The complete response (no nausea, vomiting, or use of rescue antiemetic) was significantly more frequent in the active treatment groups compared with placebo both at 2 h (A/O/P = 77%/64%/42%, respectively; P = 0.01) and 24 h postoperatively (A/O/P = 73%/52%/38%, respectively; P = 0.006). The need for rescue antiemetic was less in the treatment groups (A/O/P = 19%/28%/54%; P = 0.04). Specifically, the incidence and severity of nausea were significantly less in the A group compared with the other groups, and in the O group compared with the P group (A/O/P = 19%/40%/79%, respectively). The A group experienced less pain in the postanesthesia care unit, compared with the O and P groups. Patients in the treatment groups were more satisfied with their management of PONV compared with placebo. When used for the prevention of PONV, electro-acupoint stimulation or ondansetron was more effective than placebo with greater degree of patient satisfaction, but electro-acupoint stimulation seems to be more effective in controlling nausea, compared with ondansetron. Stimulation at P6 also has analgesic effects.


Asunto(s)
Antieméticos/uso terapéutico , Electroacupuntura , Ondansetrón/uso terapéutico , Náusea y Vómito Posoperatorios/prevención & control , Adulto , Anciano , Analgesia , Neoplasias de la Mama/cirugía , Femenino , Humanos , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/prevención & control , Náusea y Vómito Posoperatorios/epidemiología
15.
Anesth Analg ; 98(2): 336-342, 2004 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-14742366

RESUMEN

UNLABELLED: In this multicenter, double-blinded, randomized, placebo-controlled study we evaluated the analgesic and opioid-sparing efficacy of a preoperative dose of i.v. parecoxib followed by oral valdecoxib in treating pain associated with elective laparoscopic cholecystectomy. Patients were randomized to receive a single i.v. dose of parecoxib 40 mg (n = 134) or placebo (n = 129) 30-45 min before induction of anesthesia. Six to 12 h after the i.v. dose, the parecoxib group received a single oral dose of valdecoxib 40 mg, followed by valdecoxib 40 mg qd on postoperative days 1-4, then 40 mg qd prn days 5-7. The placebo i.v. group received oral placebo on an identical schedule. All patients were allowed supplemental i.v. fentanyl as needed during the first 4 h postoperatively (T0-240 min) followed by hydrocodone 5 mg/acetaminophen 500 mg (Vicodin(R); 1-2 tablets orally every 4-6 h as needed). Patients taking parecoxib used 21% less fentanyl than those receiving placebo (P = 0.011). The mean area under the curve of pain intensity (PI) scores over time from T0-240 min was 55.2 for parecoxib and 61.2 for placebo (P = 0.083). At T180 and T240 min, mean PI score was 7.0 and 7.6 points lower in the parecoxib group, respectively (P < 0.02). Fewer patients on valdecoxib required supplemental analgesics (P < 0.05) after discharge. At T240 min and at day 7, Patient's and Physician's/Nurse's Global Evaluations were significantly better in the parecoxib/valdecoxib group (P < 0.05). Incidences of adverse events, adverse events causing withdrawal, and serious adverse events were less for parecoxib/valdecoxib than for placebo. The authors conclude that preoperative parecoxib is a valuable opioid-sparing adjunct to the standard of care for treating pain after laparoscopic cholecystectomy, and subsequent treatment with oral valdecoxib extends this clinical benefit. IMPLICATIONS: Parecoxib 40 mg i.v., 30-45 min preoperatively followed by oral valdecoxib 40 mg qd reduced opioid requirements and provided superior pain relief as well as improved patient global evaluation after laparoscopic cholecystectomy.


Asunto(s)
Colecistectomía Laparoscópica , Inhibidores de la Ciclooxigenasa/uso terapéutico , Isoxazoles/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Administración Oral , Adulto , Ciclooxigenasa 2 , Inhibidores de la Ciclooxigenasa 2 , Inhibidores de la Ciclooxigenasa/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Inyecciones Intravenosas , Isoenzimas/metabolismo , Isoxazoles/administración & dosificación , Masculino , Proteínas de la Membrana , Persona de Mediana Edad , Dimensión del Dolor/efectos de los fármacos , Prostaglandina-Endoperóxido Sintasas/metabolismo , Sulfonamidas/administración & dosificación
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