Nong, L., Sun, Y., Tian, Y., Li, H., & Li, H. (2013). Effects of parecoxib on morphine analgesia after gynecology tumor operation: A randomized trial of parecoxib used in postsurgical pain management. The Journal of Surgical Research, 183, 821–826. 

To investigate the influence of parecoxib on morphine analgesia after gynecological tumor surgery

The test group (group P) was given 40 mg IV parecoxib prior to induction of anesthesia and 40 mg IV q 12 hours for 48 hours after the operation. The control group (group C) was given 2 ml saline at the same time intervals. Both groups were introduced to a patient-controlled analgesia (PCA) device and documentation of postoperative pain or adverse effects on Visual Analog Scale (VAS).

• N = 79  
• AGE RANGE = 18–60 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Gynecological tumor
• OTHER KEY SAMPLE CHARACTERISTICS: American Society of Anesthesiologists (ASA) physical status I-II

• SITE: Single-site    
• SETTING TYPE: Inpatient    
• LOCATION: Guangzhou, China

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Elder care, palliative care 

Placebo-controlled, randomized, controlled trial

• Visual Analog Scale (VAS)
• Morphine requirement
• Satisfaction score and side effects
• Sedation scale

There was a reduction of about 9% in the total morphine requirement used within the first 48 hours after gynecological tumor surgery, and overall satisfaction scores were 8.6 versus 6.8 (groups P and C, respectively). Pain scores at rest and with movement were significantly lower in the parecoxib group at all postoperative time points (p < .001).

The use of parecoxib with patient-controlled analgesic morphine in postoperative analgesia resulted in enhanced analgesic efficacy, reducing the opioid requirement, increasing patient satisfaction, and reducing pain severity after gynecological tumor surgery.

• Small sample (< 100)
• Other limitations/explanation: With regard to reporting and assessing side effects, specifically nausea, vomiting, urinary retention, and sedation, the authors reported the differences were clinically insignificant. However, the control group had twice as many reports of nausea, vomiting, and urinary retention in the 48 hours postoperatively compared to the test group (P) as well as a 7% increase in reports of sedation. The study limited itself to the use of PCA morphine only. Additional studies would be of benefit to determine the influence of parecoxib on morphine use (small study size).

This study has positive implications for nursing and healthcare professionals as it did show a 9% decrease in morphine PCA use in the first 48 hours postoperatively with fewer reported side effects. This study should be replicated with a larger sample size to validate its findings.