Head Injury and Neuroanesthesia

Effect of intravenous parecoxib on post-craniotomy pain

Williams DL, Pemberton E, Leslie K (Royal Melbourne Hosp, Parkville, Victoria, Australia) Br J Anaesth 107:398-403, 2011^§

Abstract

Background

Pain management in craniotomy patients is challenging, with mild-to-moderate pain intensity, moderate-to-high risk of postoperative nausea and vomiting (PONV), and potentially catastrophic consequences of analgesic-related side-effects. The aim of this study was to determine whether i.v. parecoxib administered at dural closure during craniotomy decreased total morphine consumption and morphine-related side-effects compared with placebo.

Methods

One hundred adult patients presenting for supratentorial craniotomy under propofol/remifentanil anaesthesia were randomized to receive parecoxib, 40 mg i.v., or placebo in a double-blind manner. All patients received local anaesthetic scalp infiltration, regular i.v. paracetamol, nurse-administered morphine in the post-anaesthesia care unit (PACU) until verbal analogue pain scores were ≤4/10 and patient-controlled morphine thereafter. Morphine consumption, pain intensity, and analgesia-related side-effects were recorded during the first 24 h after operation.

Results

Ninety-six patients (49 control and 47 parecoxib) were included in the analyses. Fifty-nine (61) patients received morphine in the PACU and only one patient (control) did not receive any morphine in the postoperative period. There were no significant differences between the two groups in morphine consumption [20 (range: 0–102) vs 16 (range: 1–92) mg; P=0.38], pain intensity [excellent/very good pain relief in 78% of parecoxib patients; 74% of control patients (P=0.72)] or analgesia-related side-effects (PONV in 51% of parecoxib patients; 56 of control patients; P=0.55) in the first 24 h after operation. No major morbidity was recorded.

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