Comparison of Preoperative and Postoperative Parecoxib Administration for Pain Control Following Major Spine Surgery

STUDY DESIGN: Prospective randomized, double-blind controlled trial. PURPOSE: Here, we aim to compare the efficacy and safety of pain control between pre- and postoperative parecoxib administration in patients who have undergone major spine surgery. OVERVIEW OF LITERATURE: Several studies have compared the efficacy of pre- and postoperative administration of parecoxib, which led to inconclusive results owing to variation in operative time. Preincisional parecoxib administration reduces inflammatory response in major spine surgery requiring longer operative time; however, it may not reduce pain as much as parecoxib administration immediately after surgery would. METHODS: Totally, 127 patients who underwent major spine surgery were randomly divided into three groups: pre-group, which received 40 mg parecoxib before skin incision and at 12 and 24 hours after the first dose; post-group, which received the same dose at wound closure and at 12 and 24 hours after the first dose; and control group, which did not receive any parecoxib. Efficacy and safety of parecoxib were measured based on pain score, morphine consumption, and side effects from both morphine and parecoxib at 24 hours after surgery. RESULTS: Initial postoperative pain score, postoperative pain score at rest, and accumulative morphine consumption at 24 hours after surgery were similar between the pre- and post-groups. Despite the significantly lower pain score and morphine consumption in both pre- and post-groups compared with the control group, cumulative morphine consumption at 24 hours after surgery was reduced by approximately 50% in the pre-group and 46% in the post-group compared. Analgesic-related complication incidence was similar in all groups. CONCLUSIONS: The timing of parecoxib administration, either before or after major spinal surgery, did not affect the safety and analgesic efficacy of pain management.