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©The Author(s) 2016.
World J Gastrointest Oncol. Jul 15, 2016; 8(7): 543-549
Published online Jul 15, 2016. doi: 10.4251/wjgo.v8.i7.543
Published online Jul 15, 2016. doi: 10.4251/wjgo.v8.i7.543
Table 1 Perioperative pain control regimen
Preoperative period | 1 tablet of acetaminophen 500 mg |
± 1 tablet of a selective cyclooxygenase-2 inhibitor (either celecoxib 400 mg, etoricoxib 90 mg or etoricoxib 120 mg) | |
Intraoperative period | Balanced general anesthesia |
Application of atraumatic O-ring wound retractor (if available) | |
Postoperative period | Infiltration of 0.5% bupivacaine into fascial layer and muscle around the wound edge |
1 tablet of acetaminophen 500 mg every 6 h in the first 3 d | |
± 1 tablet of a selective cyclooxygenase-2 inhibitor daily for 5-7 d | |
Intravenous patient-controlled morphine (or tramadol) or intermittent intravenous morphine if pain score > 3 |
Table 2 Patient characteristics and operative details
Patients with selective COX-2 inhibitor (n = 75) | Patients without selective COX-2 inhibitor (n = 75) | P-value | |
Age (yr) | 64 (55-73) | 65 (59-75) | 0.15 |
Male | 43 (57) | 42 (56) | 0.87 |
Weight (kg) | 68 (51-58) | 59 (50-66) | 0.93 |
Body mass index | 23.1 (20.9-25.4) | 22.5 (20.6-24.6) | 0.49 |
CR-POSSUM predicted mortality | 1.8 (1.0-2.5) | 1.9 (1.3-3.4) | 0.07 |
Hematocrit (%) | 38 (34-41) | 35 (31-39) | 0.0141 |
Serum albumin (g/L) | 4.0 (3.6-4.3) | 3.8 (3.4-4.1) | 0.0131 |
Operative time (min) | 180 (120-220) | 160 (120-180) | 0.21 |
Blood loss (mL) | 150 (50-250) | 150 (50-260) | 0.75 |
Operation for malignancy | 67 (89) | 68 (91) | 0.37 |
Rectal resection | 41 (55) | 37 (49) | 0.51 |
Operation without bowel restoration | 11 (15) | 12 (16) | 0.82 |
Use of atraumatic O-ring retractor | 66 (88) | 59 (79) | 0.13 |
Adherence to ERAS protocol (%) | 88 (82-88) | 82 (82-88) | 0.28 |
Table 3 Postoperative pain score and intravenous opioid requirement
Patients with selective COX-2 inhibitor (n = 75) | Patients without selective COX-2 inhibitor (n = 75) | P-value | |
Pain POD1 | 1.5 (0.7-2.1) | 1.5 (0.5-2.7) | 0.78 |
Pain POD2 | 0.7 (0-2.0) | 0.6 (0-1.5) | 0.74 |
Pain POD3 | 0.5 (0-1.5) | 0.5 (0-1.7) | 0.38 |
MME POD1 | 6 (2-12) | 13 (6-20) | < 0.0011 |
MME POD2 | 3 (0-17) | 20 (4-20) | < 0.0011 |
MME POD3 | 0 (0-0) | 5 (0-15) | < 0.0011 |
MME/KG POD1 | 0.09 (0.03-0.23) | 0.22 (0.11-0.42) | < 0.0011 |
MME/KG POD2 | 0.06 (0-0.28) | 0.25 (0.07-0.37) | < 0.0011 |
MME/KG POD3 | 0 (0-0) | 0.07 (0-0.25) | < 0.0011 |
Table 4 Gastrointestinal recovery, complication and hospital stay
Patients with selective COX-2 inhibitor (n = 75) | Patients without selective COX-2 inhibitor (n = 75) | P-value | |
Time to tolerate solid diet (d) | 1 (1-2) | 2 (2-3) | < 0.0011 |
Time to defecate (d) | 2 (2-3) | 3 (3-4) | < 0.0011 |
Overall complication | 9 (11) | 17 (23) | 0.08 |
Grade I | 4 | 7 | |
Grade II | 5 | 7 | |
Grade III | 0 | 2 | |
Grade IV | 0 | 1 | |
Prolonged postoperative ileus | 4 (5) | 6 (8) | 0.75 |
Postoperative stay (d) | |||
Median (IQR) | 4 (3-5) | 5 (4-6) | < 0.0011 |
Mean (SD) | 4.3 (3.0) | 5.3 (2.5) | 0.0231 |
Readmission within 30 d | 3 (4) | 1 (1) | 0.62 |
- Citation: Lohsiriwat V. Opioid-sparing effect of selective cyclooxygenase-2 inhibitors on surgical outcomes after open colorectal surgery within an enhanced recovery after surgery protocol. World J Gastrointest Oncol 2016; 8(7): 543-549
- URL: https://www.wjgnet.com/1948-5204/full/v8/i7/543.htm
- DOI: https://dx.doi.org/10.4251/wjgo.v8.i7.543