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Celecoxib pharmacogenetics and pediatric adenotonsillectomy: a double-blinded randomized controlled study.

ABSTRACT: Pediatric adenotonsillectomy (A&T) is associated with prolonged pain and functional limitation. Celecoxib is an effective analgesic in adult surgery patients; however, its analgesic efficacy on pain and functional recovery in pediatric A&T patients is unknown.During 2009-2012, children (age 2-18 yr) scheduled for elective A&T were enrolled in a single-centre double-blind randomized controlled trial. Study participants received either oral placebo or celecoxib 6 mg·kg(-1) preoperatively, followed by 3 mg·kg(-1) twice daily for five doses. The primary outcome was the mean "worst 24-hr pain" scores during postoperative days (PODs) 0-2 on a 100-mm visual analogue scale (VAS). Secondary outcomes for PODs 0-7 included co-analgesic consumption, adverse events, and functional recovery. The impact of the CYP2C9*3 allele - associated with reduced celecoxib hepatic metabolism - on recovery was considered.Of the 282 children enrolled, 195 (celecoxib = 101, placebo = 94) were included in the primary outcome analysis. While on treatment, children receiving celecoxib experienced a modest reduction in the average pain experienced over PODs 0-2 (7 mm on a VAS; 95% confidence interval [CI]: 0.3 to 14; P = 0.04) and a "clinically significant" reduction (? 10 mm on a VAS; P ? 0.01) on PODs 0 and 1. During PODs 0-2, the mean acetaminophen consumption was lower in the celecoxib group vs the placebo group (78 mg·kg(-1); 95% CI: 68 to 89 vs 97 mg·kg(-1); 95% CI: 85 to 109, respectively; P = 0.03). No differences in adverse events, functional recovery, or satisfaction were observed by POD 7. The CYP2C9*3 allele was associated with less pain and improved functional recovery.A three-day course of oral celecoxib reduces early pain and co-analgesic consumption; however, an increase in dose, dose frequency, and duration of dose may be required for sustained pain relief in the pediatric setting. The CYP2C9*3 allele may influence recovery. This trial was registered at: ClinicalTrials.gov: NCT00849966.

SUBMITTER: Murto K

PROVIDER: S-EPMC4457100 | biostudies-literature | 2015 Jul

REPOSITORIES: biostudies-literature

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Celecoxib pharmacogenetics and pediatric adenotonsillectomy: a double-blinded randomized controlled study.

Murto Kimmo K Lamontagne Christine C McFaul Colleen C MacCormick Johnna J Ramakko Kelly-Ann KA Aglipay Mary M Rosen David D Vaillancourt Regis R

Canadian journal of anaesthesia = Journal canadien d'anesthesie 20150407 7

<h4>Background</h4>Pediatric adenotonsillectomy (A&T) is associated with prolonged pain and functional limitation. Celecoxib is an effective analgesic in adult surgery patients; however, its analgesic efficacy on pain and functional recovery in pediatric A&T patients is unknown.<h4>Methods</h4>During 2009-2012, children (age 2-18 yr) scheduled for elective A&T were enrolled in a single-centre double-blind randomized controlled trial. Study participants received either oral placebo or celecoxib 6 ...[more]

PMID: 25846344

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Project description:BACKGROUND:Surgery for aortic coarctation requires special care during anesthesia due to severe pain during the lateral thoracotomy incision, intraoperative hemodynamic instability and the need for large doses of intra- and postoperative analgesics and vasodilators. Additionally, the postoperative care of patients is very important. AIMS:We aimed to compare ultrasound-guided paravertebral block performed using bupivacaine alone and bupivacaine with dexamethasone in terms of the intra- and postoperative analgesic requirements and hemodynamics, postoperative complications and ICU stay. STUDY DESIGN:This was a prospective, randomized, controlled, double-blinded study. METHODS:Fifty patients aged four to 12?months scheduled for aortic coarctation surgery were randomly divided into two equal groups (n?=?25). Patients in group D (dexamethasone) received 0.5?mg/kg bupivacaine 0.25% mixed with 0.1?mg/kg dexamethasone diluted with isotonic saline and those in group C (control) received 0.5?mg/kg bupivacaine 0.25% diluted with isotonic saline (total volume 15?ml in each group). Intraoperative fentanyl consumption and hemodynamics (heart rate, arterial blood pressure) at baseline, 1?min after induction, at skin incision, after 30?min, after clamping, after declamping and at the end of the surgery were recorded, along with the objective pain score (OPS) immediately postoperatively and at 4?h, 8?h, 12?h and 24?h postoperatively and the time to the first request for pethidine. The intra- and postoperative vasodilator doses, time to extubation, ICU stay duration and postoperative complications were also recorded. RESULTS:The postoperative OPS was significantly lower at 12 and 24?h in group D than in group C. The time to the first request for analgesia was significantly longer in group D than in group C (3.9?±?2.23 vs 8.6?±?0.69). Additionally, the time to extubation was significantly shorter in group D. CONCLUSION:The use of dexamethasone as an adjuvant in ultrasound-guided paravertebral block in paediatric patients undergoing surgery for aortic coarctation increased the duration of postoperative analgesia with a prolonged time to the first request for analgesics It was also associated with a decreased incidence of postoperative complications. TRIAL REGISTRATION:Trial registration number: NCT03074773 . (Prospectively registered). The initial registration date was 9/3/2017.

Dataset Information

Celecoxib pharmacogenetics and pediatric adenotonsillectomy: a double-blinded randomized controlled study.

Publications

Celecoxib pharmacogenetics and pediatric adenotonsillectomy: a double-blinded randomized controlled study.

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