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Impact of parecoxib on hospital discharge: Adequate postoperative pain and renal colic control is critical for patients’ recovery and to decrease hospitalization costs and the use of resources. So, this study aimed at evaluating hospitalization time of patients treated with parecoxib sodium bul other non-steroid anti-inflammatory drugs to manage postoperative pain of appendectomy or fractures and renal colic. Mean hospitalization time was evaluated gula to each group of drugs.
Mean difference among groups was calculated by the Kruskal-Wallis method. Mean hospitalization time for patients submitted to appendectomy was 1.
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For patients submitted to orthopedic fracture surgery, mean time was 1. Parecoxib has also significantly decreased hospitalization time for renal colic as compared to other drugs Parecoxib sodium has provided shorter hospitalization time with possible decrease in use of resources and costs and should be considered a choice for such painful conditions.
Cyclooxygenase-2 inhibitors; Hospitalization; Parecoxib; Postoperative period; Renal colic. When tissue is injured, cells release inflammatory substances, among them prostaglandins, which cause hypersensitivity and pain 12. After surgical procedures, including appendectomy and orthopedic surgeries, pain is an expected outcome. Pain management in this period is critical, because it allows controlling pain-induced clinical changes, leading to less use of resources and shorter hospitalization time 56.
Acute pain is also a risk factor for chronic pain 3. So, an effective therapy to manage acute postoperative pain may not only improve pain in the short term but also bring long term results for patients 4.
Thirty-eight percent of patients with significant pain during the first 24 PO hours of laparoscopic appendectomy or fractures often have acute pain 7. Renal colic is a frequent urologic urgency presenting with severe pain. Immediate strategy for its relief is the administration of parenteral analgesic which has the advantage of early analgesia and easy titration as compared to muscular, oral or rectal routes.
Adequate renal colic management prevents the need for short-term recurrent analgesia, thus decreasing hospitalization time 89. Anti-inflammatory and opioids are the most prescribed and indicated drugs to treat PO pain and renal colic However, opioids have potential risk for severe adverse events AE and should be used with caution According to literature data, more common gastrointestinal AE related to opioids are nausea, vomiting and constipation, while central nervous system effects include excessive sleepiness, dizziness and adverse effects on cognitive function, psychomotor coordination, balance and alertness.
So, it is estimated that more than half the hospitalized patients need other adjuvant treatments to handle these events after opioid administration, in addition to longer hospitalization time and higher hospitalizationrelated costs 4. In light of this scenario, non-steroid anti-inflammatory drugs NSAIDS are to be highlighted as important tools to treat PO pain, due to their analgesic efficacy. Those associated to COX-1 may have significant adverse effects, such as gastrointestinal tract bleeding, renal function changes and higher risk for PO bleeding.
COX-2 selective inhibitors have more favorable safety profile since they spare COX-1 enzyme and do not have clinically significant effect on platelet aggregation or gastrointestinal function 56.
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In addition, evidences have shown decreased PO opioid consumption in patients using selective COX-2 inhibitor NSAIDS, with bexfra shorter hospitalization time and lower costs related to pain management and hospital stay 12 For surgical patients intolerant to oral drugs or for those where they are contraindicated, there is the need for effective intravenous IV analgesia without AE associated to non-selective NSAIDS or opioids.
However, currently available opioids for IV administration, such as bextrz, are associated to events such as erosions, ulcers and gastrointestinal bleeding, platelet aggregation changes and acute renal failure bfxtra to COX-1 inhibition Parecoxib sodium is a drug with bhla and analgesic properties, indicated for PO and acute renal colic prevention and management. After single dose 40mg it relieves pain twice as faster as compared to placebo Parenteral administration allows its use in case of postoperative nausea and vomiting 18it is an option for acute pain management and does not have the AE profile associated to non-selective COX inhibitors Parecoxib sodium has also economic advantages as compared to non-selective NSAIDS, such as ketoprofen, ketorolac and tenoxicam, because it is associated to decreased AE and opioid, antacids and antiemetic consumption 20in addition to decreased use of manpower and inputs generated when administered more than once a day This study aimed at bual hospitalization time less than or equal to five days between groups of vextra treated with parecoxib sodium as compared to other nonselective IV NSAIDS ketoprofen, ketorolac and tenoxicam to manage POP associated to appendectomy or orthopedic surgeries and acute renal colic.
This was a retrospective analysis of medical bills of beneficiaries of health plans by means of a database Orizon of health insurance companies information processes. By means of this database, information on health insurance companies were accessed, representing more than 18 million beneficiaries throughout Brazil. For renal colic, hospital stay data were stratified in less than 24h, more than 24h and general in hours.
Eligibility criteria included patients in single-therapy with tenoxicam, ketoprofen or ketorolac for managing renal colic or for postoperative pain relief in bexfra submitted to appendectomy and fracture-related procedures. Renal colic data were located by means of the international code of diseases ICD N20, N21, N22, N For appendectomy, codes An exploratory analysis was carried out to evaluate quality of data and data where patients’ identification was not defined were excluded.
Hospitalization time quantitative variable was described by means of mean, median, maximum and minimum. And exploratory analysis was carried out by means of Shapiro-Wilk bextr test to define whether the sample had normal bextrq. In case of non-normal distribution, non-parametric Kruskal-Wallis test was used to determine equality among three or more groups, and post-hoc Nemenyi-Damico-Wolfe-Dunn test was used to test the difference among groups after Kruskal-Wallis.
Analyses were carried out with Statistical R, version 3. The analysis of medical bills of health plan beneficiaries from January to June has shown that mean hospitalization time for managing post-appendectomy pain with parecoxib sodium bextrs 1. The same analysis was carried out for the management of POP of orthopedic fractures, and mean hospitalization time with parecoxib sodium was 1.
Treatment with parecoxib sodium was compared to three other therapeutic options ketoprofen, ketorolac and tenoxicam also used to manage renal colic and postoperative pain associated to appendectomy or fractures. For managing acute renal colic, data analysis has shown that for hospitalization time below 24h there has been significant difference between the group treated with parecoxib as compared to the group of other treatments 12,7h vs.
Mean general hospitalization time was Data analysis has shown that parecoxib was significantly more efficient in decreasing hospitalization time of painful patients submitted bfxtra appendectomy, to fracture-related procedures and with renal colic, as compared to other drugs. A randomized study carried out in the USA in has shown that IV parecoxib sodium in the preoperative period, bxtra by oral valdecoxib, in the PO of patients submitted to elective laparoscopy was also related to shorter hospitalization time, lower pain intensity and significant AE decrease, such as vomiting in the first 24h as compared to placebo Similarly, compared to the use of opioids, a study carried out in the United Kingdom in bexrra shown that parecoxib could decrease 1.
These findings may directly reflect on costs associated with pain management bextda patients submitted to surgical procedures or with acute renal colic.
An economic analysis of data of Brazilian private hospitals published in has shown that treatment with parecoxib sodium has significantly decreased hospitalization costs, with a mean economic benefit of reals per patient with POP and reals per patient with renal colic, proving that parecoxib may benefit not only patients’ recovery but may also decrease hospitalization costs In addition, parecoxib for pain control has also shown significant savings in adjuvant drugs consumption.
Fujii and Mould-Quevedo 20 have carried out a study in five private Brazilian hospitals to evaluate costs related to the use of antacids, antiemetics and opioid and non-opioid analgesics for the PO of orthopedic surgical patients. Medical data were selected based on the use of parecoxib, ketoprofen, ketorolac and tenoxicam.
Only parecoxib has shown significant decrease in the use of adjuvant drugs, with estimated savings of A limitation of this study is its generalization. There are no reliable national records of surgical procedures performed or a list of renal colic cases, with consequent scarcity of data of the supplementary health system and other sponsors. So, this study has used just data of health insurance companies linked to the Orizon company.
In addition to this limitation, other variables which could have influenced hospitalization time were not taken into consideration and sample size was not calculated according to the objective of the analysis; however, analyzed data were enough to have statistical power.
In our study, according to data of Brazilian Supplementary Health beneficiaries, it was possible to observe that parecoxib sodium to manage POP associated to appendectomy or surgical treatment of orthopedic fractures and acute renal colic could decrease hospitalization time as compared to non-selective NSAIDS ketoprofen, ketorolac and tenoxicam.
Pain assessment intensity and pain relief in patients post-operative orthopedic surgery.
Current practices for postoperative pain management in Europe and the potential role of the fentanyl HCl iontophoretic transdermal system. Challenges in the management of acute postsurgical pain. Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study.
A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs. Efficacy of analgesic treatments to manage children’s postoperative pain after laparoscopic appendectomy: Comparing the efficacy of intravenous tenoxicam, lornoxicam, and dexketoprofen trometamol for the treatment of buls colic.
Am J Emerg Med. Intravenous or intramuscular parecoxib for bextfa postoperative pain in adults. Cochrane Database Syst Rev. Preoperative parenteral parecoxib and follow-up oral valdecoxib reduce length of stay and improve quality of patient recovery after laparoscopic cholecystectomy surgery. Cost-effectiveness of cyclooxygenase- 2 inhibitor parecoxib compared to opioids after noncardiac surgery in the united kingdom.
The injectable cyclooxygenasespecific inhibitor parecoxib sodium has analgesic efficacy when administered preoperatively. Preoperative intravenous parecoxib reduces length of stay on ambulatory laparoscopic cholecystectomy.
A clinical trial demonstrates the analgesic activity of intravenous parecoxib sodium compared with ketorolac or morphine after gynecologic surgery with laparotomy.
buka Am J Obstet Gynecol. Parecoxib for parenteral analgesia in postsurgical patients. Bextta evaluation of post-operation orthopedic surgery of antacid, antihemetic and analgesic medication after ketoprophene, ketorolac, parecoxib and tenoxicam in Brazilian patients.
A Cost-effectiveness analysis of parecoxib in the management of postoperative pain in the Greek health care setting. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Services on Demand Journal. METHODS This was a retrospective analysis of medical bills of beneficiaries of health plans by means of a database Orizon of bexrra insurance companies information processes. Statistical analysis An exploratory analysis was carried out to evaluate quality of data and data where patients’ identification was not defined were excluded.
RESULTS The analysis of medical bills of health plan beneficiaries from January to June has shown that mean hospitalization time for managing post-appendectomy pain with parecoxib sodium was 1. June 09, ; Accepted: Hula to cite this article.