Parecoxib possesses anxiolytic properties in patients undergoing total knee arthroplasty: A prospective, randomized, double-blind, placebo-controlled, clinical study

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Parecoxib possesses anxiolytic properties in patients undergoing total knee arthroplasty: A prospective, randomized, double-blind, placebo-controlled, clinical study
Key Take-Away: 

The study postulates that parecoxib possesses an anxiolytic effect and with further research, it can be considered as a new prophylactic regime or treatment modality in the management of pain-related anxiety

Anxiety sensitivity is the characteristic of being fearful of anxiety-related sensations. It is one of the important factors linked to the experience of pain. During the preoperative period, the patients usually experience this unusual feeling, making them more susceptible to pain after surgery. 

ABSTRACT: 
Background: 

Anxiety sensitivity is the characteristic of being fearful of anxiety-related sensations. It is one of the important factors linked to the experience of pain. During the preoperative period, the patients usually experience this unusual feeling, making them more susceptible to pain after surgery. Anxiety sensitivity is not only linked to greater pain experience rather incline patients more towards the negative thoughts or sensations of painful stimuli and therefore, towards a greater intensity of reported pain.

Continuous femoral nerve block (CFNB) affords a commonly performed practice in surgical procedures of total knee arthroplasty (TKA) as an effective means of providing postoperative analgesia. Previous studies have suggested that sedatives/tranquilizers may provide benefit to the patients with pain-related anxiety while some other studies have reported serious adverse effects with the regular use of benzodiazepines, opioids, and ketamine or fentanyl.  Intravenous administration of parecoxib could provide significant pain relief in surgical operations that require additional forms of analgesia. However, there is not much data known about its effects on the anxiety levels of patients before a surgical procedure.

 Rationale behind research

  • Very little is known about the effects of parecoxib on the anxiety levels of patients, when regularly being administered during the perioperative period.
  • The authors addressed this great area of unmet need by evaluating the effects of intravenous parecoxib on anxiety levels experienced during the perioperative period.

Objective

  • To investigate the effects of intravenous parecoxib, pre-emptively administered, on the anxiety levels experienced during the perioperative periods
Methods: 

 

NOTE: Continuous femoral nerve block was placed in a sterile fashion with neurostim guidance. 

  • Study outcomes
  1. Pain assessment: All the patients were introduced to a 10-cm visual analog scale (VAS) for procedural pain (0= no pain at all to 10=worst pain imaginable). The level of pain was assessed and recorded on preset and agreed times.
  2. Anxiety assessmet:  After 36-48 hours of surgery, under influence of  parecoxib, all patients were requested to fill in a questionnaire, in order to evaluate anxiety levels pre and post surgically (STAI 1 and STAI 2). One of the main aims was to distinguish personality-trait anxiety from state anxiety, i.e., anxiety experience due to the actual perioperative events and the actual pain endured.
Results: 

 

 

Outcomes

  • Pain: Parecoxib provided greater relief than placebo following TKA.
  • Anxiety levels: The group receiving parecoxib had lower anxiety levels both pre- and post-surgically, as compared to the placebo group, with statistical significance p = 0.012 and p = 0.002. Also, STAI2 afforded the more appropriate tool to evaluate the anxiety levels during the current perioperative period, which undoubtedly can be very stressful for any individual. Nevertheless, we considered the use of STAI1 valuable to extract information about the patient’s personality, in general.

Figure 1: Anxiety levels of pre-surgical state and post-surgical state b/w groups receiving parecoxib and placebo

Conclusion: 

In the current study, administration of parecoxib had statistically significantly improved anxiety levels for both trait and state anxiety levels, as compared to the placebo.

The current findings are in agreement with the previous study that investigated whether parecoxib, preemptively administrated, had an effect on anxiety levels during epidural catheter placement for surgical operations. Administaration of 40 mg parecoxib, intravenously 20 min before the interventional technique, improved patients’ anxiety levels, experienced prior to an epidural catheter placement.  

Pain Ther. 2016 Feb 9.
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