Effect of parecoxib alone versus parecoxib combined with nefopam hydrochloride on postoperative morphine consumption in major laparoscopic gynecologic surgery: a retrospective study

Abstract Purpose This study aimed to compare the analgesic efficacy of parecoxib alone versus parecoxib combined with nefopam hydrochloride in patients undergoing major laparoscopic gynecologic surgery at a university tertiary care medical center. The primary outcomes were the proportions of patients who needed morphine and total morphine consumption. The secondary outcomes were the maximum pain score and adverse drug effects. Methods This retrospective cohort study included 226 patients who underwent major laparoscopic gynecologic surgery between December 2019 and February 2022. The parecoxib group received 40 mg parecoxib intravenously at surgery initiation and 12 hours later. The parecoxib plus nefopam group received the same parecoxib regimen. Additionally, they received 20 mg nefopam hydrochloride intravenously over 1 hour concurrently with the first parecoxib dose, followed by 40 mg nefopam over the next 12 hours. Results The combination of parecoxib with nefopam significantly reduced both the proportion of patients necessitating morphine and the cumulative morphine consumption at 1, 6, 12, and 24 hours postoperatively (P < 0.001). The median maximum pain score at 1 hour postoperatively was also lower in the combination group. However, at 6, 12, and 24 hours postoperatively, the median maximum pain scores and adverse drug effects did not differ significantly between the two groups. Conclusions Adding nefopam to parecoxib demonstrated an opioid-sparing effect in major laparoscopic gynecologic surgery, reducing the proportion of patients requiring morphine, decreasing morphine consumption at multiple postoperative time points, and lowering early postoperative pain scores.