As per the outcomes of a single-centre randomized controlled trial published in the International Journal of Surgery, the use of parecoxib (a selective cyclooxygenase-2 inhibitor) prophylactically after PD surgery demonstrated safety and efficacy. Guangnian Liu et al. undertook this study to explore the effects of parecoxib after pancreaticoduodenectomy in 134 patients.

Participants were divided into two groups, the parecoxib group (group P, n=68) and the control group (group C, n=66). Both the groups received a routine patient-controlled epidural analgesia for three days postoperatively. Furthermore, Group P received parecoxib (40mg intravenously, Q12 h) for five days and was given opioid analgesics to manage severe pain as needed. On the other hand, Group C received opioid analgesic (morphine or pethidine) on-demand after surgery.

The major endpoints were analgesic efficacy of parecoxib (estimated using a visual analogue scale [VAS] and decline in opioid usage (estimated as accumulated doses).  Secondary endpoints incorporated the post-surgery recovery process, complications, and parecoxib's anti-inflammatory effect.

No vital differences were witnessed in VAS scores. It was observed from the study that the occurrence of side effects, postsurgery serum interleukin-6 levels, and the number of doses of opioids in group P (3.2 ± 0.3 doses) were substantially reduced as compared to group C (8.5 ± 0.4 doses). 

No vital differences between the groups were reported in terms of readmission rates or postsurgery complications. In comparison with Group C, Group P demonstrated a shorter time for (i) first mobilization out of bed, (ii) first pass flatus, and (iii) removal of the nasogastric tube. The authors concluded that parecoxib is an effective agent to manage pain after PD surgery and can offer similar optimal pain mitigation as opioids without any side effects.