Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Cox-2 Inhibitors Reduce Complications After Laparoscopic Surgery

02.06.2004


Patients given a class of anti-inflammatory drugs before and after minimally invasive laparoscopic surgery experienced less pain with fewer postoperative complications and an earlier return to normal activities, according to Duke University Medical Center researchers.


CREDIT: Duke University Medical Center



The class of drugs in question, known as cyclooxygenase (COX)-2 inhibitors, block a key enzyme in the cascade of immune system events leading to inflammation. Unlike other non-steroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors do not have any significant effect on blood platelet or gastrointestinal function.

The results of the multi-center Phase III clinical trial, which were published in the June 2004 issue of the journal Anesthesia & Analgesia, demonstrated that the use of COX-2 inhibitors lessened the amount of opiates needed to control pain, as well as reduced the incidence of postoperative nausea and vomiting (PONV). By controlling these events, the use of COX-2 inhibitors allowed patients to return home sooner and more comfortably, the researchers said.


The 24-center trial, which was led by Duke anesthesiologist Tong Joo Gan, M.D., followed 276 patients undergoing laparoscopic gall bladder removal (cholecystectomy), one of the most commonly performed minimally invasive surgical procedures.

"Ten to 15 years ago, this was an open procedure that required three or four days of recuperation in the hospital," Gan said. "Now, with laparoscopic surgery, patients can go home the same day as surgery. With the growing popularity of minimally invasive surgery, the onus is on us as anesthesiologists to come up with ways to better control pain and reduce the incidence of PONV so patients can go home comfortably after their surgery."

It is estimated that there are more than 35 million surgical procedures performed each year in the U.S., with 60 to 70 percent being performed on an outpatient basis. Furthermore, Gan said, as many as one in three surgical patients will suffer from PONV, making it a pressing health-care issue.

"PONV is also an issue that most physicians do not take seriously enough; they see it as a short-term nuisance that will soon pass," Gan said. "However, studies have shown that nausea and vomiting after surgery are the major factors influencing whether or not patients are satisfied with their surgery. The patients in our trial who received the COX-2 inhibitors were significantly more satisfied with their experience than those on placebo."

While earlier studies have demonstrated that the use of COX-2 inhibitors can reduce the need for opiates to control pain by up to 40 percent, the current trial was unique because it was among the first to show that giving the drug prior to surgery has a beneficial effect. Past studies have examined controlling side effects after the fact, instead of trying to prevent them, Gan said.

The common side effects of opiate drugs -- which increase as the dosages increase -- include PONV, itching, drowsiness, urinary retention and gastrointestinal disorders, according to Gan. PONV and pain are by far the main reasons for delaying discharge from the hospital, he added.

"It appears that COX-2 inhibitors not only reduce the amount of opiates needed for pain control, but that they also act synergistically by improving opiates ability to control pain," Gan continued. "The reduced need for opiates may account for many of the benefits we found in this study, with the patients receiving COX-2 inhibitor showing a 21 percent reduction in the use of opiates immediately after surgery, as well as a reduction in the need for additional pain relief up to five days after discharge."

While the researchers specifically examined the use of COX-2 inhibitors for laparoscopic cholecystectomy, the benefits should apply to all surgeries, including open procedures, Gan said.

"The key is giving them up front and preventing the problems before they begin," he said, adding that past trials reviewed by the Food and Drug Administration (FDA) have focused more on treating postoperative complications than preventing them.

For the trial, patients were randomized into two groups. The first group received intravenous COX-2 inhibitors prior to surgery and then in pill form for the next seven days. The second group received placebo.

Almost one-third of the patients receiving COX-2 inhibitors resumed normal to light activity one day after surgery, compared to 7 percent in the placebo arm. By the second day, more than half of the patients receiving COX-2 inhibitors were back to normal activities, compared to 36 percent in the placebo group.

The trial was supported by Pfizer Global Pharmaceuticals, New York, manufacturer of the specific COX-2 inhibitor used in the trial. Gan has no financial interest in Pfizer.

Richard Merritt | dukemed news
Further information:
http://dukemednews.org/news/article.php?id=7635

More articles from Health and Medicine:

nachricht Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University

nachricht The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

Im Focus: Molecules change shape when wet

Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water

In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...

Im Focus: Fraunhofer ISE Develops Highly Compact, High Frequency DC/DC Converter for Aviation

The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.

Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

UTSA study describes new minimally invasive device to treat cancer and other illnesses

02.12.2016 | Medical Engineering

Plasma-zapping process could yield trans fat-free soybean oil product

02.12.2016 | Agricultural and Forestry Science

What do Netflix, Google and planetary systems have in common?

02.12.2016 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>