Intravenous parecoxib for early postoperative cognitive dysfunction in elderly patients: evidence from a meta-analysis

ABSTRACT

Background

Inflammation plays a key role in the etiology and pathology of postoperative cognitive dysfunction (POCD). Cyclooxygenase (COX)-2 inhibitor parecoxib is used for the treatment of acute pain due to its potent anti-inflammatory and analgesic effects. Herein, we evaluated the efficacy and safety of parecoxib on early POCD in geriatric patients.

Objective

This study was performed to evaluate the efficacy and safety of parecoxib for early postoperative cognitive dysfunction (POCD) in elderly patients.

Methods

Comprehensive literature search based on six electronic databases was applied to retrieve all related randomized controlled trials (RCTs). Two independent reviewers screened each article for eligibility according to the predetermined inclusion criteria. The Cochrane’s Tool was applied to evaluate the methodological quality of included studies. RevMan 5.3 was used to conduct meta-analysis.

Results

Eight RCTs comprising a total of 1106 subjects prepared for orthopedic surgical operation were selected. All the identified RCTs were conducted in China. The methodological qualities of included studies were judged to be medium to high. The integrated data showed that perioperative intravenous parecoxib could remarkably reduce the incidence of POCD with improved Mini-Mental State Examination (MMSE) score. Parecoxib could significantly reduce the concentrations of interleukin-6, but results regarding the changes in tumor necrosis factor-alpha, C-reactive protein, and S100β levels remained inconsistent.

Conclusion

Perioperative parecoxib administration is effective in reducing the incidence of POCD and improving the MMSE score compared with control. However, the beneficial effect of parecoxib has been tested only in the Chinese population. Future RCTs in western countries with larger-scale and more comprehensive neurological tests are needed.

KEYWORDS:

• Parecoxib
• postoperative cognitive dysfunction
• randomized controlled trials
• joint surgery
• meta-analysis

Article highlights

• This paper is the first systematic review of pareoxib on early surgical cognitive impairment in the elderly.

• Pareoxib can reduce the incidence of POCD in elderly patients on postoperative day 1, day 3, and day 7.

• Pareoxib can improve the MMSE score after orthopedic operation.

• Parecoxib can significantly reduce the concentrations of IL-6.

Author contributions

J. Huang, Z. Lv, and M. Nie conceived and devised the study; performed the experiments; and wrote the paper. B. Zhang and W. Jiang analyzed the data and revised the manuscript. All authors have contributed to the final version and approved the publication of the final manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Jiangxi Province Ji’an City Science and Technology Bureau guidance science and technology plan project [2018632].