Potential Effect of Celecoxib on Pain Reduction and Gene Expression Related with Prostaglandins after Single Port Laparoscopic Surgery

Study Objective To evaluate the potential effect of celecoxib on pain reduction and identify change of expression of relevant genes after laparoscopic surgery for benign gynecologic diseases. Design A randomized, double-blind, placebo-controlled pilot trial Setting Under general anesthesia single port laparoscopic surgery was done in lithotomy position. Patients or Participants Patients who received single port laparoscopic surgery for benign gynecologic disease from October 2017 to April 2018. Interventions All patients were randomly assigned according to preoperative medication as follows: celecoxib 400 mg; placebo 400 mg. Two peritoneal tissues were obtained before and after capnoperitoneum, and all patients received patient-controlled analgesia (PCA) after surgery. Thereafter, we evaluated numeric rating scale (NRS), and the numbers of intravenous ketorolac used as a rescue drug. Moreover, we compared expression of genes which activate PG such as PG I2 synthase (PSGIS), PG E synthase (PTGES), PTGES3, and genes which inactivate PG including 15-hydroxyprostaglandin dehydrogenase (HDPG) and aldo-keto reductase family 1 member C3 (AKR1C3) in the two peritoneal tissues between the two groups by reverse transcription polymerase chain reaction. Measurements and Main Results A total of 62 patients received celecoxib (n=30) and placebo (n=32), and there were no differences in characteristics between the two groups. Pain reduction by celecoxib was observed in only patients whose capnoperitoneum maintained 60 min or more, and the effect was more definite in those under PCA. When we compared the five genes between the two groups, an increase of HDPG expression was also identified in only those whose capnoperitoneum maintained 60 min or more. Conclusion The potential effect of celecoxib may be related with an increase of HDPG expression in patients whose capnoperitoneum maintained 60 min or more (No. of trial; NCT03391570).