Parecoxib reduces postoperative anxiety but not cognitive decline in pancreaticoduodenectomy patients

This randomized controlled trial, reported as an abstract, was conducted at the Second Hospital of Hebei Medical University. The study population consisted of 80 patients undergoing laparoscopic pancreaticoduodenectomy. Participants were assigned to an experimental group receiving 20 mg parecoxib intravenously 10 minutes before anesthesia and at the end of surgery, or a comparator group receiving an equal volume of normal saline at the same times. The primary outcome was the effect of parecoxib on anxiety, cognitive impairment, and postoperative intestinal function recovery, with perioperative neurocognitive disorder (PND) incidence calculated using the Z-value method. Follow-up assessments occurred at 24 hours and 7 days postoperatively.

For the primary outcome, postoperative anxiety measured by State Anxiety Inventory scores at 24 hours was significantly lower in the experimental group (P < .05). Cognitive function, assessed by Montreal Cognitive Assessment scores, did not show significant differences between groups, though cognitive decline was less pronounced in the experimental group. The overall PND incidence was 5% (2/40) in the experimental group versus 12.5% (5/40) in the control group, suggesting a possible clinical tendency toward reduced incidence, but this difference did not reach statistical significance. At 24 hours postoperatively, PND incidence was 10% (4/40) in the experimental group versus 15% (6/40) in the control group, and at 7 days, it was 5% (2/40) versus 12.5% (5/40); between-group differences for both time points did not reach statistical significance.

Key secondary outcomes included pain control, length of hospital stay, postoperative recovery, complication rates, and analgesic use. Postoperative intestinal function recovery, measured by flatus passage and defecation time, showed no significant differences between groups (P > .05). Complication rates also did not differ significantly (P > .05). Specific data for pain control, hospital stay, recovery metrics, and analgesic use were not reported in the abstract.

Safety and tolerability findings were not reported in the abstract; adverse events, serious adverse events, discontinuations, and overall tolerability were not specified. This lack of safety data is a notable limitation for clinical interpretation.

These results can be compared to prior landmark studies in perioperative neurocognitive disorders, though the abstract does not reference specific prior trials. The observed reduction in anxiety aligns with some evidence on perioperative analgesics, but the non-significant PND findings contrast with studies that have shown significant effects of other interventions on cognitive outcomes. The study's focus on a specific surgical population (pancreaticoduodenectomy) adds context but limits generalizability.

Key methodological limitations include the study being reported only as an abstract, which lacks full methodological details, and the small sample size of 80 patients, reducing statistical power. The absence of reported effect sizes and confidence intervals for most outcomes limits the ability to assess precision. The trial was conducted at a single center, potentially introducing selection bias. The lack of blinding details and follow-up beyond 7 days may affect the validity of long-term conclusions. The causality note indicates that while this is an RCT, differences in PND incidence did not reach statistical significance, so causality is not definitively established.

Clinically, these findings suggest that parecoxib may alleviate postoperative anxiety without affecting intestinal function recovery or increasing complications in patients undergoing pancreaticoduodenectomy. However, the evidence is preliminary and based on an abstract, so it should not guide definitive practice decisions. The non-significant PND results indicate that parecoxib may not reliably reduce neurocognitive disorder incidence in this context.

Unanswered questions include the full safety profile of parecoxib in this population, the optimal dosing regimen, long-term cognitive outcomes beyond 7 days, and the generalizability to other surgical procedures. Future full-text publications may provide more certainty and detailed data.