Preemptive analgesia with parecoxib sodium alleviates short-term pain after endoscopic submucosal dissection for early esophageal cancer and precancerous lesions: a single-center, double-arm, and randomized controlled study.

INTRODUCTION: Endoscopic submucosal dissection (ESD) is the preferred treatment for early esophageal cancer and precancerous lesions. Postoperative pain is a prevalent but often overlooked issue.This study investigated the analgesic efficacy and safety of preemptive parecoxib sodium in patients undergoing ESD for early esophageal cancer and precancerous lesions. METHODS: Patients scheduled for ESD under general anesthesia were enrolled and randomly allocated to the medication group (intravenous parecoxib sodium 30 minutes prior to surgery) or the control group (4 mL intravenous normal saline 30 minutes before the procedure). Clinical data, including perioperative serum levels of high-sensitivity C-reactive protein, IL-6, complete blood count, and biochemical parameters, were collected. Postoperative pain intensity was assessed using the visual analog scale (VAS) at 6, 12, 24, 72, and 120 hours after the procedure. RESULTS: A total of 78 patients participated (40 in the parecoxib group, 38 in the control group). The two groups were comparable in baseline characteristics and preoperative inflammatory/nutritional indicators (all P > 0.05). At 6 and 12 hours post-operation, pain scores in the medication group were significantly lower than those in the control group (P < 0.05), while VAS scores at 24, 72, and 120 hours showed no significant differences between groups (P > 0.05). The frequency and total dosage of postoperative tramadol administration, as well as the incidence of adverse reactions, were comparable between the two groups (all P > 0.05). CONCLUSION: Preemptive analgesia with parecoxib sodium can alleviate early postoperative pain in patients with early esophageal cancer and precancerous lesions who undergo ESD for mucosal defects involving less than three-quarters of the esophageal circumference, without increasing adverse reactions or the subsequent use of analgesic drugs. CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/showproj.html?proj=218572, identifier ChiCTR2400080433.