The purpose of this study is to determine the effects of parecoxib in combination with epidural morphine in providing analgesia for patients undergoing gynecological surgery.

Researches have showed that the use of epidural and spinal block resulted in significant reduction in morbidity and mortality after surgery. Moreover, appropriate pain management results in better outcomes. Opioids therapy is recommended as the first choice medication for the management of postoperative pain but is associated with a number of undesirable adverse effects. A multimodal therapy for providing postoperative analgesia has advantages over the use of opioids alone. The use of NSAIDs and opioids together often improves analgesia and reduces the need for opioids in the postoperative period. Often, the combination of COX-2 inhibitors with epidural analgesia is preferred. With epidural analgesia, addition of COX-2 inhibitors may improve the analgesia and decrease the undesirable side effects.

Inclusion Criteria:

• women scheduled for elective gynecological surgery under combined spinal-epidural anesthesia

Exclusion Criteria:

• contraindications for CSE placement
• known allergy, sensitivity, or contraindication to opioid and nonopioid analgesic drugs
• history of bleeding disorders, peptic ulceration, or anticoagulant use within the past month
• current pregnancy or breastfeeding
• history of known or suspected drug abuse
• unable to understand the use of pain assessment scales and the PCA device
• Patient with asthma or bronchospasm, requiring treatment with glucocorticoids
• poorly controlled hypertension or diabetes, a chronic or acute renal or hepatic disorder, or inflammatory bowel disease
• patients had taken antidepressants, narcotic analgesics, antihistamines, anxiolytics, hypnotics, sedatives, NSAIDs, or corticosteroids up to 24 h before receipt of the study medication