Effect of perioperative parecoxib on postoperative pain and local inflammation factors PGE2 and IL-6 for total knee arthroplasty: a randomized, double-blind, placebo-controlled study

Abstract

To assess the efficacy of postoperative pain management and the concentration change of PGE-2 and IL-6 of joint fluid with parecoxib after postoperative total knee arthroplasty. In the study, 100 patients experiencing primary TKA were randomly divided into study group, receiving parecoxib sodium (40 mg) intravenously (IV) at the completion of surgery and once every 12 h for totally 6 times postoperatively, and placebo group, receiving normal saline 2 mL IV at the same time points. Efficacy was assessed by total amount of morphine consumed, pain intensity, range of motion (ROM), the concentration change of PGE-2 and IL-6 of joint fluid, and postoperative nausea and vomiting (PONV) postoperatively. Patients in study group consumed significantly less morphine, experienced significant less pain scores, and obtained significantly more ROM (P < 0.01) compared with that in placebo group during 3 days postoperatively. The concentration of PGE-2 and IL-6 of joint fluid in study group are significantly lower than that in placebo group (P < 0.01) during 24 h postoperatively. The overall incidence of PONV was low and was not significantly different between the two groups. The present study demonstrated that the perioperative administration of parecoxib after primary TKA resulted in significantly improved postoperative analgesic management as defined by reduction in opioid requirement, lower pain scores and ROM, and significantly lowered local inflammation factors PGE2 and IL-6.

Correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty

“…All patients began ambulation on the postoperative day (POD) 1. As an alternative multimodal analgesic protocols, all patients were sequentially treated with intravenous parecoxib (40 mg/q12h), the first injectable cyclooxygenase-2 (COX-2) selective inhibitor with approved indication of postoperative pain [28], for the first three postoperative days and followed by oral celecoxib (200 mg/q12h) which could relieve pain superior to low doses of morphine (4 mg iv) for further analgesia [29]. Tramadol (100 mg/tablet, per os) or dolantin (10 mg, intramuscular injection) was used as rescue analgesic when the NRS at rest ≥4 [30].…”

Correlation between perioperative parecoxib and postoperative acute kidney injury in patients undergoing non-cardiac surgery: a retrospective cohort analysis

“…A previous study showed that in ammation is a predictor of postoperative AKI and a mediator of increased mortality after AKI in noncardiac surgery [25]. However, perioperative parecoxib reduced local and systemic in ammatory cytokines postoperatively [26,27]. Another possible mechanism is associated with hemodynamic change.…”

Parecoxib Provides Analgesic and Opioid-Sparing Effects Following Major Orthopedic Surgery: A Subset Analysis of a Randomized, Placebo-Controlled Clinical Trial

“…However, our findings are in broad agreement with previous placebo-controlled studies of parecoxib in specific orthopedic surgery models. For example, significant improvements in postoperative pain have been associated with multiple dose parecoxib in patients undergoing total hip arthroplasty [33, 34], total knee arthroplasty [35, 36], and a variety of spinal procedures including spinal fusion [37]. In nearly all these trials, parecoxib also reduced total postoperative opioid consumption compared to placebo [33, 35–37].…”

“…Parecoxib has been shown to relieve movement-related pain following gynecological surgery [38, 39] and total hip arthroplasty (in press). Additionally, a previous placebo-controlled study has shown that parecoxib results in improved range of motion, relative to placebo, following total knee replacement [35]. …”