Intravenous Parecoxib and Continuous Femoral Block for Postoperative Analgesia after Total Knee Arthroplasty. A Randomized, DoubleBlind, Prospective Trial

Abstract

Background: Up until now, the optimal strategy for postoperative pain management after total knee arthroplasty (TKA) remains to be elucidated. Objective: The current investigation aimed to examine the analgesic efficacy and the opioid sparing effects of intravenous parecoxib in combination with continuous femoral blockade. Study Design: Randomized, double-blind, prospective trial. Setting: University hospital in the United Kingdom. Methods: In total, 90 patients underwent TKA under subarachnoid anesthesia and received continuous femoral block initially as a bolus with 20 mL of ropivacaine 0.75%. Infusion of 0.2% on 10 mL/h followed. Patients were randomized into 2 groups. Group D and Group P received parecoxib and placebo, respectively at 12 hour time intervals. Visual analog scale (VAS) pain scores were obtained at different time intervals including 4, 8, 12, 24 and 36 hours. The pain scores were measured with patients in a resting position. Morphine could also be administered with a patient controlled analgesia (PCA) pump if the specified analgesia was deemed inadequate (VAS > 5). Results: None of the patients were withdrawn from the study. Parecoxib provided greater relief than placebo following TKA. The VAS pain scores measured at rest were statistically significantly lower in parecoxib-treated patients compared to the placebo group (P = 0.007) at 4 (P = 0.044), 12 (P = 0.001), and 24 hours (P = 0.012), postoperatively. Patients receiving parecoxib consumed less morphine at all time intervals than patients receiving placebo, with borderline statistical significance (P = 0.054). In each time period, all patients receiving continuous femoral block irrespectively of the treatment group, required low morphine doses. Limitations: Current protocol did not answer question as to functional recovery. Conclusion: According to our findings intravenous parecoxib in combination with continuous femoral block provided superior analgesic efficacy and opioid sparing effects in patients undergoing TKA. Key words: Anesthesia, TKA, morphine, opioids, VAS scores, continuous femoral block

Strategies for the management of postoperative pain in total knee arthroplasty: integrative review

“…This study showed no statistically significant differences between CFNB alone and CFNB + SMI. The use of parecoxib + continuous femoral block provided superior analgesic efficacy and opioid-sparing effects in patients undergoing TKA 66 . In this context, intra-articular bupivacaine in combination with intravenous parecoxib may improve pain relief and reduce the demand for rescue analgesics in patients undergoing TKA 67 .…”

“…Further studies should be conducted with different intraoperative and postoperative pain protocols to increase the antinociceptive effect potential of Mg 89 . However, RCT studies 66,67 with 44 patients reported that magnesium sulfate administration significantly reduced POP and minimized the difference in pain intensity between the first and second surgery. Another unsuccessful approach is the application of a compression dressing after TKA.…”

The efficacy of parecoxib in improving pain after total knee or total hip arthroplasty: Systematic review and meta-analysis

“…However, from the related studies, it can be seen that the combined use of pareoxib sodium for pain relief can significantly reduce the consumption of opioids. [20][21][22][23]28,32] Orthopedic surgeons account for a large proportion of the prescription of opioids for the management of postoperative pain. How to minimize the use of opioids and effectively control postoperative pain is a long-term topic.…”

“…Bian et al [31] 66.64 ± 7.27/66.12 ± 8.34 46/42 40 mg parecoxib intravenously normal saline at the same time ①②③④ Sarridou et al [32] 70. 31 Scale scores can range from 0 to 5 points, with higher scores indicating better quality.…”

The Efficacy of the Combination of Continuous Femoral Nerve Block and Intravenous Parecoxib on Rehabilitation in Patients Undergoing Total Knee Arthroplasty: A Double-Blind, Randomized Clinical Trial

“…Nonetheless, it requires an effective postoperative analgesia plan, as TKA is considered one of the most painful procedures in orthopedic surgery [3][4][5]. As much as 50% of TKA patients report severe pain after surgery, leading to prolongation of the rehabilitation period, reduced cooperation during physiotherapy sessions, and increased risk of chronic postsurgical pain development [6][7][8][9][10]. The aforementioned aspects contribute to longer hospital stays, higher costs, and an adverse socioeconomic impact [11,12].…”