Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Abstract

Objective Total knee arthroplasty (TKA) is an established surgical technique and is the standard treatment for degenerative knee joint diseases. However, severe pain after TKA makes it difficult for many patients to perform early postoperative rehabilitation and functional exercise, which might result in subsequent unsatisfactory recovery of knee joint function and great reduction in patients’ satisfaction and quality of life. Orthopaedic surgeons have tried a large variety of analgesics and analgesic modes to relieve patients’ pain after TKA. There are many analgesic regimens available in clinical practice but all have some deficiencies. Parecoxib sodium, a highly selective inhibitor of cyclooxygenase‐2 (COX‐2), can reduce the synthesis of peripheral prostaglandin to exert the effect of analgesia, and relieve inflammation and prevent central sensitization through inhibition of peripheral and central COX‐2 expression. In addition, it can be used as a preemptive analgesic without affecting platelet aggregation. However, there does seem to be conflicting evidence in the current research as to whether parecoxib sodium can be used successfully as a preemptive analgesic; the effect of preemptive analgesia with parecoxib sodium in multimodal analgesia is still controversial. This research investigated the effects of parecoxib sodium in a preemptive multimodal analgesic regimen. Methods Eighty‐eight patients were randomized into two groups. The experimental group received parecoxib (46 patients) and the control group received saline (42 patients), administered 30 min before the initiation of the surgical procedure. A patient‐controlled analgesia (PCA) pump was applied within 48 h after surgery. The visual analogue scale (VAS), drug consumption through the PCA pump, use of salvaging analgesia, range of motion (ROM) of the knee joints, and postoperative complications were observed. Results The VAS score in the post‐anesthesia care unit (PACU) of the parecoxib group was significantly lower than that of the control group (P = 0.039). There was no significant difference in the demographic profiles, duration of operation, hemorrhage in surgery, postoperative hemorrhage, postoperative drainage, VAS at different time points, function of knee joints, length of hospital stay, use of salvaging analgesia, and postoperative drug consumption through the PCA between the two groups (P > 0.05). Conclusion In preemptive multimodal analgesia regimens, parecoxib sodium can significantly decrease the VAS score in the short term, relieve pain shortly after surgery, and does not increase the incidence of complications. Parecoxib sodium is a safe and effective drug in the perioperative analgesic management for TKA.

Postoperative Pain Management in Total Knee Arthroplasty

“…Cyclooxygenase‐2 (COX‐2) inhibitors, such as parecoxib sodium and celecoxib, administered 30–60 min before surgery significantly decrease postoperative pain and morphine consumption without increasing the incidence of other postoperative complications. Parecoxib sodium 40 mg administered 30 min before surgery significantly decreased postoperative pain in a post‐anesthesia care unit without increasing the incidence of other postoperative complications. Patients administered with celecoxib 400 mg within 1 h before surgery had less pain at rest and walking during the first week postoperatively, and received less morphine at 48 h after the procedure.…”

“…Apart from analgesia, celecoxib and parecoxib could also decrease early postoperative cognitive dysfunction incidence after TKA in elderly patients. At present, COX‐2 inhibitors are usually added to multimodal analgesia to reduce the consumption of opioids, without serious complications.…”

The efficacy and safety of selective COX-2 inhibitors for postoperative pain management in patients after total knee/hip arthroplasty: a meta-analysis

“…All included studies were randomized controlled trials. In summary, 17 studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] described random sequence generation and allocation concealment. Nine studies [12-14, 20, 22, 24, 25, 27, 28] described the blinding of participants and personnel.…”

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

“…[13][14][15] Because it mitigates pain hypersensitivity and has an opioid-sparing effect, the cyclooxygenase-2 (COX-2)selective inhibitor parecoxib has been increasingly used as a perioperative multimodal analgesic regimen. 16,17 The aim of this randomized, controlled trial was to investigate the analgesic efficacy and safety of PVB combined with parecoxib and to assess postoperative outcomes in patients undergoing VATS.…”