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Original ArticleOpen Access
Multimodal Pain Management Following Minimally Invasive Total Knee Arthroplasty: An Experience in 3-Dose Parecoxib
Tanavalee A 
,
Thiengwittayaporn S
,
Thiengwittayaporn S Objective: To report the results of multimodal pain control with the use of parecoxib following minimally
invasive total knee arthroplasty (MIS-TKA).
Material and Method: A consecutive series of 103 patients who underwent 122 MIS-TKAs in 120 episodes of
admission by a single surgical team was included in the study. A uniform multimodal pain management
protocol was used; including 3-dose regimen of parecoxib in patients who had no contraindication. From 12
hours after complete surgery, early ambulation was started according to patient ability. Serial pain scores
were recorded, postoperatively. Intravenous tramadol was prescribed for pain rescue as needed.
Results: Mean age was 67.5 + 7.8 years and 68% of patients had medical co-morbidities. Twelve patients
(10%) did not receive parecoxib. Eighty-nine patients of the studied group (86%) could ambulate within 24
hours after surgery. The mean preoperative and postoperative pain scores of the group at 6 hours, 12 hours, 24
hours and 36 hours were 6.9, 2.5, 2.4, 2.2 and 1.8, respectively. The postoperative pain following TKA was
rated as satisfied pain relief (pain score < 3), of which, the parecoxib group had less need of tramadol than
that of non-parecoxib group (10.2% vs. 33%). There was no fluctuation of postoperative blood pressure, as
well as no complication related to the use of 3-dose intravenous parecoxib. The serum creatinine level after
the second dose in the parecoxib group was found 0.1 mg/dL higher than those who did not take parecoxib
(Δ, 0.3 vs. 0.2 mg/dL). With a variable intravenous fluid rate to maintain adequate hourly urine, the parecoxib
group had more volume of 24-hour fluid intake after surgery (3658 vs. 2918 mL).
Conclusion: Multimodal postoperative pain control after MIS-TKA provided satisfied postoperative pain
relief, and patients receiving parecoxib had less injectable narcotic administration. Although we prevented
perioperative inadequate fluid intake, the serum creatinine level was found slightly higher in parecoxib
group. Thus, appropriate fluid intake should be considered when parecoxib is prescribed for postoperative
pain in TKA.
Keywords: Parecoxib, Pain, Postoperative pain, Minimally invasive, MIS, Total knee arthroplasty, TKA,
Multimodal
invasive total knee arthroplasty (MIS-TKA).
Material and Method: A consecutive series of 103 patients who underwent 122 MIS-TKAs in 120 episodes of
admission by a single surgical team was included in the study. A uniform multimodal pain management
protocol was used; including 3-dose regimen of parecoxib in patients who had no contraindication. From 12
hours after complete surgery, early ambulation was started according to patient ability. Serial pain scores
were recorded, postoperatively. Intravenous tramadol was prescribed for pain rescue as needed.
Results: Mean age was 67.5 + 7.8 years and 68% of patients had medical co-morbidities. Twelve patients
(10%) did not receive parecoxib. Eighty-nine patients of the studied group (86%) could ambulate within 24
hours after surgery. The mean preoperative and postoperative pain scores of the group at 6 hours, 12 hours, 24
hours and 36 hours were 6.9, 2.5, 2.4, 2.2 and 1.8, respectively. The postoperative pain following TKA was
rated as satisfied pain relief (pain score < 3), of which, the parecoxib group had less need of tramadol than
that of non-parecoxib group (10.2% vs. 33%). There was no fluctuation of postoperative blood pressure, as
well as no complication related to the use of 3-dose intravenous parecoxib. The serum creatinine level after
the second dose in the parecoxib group was found 0.1 mg/dL higher than those who did not take parecoxib
(Δ, 0.3 vs. 0.2 mg/dL). With a variable intravenous fluid rate to maintain adequate hourly urine, the parecoxib
group had more volume of 24-hour fluid intake after surgery (3658 vs. 2918 mL).
Conclusion: Multimodal postoperative pain control after MIS-TKA provided satisfied postoperative pain
relief, and patients receiving parecoxib had less injectable narcotic administration. Although we prevented
perioperative inadequate fluid intake, the serum creatinine level was found slightly higher in parecoxib
group. Thus, appropriate fluid intake should be considered when parecoxib is prescribed for postoperative
pain in TKA.
Keywords: Parecoxib, Pain, Postoperative pain, Minimally invasive, MIS, Total knee arthroplasty, TKA,
Multimodal
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