Parenteral Parecoxib Provides a Similar Reduction in
Opioid Requirement to Single-Shot Sciatic Nerve Block
after Total Knee Arthroplasty when Combined with
Continuous Femoral Nerve Block
Nuj Tontisirin MD*,
Theerawat Chalacheewa MD*, Suwimolwadee Saipimpong MD*,
De QH Tran MD, FRCPC§, Roderick J Finlayson MD, FRCPC§
Affiliation :
* Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
§ Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Canada
Objective : Continuous femoral nerve blockade has become an accepted modality in the management of pain after total knee
arthroplasty (TKA); however, posterior knee pain can be problematic and often requires additional analgesia. The present
study compared the use of parenteral parecoxib to single-shot sciatic block for this purpose.
Material and Method: After the Ethic Review Board gave approval, adults undergoing TKA were randomly divided into
3 groups. Group 1 (Gr-F+S) received single-shot sciatic nerve block (SNB) with 0.25% bupivacaine 25 ml in addition to
continuous femoral analgesia (CFA) (0.125% bupivacaine 7 ml/h); group 2 (Gr-F+P) received parenteral parecoxib 40 mg
q 12 hours with CFA; and group 3 (Gr-F) received only CFA. Assessments were performed at 0, 6, 12, and 24 hours post
op. and included the following variables: NRS (numerical rating score) at rest, morphine use, time to first analgesic dose
and side effects.
Results : Seventy-eight patients were enrolled, with 26 participants in each of the 3 groups. There was no inter-group
difference in pain score (NRS). However, morphine requirements in the first 24 hours were significantly increased in Gr-F
(17±12 mg) when compared to Gr-F+S (10±7 mg) and Gr-F+P (9±5 mg) (p<0.001). There was no difference in time to first
analgesic dose, side effects or patient satisfaction.
Conclusion : Parenteral parecoxib and single-shot SNB both significantly reduced morphine requirements when used in
combination with femoral nerve blockade after TKA.
Keywords : Parecoxib, Total knee arthroplasty, Sciatic nerve block
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