Background: The use of analgesics with different mechanism of action enhances post-operative pain relief by opioids. Both celecoxib and gabapentin have opioid-sparing effect, but it is unclear whether combination of the two drugs accentuates postoperative analgesia and further reduced opioid requirement. Objective: Determine whether the perioperative use of celecoxib in combination with gabapentin reduces the amount of post-operative opioid consumption in comparison to celecoxib alone or gabapentin alone in patients that have major orthopedic surgery. Materials and methods: Randomized double-blinded placebo controlled trial was done in 99 patients underwent major orthopedic surgery. They were randomly allocated into four groups. One to two hours before anesthesia, they received midazolam 7.5 mg plus study drugs. Group P received placebo plus placebo at 12 and 24 hours later. Group C received celecoxib 400 mg plus celecoxib 200 mg at 12 and 24 hour later. Group G received gabapentin 400 mg plus gabapentin 300 mg at 12 and 24 hour later. Finally, group CG received celecoxib 400 mg + gabapentin 400 mg plus celecoxib 200 mg + gabapentin 300 mg at 12 and 24 hour later. The patients underwent surgery under general anesthesia. Post-operative pain was treated by intravenous morphine patient-controlled analgesia. Results: Median morphine consumption (minimum-maximum) in twenty-four hours was 18.0, 15.0, 15.5, and 8.0 mg, in group P, C, G, and CG, respectively. The group CG significantly consumed less morphine (41%) in 24 hour than group G, but not significantly less (38%) than group C. Pain score, sedation score, and nausea/vomiting at postoperative hour 1, 4, 8, 12, 16, 20, and 24 was not significantly different. Conclusion: Combination of celecoxib and gabapentin further accentuated post-operative analgesia by morphine comparing to celecoxib or gabapentin alone without change in pain score and other side effects of the medications.Major orthopedic surgery, such as spine, major limb, and joint, usually causes moderate-to-severe postoperative pain that requires strong opioids to relief. The merit of strong opioids in severe pain reduction is obscured by its dose-related unwanted side effects. The concurrent use of more than one analgesic agent provided effective analgesia with smaller doses of each component, thereby minimizing adverse effects.Multimodality approaches for the treatment of postoperative pain have been widely practiced. Recently, several types of drug have been reported in many clinical trials, especially non-steroidal antiinflammatory drugs (NSAIDs) and coxibs. These drugs provide analgesic effect by inhibition of prostaglandins synthesis at the site of tissue injury and in the central nervous system. When given in perioperative period, they have shown significant opioid-sparing effect, reduction in opioid analgesic consumption, postoperative pain reduction, and patient satisfaction compared with placebo [1].

Treatment with bromelain-containing enzyme preparation for 3-4 weeks is effective for treatment of knee osteoarthritis (OA). Here, we aimed to assess 16-week treatment with bromelain in mild-to-moderate knee OA patients. We performed a randomized, single-blind, active-controlled pilot study. Forty knee OA patients were randomized to receive oral bromelain (500 mg/day) or diclofenac (100 mg/day). Primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) analyzed by Wilcoxon signed rank test. Secondary outcome was the short-form 36 (SF-36). Plasma malondialdehyde (MDA) and nitrite were measured as oxidative stress markers. There was no difference in WOMAC and SF-36 scores compared between bromelain and diclofenac groups after 4 weeks. At week 4, the improvement of total WOMAC and pain subscales from baseline was observed in both groups; however, two patients given diclofenac had adverse effects leading to discontinuation of diclofenac. However, observed treatment difference was inconclusive. At week 16 of bromelain treatment, the patients had improved total WOMAC scores (12.2 versus 25.5), pain subscales (2.4 versus 5.6), stiffness subscales (0.8 versus 2.0), and function subscales (9.1 versus 17.9), and physical component of SF-36 (73.3 versus 65.4) as compared with baseline values. OA patients had higher plasma MDA, nitrite, and prostaglandin E2 (PGE2) in lipopolysaccharide (LPS)-stimulated whole blood but lower plasma α-tocopherol than control subjects. Plasma MDA and LPS-stimulated PGE2 production were decreased at week 16 of bromelain treatment. Bromelain has no difference in reducing symptoms of mild-to-moderate knee OA after 4 weeks when compared with diclofenac.

The acetabular labrum is the connective tissue between femoral head and hip joint that acts like a shock absorber. Labral injury could happen after hip dislocation or internal derangement such as femeroacetabular impingement (FAI) syndrome. The surgeon usually attempts to repair or reconstruct the torn labrum to obtain the native hip biomechanical loading. There has been no scientific evidence study for the different surgical techniques. Hip simulation machine was made to let a femur move in six conditions including flexion, extension, abduction, adduction, internal rotation and external rotation. The hip was compressed with a force of half of the body weight (350 N). The purpose of this study was to study pressurization in three labral conditions including intact labrum, labral repair and labral reconstruction. The machine was designed and simulated by SolidWorks software. A device's controller had two mode including a manual mode to set zero before an operation and automation mode to move in six conditions and compressed with a force of body weight. After the construction, the machine was tasted by using counterfeit pelvis and femur. The device was reformed before a real taste. Dissected cadaveric pelvises were used and measured pressure through the film piezoresistive load sensors. The testing result was helped the surgeon to make a decision in surgery process.