Combined parecoxib and I.V. paracetamol provides additional analgesic effect with better postoperative satisfaction in patients undergoing anterior cruciate ligament reconstruction

Abstract

Background:Adequacy of postoperative analgesia is one of the most important factors that determine early hospital discharge and patients’ ability to resume their normal activities postoperatively. The optimal non-opioid analgesic technique for postoperative pain management would reduce pain and enhance patient satisfaction, and it also facilitates earlier mobilization and rehabilitation by reducing pain-related complications after surgery. The aim of this study was to evaluate the analgesic efficacy of intravenous paracetamol and parecoxib when used alone, or in combination.Methods:Sixty American Society of Anesthesiology (ASA) physical status I and II adult patients who were scheduled for anterior cruciate ligament reconstruction were included in this study. Patients were allocated into three groups: group I patients received 1g intravenous paracetamol after induction and another 1 g 4 h later, group II received 40 mg parecoxib after induction, while group III received combination of both drugs (paracetamol 1 g and parecoxib 40 mg). Pain during rest and mobility was assessed in the immediate postoperative period, 2 h and 8 h successively using visual analog scale (VAS). Patient satisfaction was rated according to satisfaction score.Results:Total morphine requirements were lower in group III patients (6.9±2.7 mg) in comparison to group I patients (12.6±3.6 mg) or group II patients (9.8±2.8 mg). The least VAS scores were recorded during knee movement (3.8±1.1) in group III patients compared to group I (6.0±1.8) and group II patients (4.8±1.9). Eight hours postoperatively, group III patients were more satisfied regarding the postoperative pain management.Conclusion:Combination of intravenous paracetamol and parecoxib provided better analgesia and higher patient satisfaction than each drug when used separately.

Parecoxib, propacetamol, and their combination for analgesia after total hip arthroplasty: a randomized non‐inferiority trial

“…Several RCTs have compared the efficacy of PAR with IV PRO or paracetamol for post‐operative analgesia in various surgical settings, including combination therapy with PAR and PRO or paracetamol vs. either agent alone . Systematic reviews that compared NSAIDs/COX‐2 inhibitors, paracetamol, and their combinations for treatment of post‐surgical pain concluded that the combination may provide additional analgesic efficacy than either drug alone, although evidence for additive or synergistic effects of most combination regimens is lacking .…”

Intravenous Parecoxib for Pain Relief after Orthopedic Surgery: A Systematic Review and Meta-analysis

“…A total of 27 RCTs with 2840 participants were included [ 14 , 15 , 24 – 48 ], with between 15 and 310 participants receiving intravenous parecoxib per study. There were 15 RCTs on knee and hip arthroplasty [ 14 , 15 , 24 – 27 , 29 – 31 , 33 , 36 , 42 , 46 – 48 ], 5 on lumbar spine surgery [ 32 , 38 , 40 , 41 , 44 ], 2 on anterior cruciate ligament reconstruction [ 34 , 37 ], 2 on bunionectomy [ 39 , 45 ], and 3 on other orthopedic surgery [ 28 , 35 , 43 ]. The control groups included placebo (23 trials), ketorolac (3 trials), paracetamol (3 trials), and celecoxib (1 trial).…”

Decrease Anesthetic Requirements and Analgesics Postop, In Patients Undergoing Laparoscopic Cholecystectomy: Premedication with Acetaminophen versus Intravenous Ketorolac

“…For future research, we recommend evaluating the behavior of paracetamol and ketorolac in combination with other analgesics families in different age populations; this would allow us to open our knowledge on the subject of multimodal analgesia and preemptive analgesia, so we recommend continuing these studies [41][42][43].…”