| ObjectiveTo evaluate the pain relief effect and safety of parecoxib sodium (selective cyclooxygenase-2 inhibitor) versus flurbiprofen axetil (non-selective cyclooxygenase inhibitor ) used in patients undergoing total knee arthroplasty in early short-term functional recovery process.MethodsThis is a prospective, randomized, double-blind, parallel and controlled study. According to the inclusion / exclusion criteria, 60 patients undergoing unilateral total knee arthroplasty because of degenerative osteoarthritis were randomly assigned to one of the 2 groups from June, 2009 to March, 2010. Each of the patients got a random number after admitted to our hospital, and was assigned to the group of parecoxib sodium or the group of flurbiprofen axetil according to the random number. The general datas of the patients such as name, gender, height, weight and et al were recorded. The patients were evaluated by the American knee society knee score ( KSS ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) before the operation. All the operations were performed by the same group of orthopedists under combined spinal and epidural anesthesia. Before and after the knee prothesis were installed, the intra-articular"cocktail analgesic injection"was given to every patient, which contained 150 mg ropivacaine, 0.5 ml epinephrine and was mixed with sterile normal saline solution to make up a combined volume of 100 ml. All the patients received patient-controlled intravenous analgesia ( PCIA ) at the end of the operation, and got the exercise training including isometric contraction of the quadriceps femoris, straight leg raising ( SLR ) and flexion / extension of the ankle joint by the nurses after the anesthetic stage. On the first postoperative day the patients were encouraged to perform knee joint exercise of active flexion and extension, and practiced continuous passive motion of the knee with a machine.The low molecular weight heparin calcium (0.4 ml ) was administered subcutaneously once a day to prevent deep venous thrombosis ( DVT ) from the first postoperative day to the fourteenth postoperative day. Clinical trial interventions were given from the third postoperative day to the fifth postoperative day, when the PCIA was stopped. The trial group received parecoxib sodium (40 mg, i.v. , every 12 hours), while the control group received flurbiprofen axetil (100 mg, i.v. , every 12 hours). Such datas as the pain score (visual analog scale,VAS ) at rest and during activity, active range of motion ( ROM ) of the operated knee from the third to the fifth postoperative day, the hemoglobin of the second and the sixth postoperative day, as well as the American Knee Society Score ( KSS ) and active ROM of the operated knee on the thirtieth postoperative day were observed. ResultsThere were no significant differences in such outcome measures as VAS scores at rest and during activity, active ROM of the operated knee from the third to the fifth postoperative day, and active ROM of the operated knee as well as the KSS score on the thirtieth postoperative day. With anticoagulant therapy, the difference of hemoglobin between the second and the sixth postoperative day in the parecoxib sodium group was significantly lower than that in the flurbiprofen axetil group ( P=0.042 ).ConclusionThis study did not reveal that there is better pain relief effect of parecoxib sodium than flurbiprofen axetil used in patients undergoing total knee arthroplasty in early short-term functional recovery process. But it is safer to use parecoxib sodium for pain management because it can decrease the risk of hidden blood loss during the period of anticoagulant therapy. |
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