The Effect of Parecoxib Sodium Versus Flurbiprofen Axetil in Multimodal Pain Management in Patients Undergoing Total Knee Arthroplasty

Objective:To evaluate the pain relief effect of parecoxib sodium(selective cyclooxygenase-2 inhibitor) versus flur-biprofen axetil(non-selective cyclooxygenase inhibitor) used in patients undergoing total knee arthroplasty in early short-term fuctional recovery.Methods:This is a prospective,randomized,double-blind,parallel and controlled study.According to inclusion/exclusion crite-ria,60 patients undergoing unilateral total knee arthroplasty were randomly assigned to one of the 2 groups from June,2009 to March,2010.All the operations were performed by the same group of surgeons under combined spinal and epidural anesthesia.Before the knee prothesis were installed,the intra-articular cocktail anagesic injection was given to every patient,which contained 150 mg ropivacaine,0.5 ml epinephrine(1:1000).All patients received patient-controlled intravenous analgesia(PCIA) at the end of the operation,and got the exercise training from the nurses after the operation.Clinical trial interventions were given from the third postoperative day to fifth post-operative day,when the PCIA was stopped.The trial group received parecoxib sodium(40 mg,every 12 hours),while the control group received flurbiprofen axetil(100 mg,every 12 hours).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,active ROM of the operated knee as well as Knee Society Score(KSS) on postoperative day 30 and the hemoglobin of the second and the sixth postoperative day were observed.Results:There 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 Knee Society Score on postoperative day 30.With anticoagulant therapy,the difference of hemoglobin between the second and the sixth postoperative day in the parecoxib sodium group was lower than that in the flurbiprofen axetil group.Conclusions:This 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 fuctional recovery.But it is safer to use parecoxib sodium for pain management with anticoagulant therapy because it can decrease the risk of hidden blood loss.