title: Multimodal pain management following minimally invasive total knee arthroplasty: an experience in 3-dose parecoxib.
abstract: OBJECTIVE
  To report the results of multimodal pain control with the use of parecoxib following minimally invasive total knee arthroplasty (MIS-TKA).
  
  
  METHODS
  A consecutive series of 103 patients who underwent 122 MIS-TKAs in 120 episodes of admission by a single surgical team was included in the study. A uniform multimodal pain management protocol was used; including 3-dose regimen of parecoxib in patients who had no contraindication. From 12 hours after complete surgery, early ambulation was started according to patient ability. Serial pain scores were recorded, postoperatively. Intravenous tramadol was prescribed for pain rescue as needed.
  
  
  RESULTS
  Mean age was 67.5 +/- 7.8 years and 68% of patients had medical co-morbidities. Twelve patients (10%) did not receive parecoxib. Eighty-nine patients of the studied group (86%) could ambulate within 24 hours after surgery. The mean preoperative and postoperative pain scores of the group at 6 hours, 12 hours, 24 hours and 36 hours were 6.9, 2.5, 2.4, 2.2 and 1.8, respectively. The postoperative pain following TKA was rated as satisfied pain relief (pain score < 3), of which, the parecoxib group had less need of tramadol than that of non-parecoxib group (10.2% vs. 33%). There was no fluctuation of postoperative blood pressure, as well as no complication related to the use of 3-dose intravenous parecoxib. The serum creatinine level after the second dose in the parecoxib group was found 0.1 mg/dL higher than those who did not take parecoxib (delta, 0.3 vs. 0.2 mg/dL). With a variable intravenous fluid rate to maintain adequate hourly urine, the parecoxib group had more volume of 24-hour fluid intake after surgery (3658 vs. 2918 mL).
  
  
  CONCLUSIONS
  Multimodal postoperative pain control after MIS-TKA provided satisfied postoperative pain relief and patients receiving parecoxib had less injectable narcotic administration. Although we prevented perioperative inadequate fluid intake, the serum creatinine level was found slightly higher in parecoxib group. Thus, appropriate fluid intake should be considered when parecoxib is prescribed for postoperative pain in TKA.
authors.affiliation: Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. areetana@hotmail.com
authors.forename: Aree
authors.initials: A
authors.lastname: Tanavalee
authors.forename: Satit
authors.initials: S
authors.lastname: Thiengwittayaporn
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003131:Combined Modality Therapy; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007555:Isoxazoles / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000534:rehabilitation; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D020127:Recovery of Function; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D052246:Cyclooxygenase 2 Inhibitors; D007555:Isoxazoles; D000082:Acetaminophen; D009020:Morphine; C409945:parecoxib