title: 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.
  
  
  CONCLUSIONS
  Combination of intravenous paracetamol and parecoxib provided better analgesia and higher patient satisfaction than each drug when used separately.
authors.affiliation: AL-Ahli Hospital, Doha, Qatar.
authors.forename: Zeinab Ahmed
authors.initials: ZA
authors.lastname: Elseify
authors.forename: Salwa Omar
authors.initials: SO
authors.lastname: El-Khattab
authors.forename: Ahmed Metwally
authors.initials: AM
authors.lastname: Khattab
authors.forename: Eman Mohammed
authors.initials: EM
authors.lastname: Atta
authors.forename: Layal Fares
authors.initials: LF
authors.lastname: Ajjoub