title: Short stay and less pain after ambulatory anterior cruciate ligament (ACL) repair: COX-2 inhibitor versus glucocorticoid versus both combined.
abstract: BACKGROUND
  Many studies have demonstrated that either COX-2 antagonists or glucocorticoids are efficient analgesics after orthopaedic surgery. We wanted to evaluate if the combination of these two drugs was better than one drug alone when added to paracetamol, local anaesthesia, and cryo-cuff for outpatient anterior crucial ligament (ACL) surgery.
  
  
  METHODS
  In a double-blind design, 89 adult patients scheduled for day-case ACL repair in general anaesthesia were randomly assigned into three groups: The COXIB group (n = 30) received either 40 mg parecoxib iv or 120 mg etoricoxib orally 1 h before surgery. The STEROID group (n = 30) received 8 mg dexamethasone iv, and the combination group (Group COMBI, n = 29) received both.
  
  
  RESULTS
  At 24 h, Group COMBI had significantly lower visual analogue scale (0-10 cm) scores during rest (2.1 ± 1.3) (mean ± standard deviation) and movement (4.2 ± 2.5) when compared to both the COXIB group (P = 0.04) and the STEROID group (P = 0.035). The accumulated consumption of rescue opioids (5.2 ± 4,5 mg morphine) was also significantly lower at 24 h compared to the other groups (P = 0.02). Mean time to discharge from hospital was about 3 h in all groups. The pain scores in the post-anaesthetic care unit, mobilization at 24 h and 7 days, and general level of satisfaction were similar between the groups.
  
  
  CONCLUSIONS
  The combination of a COX-2 inhibitor and dexamethasone results in better pain relief 24 h after surgery in patients undergoing outpatient ACL surgery, compared to COX-2 inhibitor alone or dexamethasone alone. With a dedicated multimodal pain regime, most ACL patients may be discharged within 3 h.
authors: Department of Anaesthesia and Intensive Care, Baerum Hospital, RUD, Norway. vegard.dahl@vestreviken.no
authors: V
authors: V
authors: Dahl
authors: U J
authors: UJ
authors: Spreng
authors: M
authors: M
authors: Waage
authors: J C
authors: JC
authors: Raeder
mesh_terms: D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000704:Analysis of Variance; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D023381:Endpoint Determination; D000077613:Etoricoxib; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D007555:Isoxazoles / Q000008:administration & dosage / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011725:Pyridines / Q000008:administration & dosage / Q000627:therapeutic use; D018401:Sample Size; D013450:Sulfones / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D005938:Glucocorticoids; D007555:Isoxazoles; D011725:Pyridines; D013450:Sulfones; D003907:Dexamethasone; C409945:parecoxib; D000077613:Etoricoxib