title: Parecoxib added to ropivacaine prolongs duration of axillary brachial plexus blockade and relieves postoperative pain.
abstract: BACKGROUND
  Cyclooxygenase (COX)-2 antagonist is widely used for intravenous postoperative pain relief. Recent studies reported COX-2 in the spinal dorsal horn could modulate spinal nociceptive processes. Epidural parecoxib in rats showed no neurotoxicity. These findings suggested applying a COX-2 antagonist directly to the central or peripheral nerve might provide better analgesia.
  
  
  OBJECTIVE
  We therefore determined: (1) whether the addition of parecoxib to ropivacaine injected locally on the nerve block affected the sensory and motor block times of the brachial plexus nerve block; and (2) whether parecoxib injected locally on the nerve or intravenously had a similar analgesic adjuvant effect.
  
  
  METHODS
  We conducted a randomized controlled trial from January 2009 to November 2010 with 150 patients scheduled for elective forearm surgery, using a multiple-nerve stimulation technique. Patients were randomly allocated into one of three groups: Group A (n = 50) received ropivacaine 0.25% alone on the brachial plexus nerve; Group B (n = 50) received ropivacaine together with 20 mg parecoxib locally on the nerve block; and Group C (n = 50) received 20 mg parecoxib intravenously. We recorded the duration of the sensory and motor blocks, and the most severe pain score during a 24-hour postoperative period.
  
  
  RESULTS
  Parecoxib added locally on the nerve block prolonged the motor and sensory block times compared with Group A. However, parecoxib injected intravenously had no such effect. Pain intensity scores in Group B were lower than those in Groups A and C.
  
  
  CONCLUSIONS
  Parecoxib added to ropivacaine locally on the nerve block prolonged the duration of the axillary brachial plexus blockade and relieved postoperative pain for patients having forearm orthopaedic surgery.
  
  
  METHODS
  Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Anesthesiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 200092, Shanghai, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Liu
authors.forename: Xuan
authors.initials: X
authors.lastname: Zhao
authors.forename: Jian
authors.initials: J
authors.lastname: Lou
authors.forename: Yingwei
authors.initials: Y
authors.lastname: Wang
authors.forename: Xiaofang
authors.initials: X
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000577:Amides / Q000494:pharmacology / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000494:pharmacology / Q000627:therapeutic use*; D001917:Brachial Plexus / Q000187:drug effects / Q000601:surgery; D052246:Cyclooxygenase 2 Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000601:surgery; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D052246:Cyclooxygenase 2 Inhibitors; D007555:Isoxazoles; D000077212:Ropivacaine; C409945:parecoxib