title: Parecoxib prevents early postoperative cognitive dysfunction in elderly patients undergoing total knee arthroplasty: A double-blind, randomized clinical consort study.
abstract: BACKGROUND
  Trial design neuroinflammation and postoperative pain after surgery are increasingly reported in association with postoperative cognitive dysfunction (POCD). Parecoxib, a selective cyclooxygenase (COX)-2 inhibitor, is used for postoperative analgesia for its potent anti-inflammatory and analgesic effects. This study aimed to evaluate parecoxib's effects on POCD in elderly patients undergoing total knee arthroplasty.
  
  
  METHODS
  Around 134 elderly patients undergoing total knee arthroplasty were randomly divided into parecoxib (group P) and control (group C) groups, and treated with parecoxib sodium and saline, respectively, shortly after induction of general anesthesia and 12-h postsurgery, respectively. Perioperative plasma IL-1β, IL-6, TNF-α, and C-reactive protein (CRP) 1evels were measured. Postoperative pain was assessed following surgery. Neuropsychological tests were performed before surgery, and 1 week and 3 months postoperation.
  
  
  RESULTS
  POCD incidence in group P was significantly lower compared with that of group C at 1 week after surgery (16.7% vs 33.9%; P < 0.05); no significant difference was found between groups C and P at 3-month follow-up (9.7% vs 6.7%). Compared with group C values, visual analog pain scale (VAS) scores at 3, 6, and 12 hours after surgery were significantly lower in group P(P < 0.05). Plasma IL-1β, IL-6, and TNF-α levels were lower in group P than in group C after the operation (P < 0.05). No significant difference in the plasma CRP level was found between groups P and C.
  
  
  CONCLUSIONS
  Parecoxib sodium decreases POCD incidence after total knee arthroplasty in elderly patients and may explain how this drug suppresses inflammation and acute postoperative pain caused by surgical trauma.
authors.affiliation: Department of Anesthesiology, Xuzhou Central Hospital Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University Department of neurology, Xuzhou Central Hospital, Xuzhou, PR China.
authors.forename: Yang-Zi
authors.initials: YZ
authors.lastname: Zhu
authors.forename: Rui
authors.initials: R
authors.lastname: Yao
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhang
authors.forename: Hui
authors.initials: H
authors.lastname: Xu
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D015415:Biomarkers / Q000097:blood; D060825:Cognitive Dysfunction / Q000517:prevention & control*; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use*; D008297:Male; D009483:Neuropsychological Tests; D010149:Postoperative Pain / Q000517:prevention & control*
chemical_list: D015415:Biomarkers; D052246:Cyclooxygenase 2 Inhibitors; D007555:Isoxazoles; C409945:parecoxib