Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China.
Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Pain Physician. 2019 Nov;22(6):575-582.
Controlling postoperative pain and improving outcomes after total hip arthroplasty (THA) remain an important challenge, which affects the functional recovery of the hip.
To assess the effect of preemptive administration of the selective cyclooxygenase-2 inhibitor parecoxib sodium (PS) after THA.
A prospective, randomized, double-blinded clinical trial.
An academic medical center.
This randomized double-blind clinical trial compared postoperative analgesia intervention for unilateral primary THA. Patients were assigned in a 1:1 ratio to the PS group and the control group. The PS group received 40 mg dose of PS 30 minutes before incision, 12 hours after THA, and every 12 hours for 2 days postoperatively, and the control group received normal saline solution at the same time point. In addition, both groups received patient-controlled intravenous analgesia of morphine. Perioperative visual analog scale (VAS) scores, cumulative morphine consumption, functional recovery, perioperative bleeding risk, and the selected indicators of the inflammatory response were compared between the PS group and the control group.
From October 2014 to June 2015, 180 patients undergoing unilateral primary THA were screened for this prospective clinical trial. A total of 141 patients were enrolled and randomly assigned into the PS group (n = 69) and the control group (n = 72). Compared with the control group, VAS scores at rest were significantly lower in the PS group at 4, 12, and 24 hours after surgery, and VAS scores during movement were also lower in the PS group at 4, 12, 24, 36, and 48 hours after surgery (all P < 0.001). Both the cumulative morphine consumption and its associated nausea and vomiting were reduced in the PS group (P < 0.001 and P = 0.021, respectively). The length of hospitalization in the PS group was shorter than the control group (PS group 5.91 ± 1.15 days, control group 6.41 ± 1.49 days; P = 0.019). The PS group had lower body temperature than the control group at postoperative day (POD) 1 (P = 0.003) and POD 3 (P = 0.001), and the levels of high-sensitivity C-reactive protein in the PS group at POD 3 (P = 0.016) and POD 6 (P = 0.006) were also lower than those in the control group. The concentration of interleukin (IL)-6 and IL-10 were significantly different between the 2 groups (IL-6, P = 0.007; IL-10, P = 0.006) on the first day postoperatively. The PS group was not significantly different from the control group with respect to any outcomes: blood loss, postoperative blood drainage and blood transfusion, and number of days needed to accomplish straight-leg raising and off-bed exercise.
PS was used only until POD 2, and there was no long-term follow-up.
Perioperative administration of PS is an effective addition to a multimodal regimen that alleviates postoperative pain, reduces the cumulative morphine consumption, length of hospitalization, and perioperative inflammatory response, without increasing perioperative bleeding risk.
Parecoxib sodium, multimodal analgesia, total hip arthroplasty, inflammatory response.
控制全髋关节置换术后的疼痛和改善术后结果仍然是一个重要的挑战，这会影响髋关节的功能恢复。
评估选择性环氧化酶-2 抑制剂帕瑞昔布钠（PS）在全髋关节置换术后的预先给药效果。
前瞻性、随机、双盲临床试验。
学术医疗中心。
本随机双盲临床试验比较了单侧初次全髋关节置换术后的术后镇痛干预措施。患者以 1:1 的比例随机分配到 PS 组和对照组。PS 组在切口前 30 分钟给予 40mgPS，在全髋关节置换术后 12 小时、术后 2 天的每 12 小时给予一次，对照组在同一时间点给予生理盐水。此外，两组均接受吗啡患者自控静脉镇痛。比较 PS 组和对照组之间围手术期视觉模拟评分（VAS）评分、累积吗啡用量、功能恢复、围手术期出血风险以及炎症反应的选定指标。
2014 年 10 月至 2015 年 6 月，对 180 例接受单侧初次全髋关节置换术的患者进行了这项前瞻性临床试验筛选。共纳入 141 例患者，并随机分为 PS 组（n=69）和对照组（n=72）。与对照组相比，PS 组术后 4、12 和 24 小时静息时 VAS 评分显著降低，PS 组术后 4、12、24、36 和 48 小时运动时 VAS 评分也较低（均 P<0.001）。PS 组累积吗啡用量及其相关恶心和呕吐均减少（均 P<0.001 和 P=0.021）。PS 组的住院时间短于对照组（PS 组 5.91±1.15 天，对照组 6.41±1.49 天；P=0.019）。PS 组术后第 1 天（P=0.003）和第 3 天（P=0.001）的体温低于对照组，PS 组术后第 3 天（P=0.016）和第 6 天（P=0.006）的高敏 C 反应蛋白水平也低于对照组。术后第 1 天两组白细胞介素（IL）-6 和 IL-10 浓度差异有统计学意义（IL-6，P=0.007；IL-10，P=0.006）。PS 组与对照组在出血量、术后引流和输血、完成直腿抬高和离床活动所需的天数等方面无显著差异。
PS 仅在术后第 2 天使用，没有长期随访。
围手术期使用 PS 是一种有效的多模式治疗方法，可以减轻术后疼痛，减少累积吗啡用量、住院时间和围手术期炎症反应，而不会增加围手术期出血风险。
帕瑞昔布钠、多模式镇痛、全髋关节置换术、炎症反应。
