Chuaychoosakoon Chaiwat, Parinyakhup Wachiraphan, Wiwatboworn Arnan, Purngpiputtrakul Peeranut, Wanasitchaiwat Pawin, Boonriong Tanarat
Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Orthop J Sports Med. 2021 Oct 20;9(10):23259671211041660. doi: 10.1177/23259671211041660. eCollection 2021 Oct.
A nonsteroidal anti-inflammatory drug such as oral diclofenac is normally used to relieve postoperative pain after anterior cruciate ligament reconstruction (ACLR), but most patients continue to have moderate-to-severe pain that disturbs their rehabilitation. Some orthopaedists prefer to use intravenous (IV) parecoxib for postoperative pain control.
To compare the efficacy of IV parecoxib and oral diclofenac for postoperative pain control in ACLR.
Cohort study; Level of evidence, 3.
We retrospectively collected and analyzed postoperative pain in patients who underwent both single- and double-bundle ACLR; pain was reported on a 10-point visual analog scale (VAS; 10 = worst pain). After the operation, each patient was given either IV parecoxib twice a day or oral diclofenac 3 times a day, and all patients received paracetamol 6 times per day for 24 hours postoperatively. If the patient complained of moderate or severe pain (VAS >3) after surgery, 3 mg of morphine would be given intravenously every 3 hours and 1 mg of morphine as a rescue analgesic every 1 hour for 24 hours postoperatively. Postoperative VAS and morphine consumption were recorded every 4 hours for 24 hours. Data were analyzed using paired test, analysis of variance, and chi-square test.
Overall, 161 patients were included in this study, of whom 47 received IV parecoxib and 114 received oral diclofenac. The mean VAS scores at 4 and 8 hours postoperatively were 3.5 and 3.4, respectively, in the parecoxib group, and 4.4 and 4.7, respectively, in the diclofenac group. The parecoxib group had significantly lower mean VAS than the diclofenac group at 4 hours ( = .047) and 8 hours ( = .005), and the mean cumulative morphine consumption in the parecoxib group was significantly lower than in the diclofenac group at all time points ( < .05) except 4 hours postoperatively.
This study found that IV parecoxib was more effective than oral diclofenac in controlling postoperative pain and resulted in lower postoperative morphine consumption within the first 24 hours after ACLR.
非甾体类抗炎药如口服双氯芬酸通常用于缓解前交叉韧带重建术（ACLR）后的术后疼痛，但大多数患者仍有中度至重度疼痛，这妨碍了他们的康复。一些骨科医生更倾向于使用静脉注射（IV）帕瑞昔布来控制术后疼痛。
比较静脉注射帕瑞昔布和口服双氯芬酸在ACLR术后疼痛控制中的疗效。
队列研究；证据等级，3级。
我们回顾性收集并分析了接受单束和双束ACLR手术患者的术后疼痛情况；疼痛程度采用10分视觉模拟评分法（VAS；10 = 最严重疼痛）进行报告。术后，每位患者每天接受两次静脉注射帕瑞昔布或每天三次口服双氯芬酸，所有患者术后24小时内每天接受6次对乙酰氨基酚治疗。如果患者术后主诉中度或重度疼痛（VAS > 3），术后24小时内每3小时静脉注射3 mg吗啡，每1小时静脉注射1 mg吗啡作为解救镇痛药。术后24小时内每4小时记录一次术后VAS和吗啡用量。数据采用配对t检验、方差分析和卡方检验进行分析。
总体而言，本研究共纳入161例患者，其中47例接受静脉注射帕瑞昔布，114例接受口服双氯芬酸。帕瑞昔布组术后4小时和8小时的平均VAS评分分别为3.5和3.4，双氯芬酸组分别为4.4和4.7。帕瑞昔布组在术后4小时（P = .047）和8小时（P = .005）的平均VAS显著低于双氯芬酸组，除术后4小时外，帕瑞昔布组在所有时间点的平均吗啡累积用量均显著低于双氯芬酸组（P < .05）。
本研究发现，静脉注射帕瑞昔布在控制ACLR术后疼痛方面比口服双氯芬酸更有效，且在术后24小时内吗啡用量更低。
