ABSTRACT
Objective: Continuous femoral nerve blockade has become an accepted modality in the management of pain after total knee arthroplasty (TKA); however, posterior knee pain can be problematic and often requires additional analgesia. The present study compared the use of parenteral parecoxib to single-shot sciatic block for this purpose. Material and Method: After the Ethic Review Board gave approval, adults undergoing TKA were randomly divided into 3 groups. Group 1 (Gr-F+S) received single-shot sciatic nerve block (SNB) with 0.25% bupivacaine 25 ml in addition to continuous femoral analgesia (CFA) (0.125% bupivacaine 7 ml/h); group 2 (Gr-F+P) received parenteral parecoxib 40 mg q 12 hours with CFA; and group 3 (Gr-F) received only CFA. Assessments were performed at 0, 6, 12, and 24 hours post op. and included the following variables: NRS (numerical rating score) at rest, morphine use, time to first analgesic dose and side effects. Results: Seventy-eight patients were enrolled, with 26 participants in each of the 3 groups. There was no inter-group difference in pain score (NRS). However, morphine requirements in the first 24 hours were significantly increased in Gr-F (17±12 mg) when compared to Gr-F+S (10±7 mg) and Gr-F+P (9±5 mg) (p<0.001). There was no difference in time to first analgesic dose, side effects or patient satisfaction. Conclusion: Parenteral parecoxib and single-shot SNB both significantly reduced morphine requirements when used in combination with femoral nerve blockade after TKA.
