Randomized, Double-Blind, Placebo-Controlled Study to Assess the Efficacy of Nonopioid Analgesics on Pain following Arthroscopic Knee Surgery

Abstract

Purpose. In a randomized, double-blind trial, the efficacy of nonopioid analgesics on postoperative piritramide consumption was compared for pain relief during the first 24 h in patients recovering from arthroscopic knee surgery. Methods. 120 patients were treated with normal saline and/or one of the nonopioid analgesics (parecoxib, metamizole, paracetamol) in addition to piritramide using the PCA pump. Beginning in the postanesthesia care unit (PACU), patients were asked to quantify their pain experience at rest while piritramide consumption was recorded. Results. Piritramide consumption upon arrival in the PACU was high in all groups. However, cumulative consumption in the parecoxib group was significantly lower than that in the placebo group at 6 and 12 h after surgery. At discharge from the PACU, VAS scores dropped in all groups and were significantly lower in the parecoxib group. In the PACU, satisfaction of the patients was moderate and improved with time after surgery. Conclusions. There was statistically significant opioid-saving effect by administering parecoxib with better VAS scores and satisfaction level compared to placebo. The high pain score in the PACU in all groups immediately after recovering from remifentanil-based anesthesia would be prevented if local anesthetics were administered intra-articularly as part of a multimodal analgesic approach.

Figure 1

The CONSORT flow diagram of the study design for arthroscopic knee surgery study.

Figure 2

Incremental piritramide consumption in mg (mean and standard deviations) in the four groups over 24 hours postoperatively after arthroscopic knee surgery. There is no significant difference between the groups.

Figure 3

Cumulative piritramide consumption in mg (mean and standard deviations) over 24 hours postoperatively after arthroscopic knee surgery. *Parecoxib versus placebo at 6 h (P = 0.033) and at 12 h (P = 0.032).

Figure 4

Visual analog scale (VAS, mean and standard deviations) over 24 hours postoperatively ^‡ P = 0.006 NaCl versus parecoxib; *parecoxib versus paracetamol at 12 h (P = 0.002), at 18 h (P = 0.001), and at 24 h (P = 0.003).