Combined parecoxib and I.V. paracetamol provides additional analgesic effect with better postoperative satisfaction in patients undergoing anterior cruciate ligament reconstruction

Background : Adequacy of postoperative analgesia is one of the most important factors that determine early hospital discharge and patients′ ability to resume their normal activities postoperatively. The optimal non-opioid analgesic technique for postoperative pain management would reduce pain and enhance patient satisfaction, and it also facilitates earlier mobilization and rehabilitation by reducing pain-related complications after surgery. The aim of this study was to evaluate the analgesic efficacy of intravenous paracetamol and parecoxib when used alone, or in combination. Methods : Sixty American Society of Anesthesiology (ASA) physical status I and II adult patients who were scheduled for anterior cruciate ligament reconstruction were included in this study. Patients were allocated into three groups: group I patients received 1g intravenous paracetamol after induction and another 1 g 4 h later, group II received 40 mg parecoxib after induction, while group III received combination of both drugs (paracetamol 1 g and parecoxib 40 mg). Pain during rest and mobility was assessed in the immediate postoperative period, 2 h and 8 h successively using visual analog scale (VAS). Patient satisfaction was rated according to satisfaction score. Results : Total morphine requirements were lower in group III patients (6.9±2.7 mg) in comparison to group I patients (12.6±3.6 mg) or group II patients (9.8±2.8 mg). The least VAS scores were recorded during knee movement (3.8±1.1) in group III patients compared to group I (6.0±1.8) and group II patients (4.8±1.9). Eight hours postoperatively, group III patients were more satisfied regarding the postoperative pain management. Conclusion : Combination of intravenous paracetamol and parecoxib provided better analgesia and higher patient satisfaction than each drug when used separately.