Comparing the Efficacy of Postoperative Pain Control Between Intravenous Parecoxib and Oral Diclofenac in ACL Reconstruction.

BACKGROUND: 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. PURPOSE: To compare the efficacy of IV parecoxib and oral diclofenac for postoperative pain control in ACLR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: 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 t test, analysis of variance, and chi-square test. RESULTS: 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 (P = .047) and 8 hours (P = .005), and the mean cumulative morphine consumption in the parecoxib group was significantly lower than in the diclofenac group at all time points (P < .05) except 4 hours postoperatively. CONCLUSION: 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.

Comparing post-operative pain between single bundle and double bundle anterior cruciate ligament reconstruction: a retrospective study.

BACKGROUND: In anterior cruciate ligament (ACL) reconstruction, the clinical outcome and level of post-operative pain are important factors. To date there have been no studies evaluating differences in post-operative pain between single bundle and double bundle ACL reconstruction with a hamstring graft. HYPOTHESIS/PURPOSE: We hypothesized that post-operative pain in single bundle ACL reconstruction would be less than in double bundle ACL reconstruction. This study was to compare post-operative pain between patients undergoing single bundle versus double bundle ACL reconstruction. STUDY DESIGN: Cohort study. METHODS: This was a retrospective study comparing post-operative pain scores between single bundle and double bundle ACL reconstruction. Each patient was given our standard regimen of oral diclofenac (25 mg/tab) three times per day and paracetamol (500 mg/tab) six times per day for 1 day post-operatively. If the patient complained of moderate to severe pain (pain numeric rating scale (PNRS) > 3), 3 mg of morphine was injected intravenously every 3 h for 24 h and 1 mg of morphine as a rescue medication every 1 h for 24 h. PNRS and morphine consumption were recorded at 4-h intervals for 24 h. RESULTS: 209 patients were included in this study of whom 102 and 107 patients received single bundle and double bundle ACL reconstruction, respectively. The average post-operative pain scores of the single bundle group were lower at all time points. Linear mixed effect regression analyses showed that the single bungle group had lower post-operative pain than the double bundle group after adjusting for confounders (beta = - 0.45; 95% CI = - 0.838, - 0.062) but there was no statistically significant difference between numbers of bundle ACL reconstruction with regard to morphine consumption. CONCLUSION: Single bundle ACL reconstruction had significantly lower post-operative pain scores than double bundle ACL reconstruction. CLINICAL RELEVANCE: Double bundle ACL reconstruction results in higher post-operative pain, which may slow the start of rehabilitation and reduce patient satisfaction. In middle-aged adult patients with low-demand activities, we suggest performing a single bundle ACL reconstruction.

Factors Affecting Adherence to Follow-up Appointments after total knee arthroplasty.

BACKGROUND: Regular attendance of follow-up visits after total knee arthroplasty (TKA) is an important aspect of post-TKA patient care. Hence, this study was conducted to evaluate patient adherence to follow-up visits after TKA and analyze the factors that are associated with adherence to follow-up visits following TKA. MATERIAL AND METHODS: This study was a retrospective study. The data of 411 knee osteoarthritis patients who had primary TKA were extracted from a single tertiary care hospital's electronic database. All of the pa-tients underwent the same patient care protocol. The log-rank test was used for detecting differences in follow-up survival and influencing factors. Hazard ratios (HR) were calculated using Cox proportional hazard models. RESULTS: The percentage of patients attending postoperative follow-up was 99.3 percent at 6 weeks, 61.1 percent after 1 year, 38.4 percent at 2 years, 32.1 percent after 3 years, and 24.6 percent at 4 years. Hazard ratios for loss to follow-up in patients younger than 65 years of age and those 65-75 years old, compared with those over 75 years old were 2.09 and 1.49, respectively (P<0.05). Patients classified as ASA II better adhered to follow-up visits than ASA III patients. (HR 0.71, P = 0.04). Lastly, HR in patients who lived at least 100 km away from the hospital compared with those who lived less than 100 km away was 0.78 (P = 0.033). CONCLUSIONS: 1. Adherence to follow-up visits after TKA was lower than we had expected. 2. The importance of follow-up visits should be emphasized to all patients, and especially in those who require special attention, such as patients who are at high risk of post-operative complications.