Comparison of preincisional and postincisional parecoxib administration on postoperative pain control and cytokine response after total hip replacement.

OBJECTIVE: To investigate whether preincisional parecoxib administration can reduce postoperative pain and modulate the inflammatory cytokine response to a greater extent than preincisional parecoxib administration in total hip replacement patients.

METHODS: Patients were randomized to receive 40 mg parecoxib intravenously either before or after skin incision (preincisional and postincisional groups, respectively). Morphine was administered for postoperative analgesia. Visual analogue pain scale (VAS) scores and morphine consumption were recorded at 1, 6, 18 and 24 h postoperation. Plasma levels of interleukin (IL)-6, IL-8 and tumour necrosis factor-α were measured 30 min before skin incision and 6 h postoperation.

RESULTS: Compared with the postincisional group, VAS pain scores at 1 and 6 h postoperation were significantly lower in the preincisional group. Morphine consumption was significantly lower in the preincisional group at 6, 18 and 24 h postoperation. In both groups, IL-6 and IL-8 levels increased significantly at 6 h postoperation compared with preoperation, and the preincisional group had significantly lower levels of IL-6 and IL-8 at 6 h postoperation compared with the postincisional group.

CONCLUSIONS: Preincisional parecoxib administration reduced postoperative pain and morphine consumption compared with postincisional administration, and attenuated IL-6 and IL-8 production 24 h after hip replacement surgery.