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Parecoxib Added to Ropivacaine Prolongs Duration of Axillary Brachial Plexus Blockade and Relieves Postoperative Pain

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

An Erratum to this article was published on 14 December 2012

Abstract

Background

Cyclooxygenase (COX)-2 antagonist is widely used for intravenous postoperative pain relief. Recent studies reported COX-2 in the spinal dorsal horn could modulate spinal nociceptive processes. Epidural parecoxib in rats showed no neurotoxicity. These findings suggested applying a COX-2 antagonist directly to the central or peripheral nerve might provide better analgesia.

Questions/purposes

We therefore determined: (1) whether the addition of parecoxib to ropivacaine injected locally on the nerve block affected the sensory and motor block times of the brachial plexus nerve block; and (2) whether parecoxib injected locally on the nerve or intravenously had a similar analgesic adjuvant effect.

Methods

We conducted a randomized controlled trial from January 2009 to November 2010 with 150 patients scheduled for elective forearm surgery, using a multiple-nerve stimulation technique. Patients were randomly allocated into one of three groups: Group A (n = 50) received ropivacaine 0.25% alone on the brachial plexus nerve; Group B (n = 50) received ropivacaine together with 20 mg parecoxib locally on the nerve block; and Group C (n = 50) received 20 mg parecoxib intravenously. We recorded the duration of the sensory and motor blocks, and the most severe pain score during a 24-hour postoperative period.

Results

Parecoxib added locally on the nerve block prolonged the motor and sensory block times compared with Group A. However, parecoxib injected intravenously had no such effect. Pain intensity scores in Group B were lower than those in Groups A and C.

Conclusions

Parecoxib added to ropivacaine locally on the nerve block prolonged the duration of the axillary brachial plexus blockade and relieved postoperative pain for patients having forearm orthopaedic surgery.

Level of Evidence

Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We acknowledge the assistance of Ximing Chen PhD for the study design and statistical analysis and Qin Ying AS for drug and solutions preparations. We also acknowledge the assistance of Tyler Andrew Long BA for help editing the manuscript.

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Authors and Affiliations

  1. Department of Anesthesiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 200092, Shanghai, China

    Xiaoming Liu PhD, Xuan Zhao MD, Jian Lou MD, Yingwei Wang PhD & Xiaofang Shen MD

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  1. Xiaoming Liu PhD
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  2. Xuan Zhao MD
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  3. Jian Lou MD
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  4. Yingwei Wang PhD
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  5. Xiaofang Shen MD
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Correspondence to Xuan Zhao MD.

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Liu, X., Zhao, X., Lou, J. et al. Parecoxib Added to Ropivacaine Prolongs Duration of Axillary Brachial Plexus Blockade and Relieves Postoperative Pain. Clin Orthop Relat Res 471, 562–568 (2013). https://doi.org/10.1007/s11999-012-2691-y

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  • DOI: https://doi.org/10.1007/s11999-012-2691-y

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