Pain Management Using Perioperative
Administration of Parecoxib for Total Hip
Arthroplasty: A Randomized, Double-Blind,
Placebo-Controlled Trial
Authors: Weng Xisheng 
Published: February 2021

Background: Controlling postoperative pain and improving outcomes after total hip arthroplasty
(THA) remain an important challenge, which affects the functional recovery of the hip.
Objectives: To assess the effect of preemptive administration of the selective cyclooxygenase-2
inhibitor parecoxib sodium (PS) after THA.
Study Design: A prospective, randomized, double-blinded clinical trial.
Setting: An academic medical center.
Methods: This randomized double-blind clinical trial compared postoperative analgesia intervention
for unilateral primary THA. Patients were assigned in a 1:1 ratio to the PS group and the control
group. The PS group received 40 mg dose of PS 30 minutes before incision, 12 hours after THA,
and every 12 hours for 2 days postoperatively, and the control group received normal saline solution
at the same time point. In addition, both groups received patient-controlled intravenous analgesia
of morphine. Perioperative visual analog scale (VAS) scores, cumulative morphine consumption,
functional recovery, perioperative bleeding risk, and the selected indicators of the inflammatory
response were compared between the PS group and the control group.
Results: From October 2014 to June 2015, 180 patients undergoing unilateral primary THA
were screened for this prospective clinical trial. A total of 141 patients were enrolled and randomly
assigned into the PS group (n = 69) and the control group (n = 72). Compared with the control
group, VAS scores at rest were significantly lower in the PS group at 4, 12, and 24 hours after
surgery, and VAS scores during movement were also lower in the PS group at 4, 12, 24, 36, and 48
hours after surgery (all P < 0.001). Both the cumulative morphine consumption and its associated
nausea and vomiting were reduced in the PS group (P < 0.001 and P = 0.021, respectively). The
length of hospitalization in the PS group was shorter than the control group (PS group 5.91 ±
1.15 days, control group 6.41 ± 1.49 days; P = 0.019). The PS group had lower body temperature
than the control group at postoperative day (POD) 1 (P = 0.003) and POD 3 (P = 0.001), and the
levels of high-sensitivity C-reactive protein in the PS group at POD 3 (P = 0.016) and POD 6 (P =
0.006) were also lower than those in the control group. The concentration of interleukin (IL)-6 and
IL-10 were significantly different between the 2 groups (IL-6, P = 0.007; IL-10, P = 0.006) on the
first day postoperatively. The PS group was not significantly different from the control group with
respect to any outcomes: blood loss, postoperative blood drainage and blood transfusion, and
number of days needed to accomplish straight-leg raising and off-bed exercise.
Limitations: PS was used only until POD 2, and there was no long-term follow-up.
Conclusions: Perioperative administration of PS is an effective addition to a multimodal regimen
that alleviates postoperative pain, reduces the cumulative morphine consumption, length of
hospitalization, and perioperative inflammatory response, without increasing perioperative
bleeding risk.