Comparison of Continuous Infusions of Ketorolac, Paracetamol and Parecoxib for postoperative pain management in orthopedic lower limb surgery under spinal anesthesia

Background: the effect of three drugs; Ketorolac, Paracetamol and Parecoxib, on patients undergoing lower extremities orthopedic surgeries were compared regarding their analgesic effects.Materials and methods: 140 patients undergoing lower extremities orthopedic surgery were assigned in four groups: 35 patients in each. In Parecoxib group, 20 mg of the drug was infused in 20 minutes and then 60 mg of Parecoxib was added to the pump and the rest of the pump was filled with normal saline up to100 ml. In Ketorolac group, 15 mg Ketorolac was infused in 20 minutes and then, 45 mg of Ketorolac was added into the pump and the rest of the pump was filled with normal saline up to 100 ml. In Paracetamol group 500 mg Paracetamol was infused in 20 minutes and then 1500 mg of Paracetamol was added into the pump and the rest of the pump was filled with normal saline up to 100 ml. In the placebo group, infusion pump was filled with 100 ml of normal saline.Results: Pain score was not significantly different between Paracetamol and placebo groups. Six hours after operation, only the difference in the mean pain scores between Parecoxib and placebo groups was significant. However, 12 and 18 hours after operation, the mean pain score in Parecoxib group was significantly lower than Paracetamol and placebo groups (p<0.05). Nevertheless, 24 hours after operation, the mean pain score in Parecoxib and Ketorolac groups were significantly lower than placebo group (p<0.05).Conclusion: The results showed that Parecoxib could be used for postoperative pain management in orthopedic lower limb surgeries. Ketorolac and Paracetamol could reduce morphine requirements in similar patterns.Keywords: Ketorolac, Paracetamol, Parecoxib