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Pain control during immediate post operative period is necessary in Total Knee Arthroplasty(TKA) patients for early mobilization. The use of COX-2 inhibitors preoperatively has shown significant reduction in opiod usage and in pain relief post operatively. Furthermore, some studies have suggested that the addition of pregabalin preoperatively has led to further reduction in postoperative pain and opiod use.The aim of this study is to compare pain scores in a group of patients who receive a single preoperative dose of pregabalin combined with a COX-2 inhibitor and a control group which receives only COX-2 inhibitor. A prospective randomiazed control study was carried in which 200 patients undergoing primary unilateral total knee replacement received preoperatively either 200 mg celecoxib alone (Group A, n=100) or combination of celecoxib 200 mg plus 75 mg of Pregabalin (Group B n=100) approximately one hour before the surgery. All patients underwent primary unilateral TKA under spinal analgesia using the standard medial parapatellar approach under tourniquet. Pain was assessed pre operatively, after 6 hours, 24 hours, 48 hours post operatively using Visual Analogue scale (VAS) in all patients.Both the groups were comparable regarding the demographic parameters and showed a significant postoperative pain relief at the end of 48 hours (p<0.05). The mean preoperative VAS score in group A was 5.82 which decreased to 2.86 after 48 hours (p<0.05). Similarly, mean preoperative VAS score in group B was 5.12 which decreased to 2.05 after 48 hours after surgery. No significant intergroup difference in functional outcome was noted. However, mean cumulative opioid consumption was lower in group B compared to group A (p<0.05).Preoperative administration of celecoxib lowers the pain scores in the post operative period. Addition of pregabalin reduces the postoperative pain significantly in TKA patients.

iosr journal of dental and medical sciences

A Comparative Study to Evaluate Selective COX-2 Inhibitors Alone or in Combination with Pregabalin Given Pre-Operatively For Pain Management in Total Knee Arthroplasty.