Summary

A single preoperative dose of Sebacoyl dinalbuphine ester (SDE) used for perioperative pain management in total knee replacement provides sufficient analgesia along with a manageable safety profile and no interference with surgical anesthetics when compared to groups that underwent SDE with additional parecoxib treatment.

Abstract

Purpose

Perioperative pain management plays an important role in improving enhanced recovery after surgery (ERAS) in total knee replacement. This retrospective study aimed to observe the efficacy and safety of mixed κ agonist-μ antagonist Sebacoyl dinalbuphine ester (SDE, Naldebain®) use along with and without parecoxib (Dynastat®), a COX-2 selective inhibitor, when necessary for the management of post-total knee arthroplasty pain.

Patients and Methods:
We reviewed electronic medical records of patients with total knee arthroplasty admitted from January 2018 to May 2024, who received a single dose of SDE, 150 mg intramuscularly 24 ± 12 h before surgery. Some of the patients also take parecoxib within 24 hours post-surgery. We included 115 patients, which were divided into two groups, with 81 people receiving SDE without parecoxib and 34 took SDE with parecoxib. We analyzed the maximum numerical rating scale for static and dynamic pain scores and other pain control medication consumption up to 96 hours after the operation.

Results

There were no statistically significant differences between the two treatment groups with respect to the average visual analog scale pain score in the post-operative anesthesia care unit (PACU), and at 24, 48, 72 and 96 hours post-procedure. Parecoxib was required only during the first postoperative day among those in the SDE/Parecoxib group, for the percentage of patients using Tramadol, SDE/Parecoxib group was lower than the SDE group (51.8% vs 29.4%, p = 0.011). The other pain control oral and opioid medications have no statistically significant difference.

Conclusion

A single preoperative dose of SDE provides sufficient analgesia along with a manageable safety profile and no interference with surgical anesthetics when compared to groups that underwent SDE with additional parecoxib treatment. This retrospective study suggests that postoperative administration of Parecoxib as salvage may decrease the need for postoperative tramadol use for patients who received total knee arthroplasty.

Keywords: Sebacoyl Sinalbuphine Ester, nalbuphine, Naldebain, parecoxib, Dynastat, enhanced recovery after surgery, multimodal analgesia, preventive analgesia, total knee replacement, total knee arthroplasty, TKA, TKR.