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Perioperative celecoxib improves postoperative resting pain and active ROM after TKR
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March 2013
Perioperative celecoxib improves postoperative resting pain and active ROM after TKR
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
Perioperative celecoxib administration for pain management after total knee arthroplasty - A randomized, controlled study
BMC Musculoskelet Disord. 2008 Jun 3;9:77.Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
80 patients scheduled to undergo total knee arthroplasty were randomized to receive celecoxib perioperatively along with the morphine PCA or just the morphine PCA. The purpose of this study was to evaluate efficacy of postoperative pain management. The perioperative celecoxib was found to significantly improve the postoperative resting pain scores at 48 and 72 hours and active ROM in the first three days after total knee arthroplasty. It also decreased the opioid consumption, without any increase in the occurrence of bleeding.
Publication Funding Details
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Funding:
Non-Industry funded
Sponsor:
National Taiwan University & Hospital
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
2/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most common medications chiefly used for multimodal pain management. Celecoxib is a newer selective COX-2 inhibitor with improved efficacy and lesser side effects. This study evaluated the opioid-sparing effects and post operative pain control after total knee arthroplasty.
What was the principal research question?
How does oral celecoxib compare to patient controlled analgesia with morphine in post-operative pain management after total knee arthroscopy?
Study Characteristics
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Population:
80 patients over the age of 60with primary osteoarthritis that underwent total knee arthroplasty.
Intervention:
Celecoxib Group: Received a single 400 mg dose of oral celecoxib one hour before surgery, followed by 200 mg of celecoxib every 12 hourly for first 5 days, along with morphine patient-controlled analgesia (PCA) (n=40; Mean age: 70+/-7years)
Comparison:
Control Group: Received only morphine PCA for postoperative pain management for first 5 postoperative days (n=40; Mean age: 70+/-7years)
Outcomes:
Visual analog scale (VAS) pain scores, active range of motion (ROM), total opioid use and postoperative nausea/vomiting
Methods:
RCT: Prospective, Observer-Blinded
Time:
6, 12, 24, 48, and 72 hrs and 7 days after TKA surgery
What were the important findings?
- Resting VAS pain scores improved significantly with the celecoxib compared to control treatment at 48 hrs (2.13
- +/- 1.68 vs. 3.43+/-1.50, p=0.03) and 72 hrs (1.78+/-1.66 vs. 3.17+/-2.01, p=0.02) after surgery. Moreover, the resting VAS pain reduction was more significant with celecoxib versus the control (p=0.023).
- Active ROM increased significantly in the celecoxib group, particularly in the first 72 hrs [40.8°+/-17.3° vs. 25.8°+/-11.5°, p=0.01 (day 1); 60.7°+/-18.1° vs. 45.0°+/-17.3°, p=0.004 (day 2); 77.7°+/-15.1° vs. 64.3°+/-16.9°, p=0.004 (day 3)]. Moreover, improvement in ROM was significantly greater with celecoxib versus the control (p=0.0009).
- With the celecoxib use, the opioid requirements (PCA morphine) decreased by 40% (p=0.03). Furthermore, the number of patients suffering from post-operative nausea/vomiting decreased from 43% in control group to 28% in celecoxib group - this was non significant (p=0.57).
- There were no differences in the perioperative blood losses between the groups; the patients on celecoxib had no greater requirement for blood transfusions.
What should I remember most?
The perioperative celecoxib was found to significantly improve the postoperative resting pain scores at 48 and 72 hrs and active ROM in the first three days after total knee arthroplasty, while decreasing the opioid consumption without any increase in the occurrence of bleeding.
How will this affect the care of my patients?
Celecoxib will serve as a good analgesic choice according to the study results. Caution should be exercised for their interpretation, keeping in mind the small sample size studied. The long-term effects require further research.
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