Efficacy of Novel Oral Non-Steroid Anti-Inflammatory Drugs for Pain Management After Total Knee Arthroplasty

Abstract

Background. Total knee arthroplasty (TKA) typically associated with moderate to severe post-operative pain that resolves quite slowly. Therefore, injectable forms of non-steroid anti-inflammatory drugs became the key element of multi-modal analgesia in early post-operative period.
 Aim of the study to evaluate the effectiveness and safety of ketorolac vs. ketoprofen for relief of postoperative pain in patients after TKA.
 Methods. 100 end-stage osteoarthritic patients (mean age 66,6 years, 80 women and 20 men) that consecutively admitted for primary uncomplicated TKA were randomized in two groups. Ketorol Express (10 mg oral, 4 times per day) used for post-op pain management in the first (49 patients) while Ketonal (100 mg oral, twice a day) in the second (51 patients). The outcomes assessed by numeral rating scale (NRS), visual analog scale (VAS), pain diaries, comorbidities, peri-operative characteristics, knee function (Oxford Knee Score 12), adverse effects, drug tolerance and usability, overall satisfaction of treatment. Both groups had no significant gender, age, clinical, radiological, functional or intra-operative differences.
 Results. The NRS and VAS ratings showed the similar tendency in both groups: the next day after surgery the pain increased up to moderate, followed by 2 times reduction at day four. There were no differences in average, minimal and maximal pain both in rest and movement as well as amount of daily moderate to severe pain and speed of analgesic effect after oral drug intake. The similar number of patients needed additional analgesics in both groups: on average 3,57 and 4,41 injections correspondently. However, in ketorolac group at day 3 4 the percentage of such patients was significantly lower: by 30% at day 3 (p0,05) and 50% at day 4 (p0,05). Reported side effects were comparable in both groups but the high level of overall satisfaction was two times more in the patients who took ketorolac.
 Conclusion. Oral administration both of ketorolac and ketoprofen proved to be highly effective for pain management after TKA with appropriate tolerance therefore could be used instead of injections since early post-op period.