Patch transdermique de buprénorphine versus Celecoxib oral pour la gestion de la douleur après une arthroplastie totale du genou : essai contrôlé randomisé ouvert en simple aveugle

Abstract

BackgroundThis study was performed to evaluate the analgesic efficacy and safety of transdermal buprenorphine (TDB) patched for postoperative pain control after total knee arthroplasty (TKA). The hypothesis was that patients receiving the TDB patch would have less pain in comparison to those treated with the oral COX-2 inhibitor celecoxib without increasing side effects. Patients and methodsA total of 160 patients scheduled for primary TKA were randomly assigned to two groups: patients provided a TDB patch (10μg/h) (TDB group) and those provided oral celecoxib (CX group). The outcomes were pain scores measured using the visual analogue scale (VAS) during rest and activity, as well as morphine requirement, operated knee functional recovery and adverse events postoperatively. ResultsThe total morphine given during the first 72h postoperatively was significantly lower in the TDB group than CX group. The VAS scores were significantly lower in the TDB group than CX group during rest at 2, 4, 6, 12, 24 and 48h postoperatively, and during activity at 12, 24 and 48h and 3 days postoperatively. The mean range of motion on postoperative days (PD) 1, 2 and 3 were significantly greater in the TDB group. In addition, the Lysholm score was significantly higher in the TDB group on PD 3. There were no remarkable adverse events in either group. DiscussionUse of a TDB patch provides effective pain relief and reduces the requirement for rescue morphine without increasing side effects in comparison with oral celecoxib during the early post-operative stage following TKA. Level of evidenceII.