Abstract
BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. We evaluated opioid-sparing effects and rehabilitative results after perioperative celecoxib administration for total knee arthroplasty.MethodsThis was a prospective, randomized, observer-blind control study. Eighty patients that underwent total knee arthroplasty were randomized into two groups of 40 each. The study group received a single 400 mg dose of celecoxib, one hour before surgery, and 200 mg of celecoxib every 12 hours for five days, along with patient-controlled analgesic (PCA) morphine. The control group received only PCA morphine for postoperative pain management. Visual analog scale (VAS) pain scores, active range of motion (ROM), total opioid use and postoperative nausea/vomiting were analyzed.ResultsGroups were comparable for age, pre-operative ROM, operation duration and intraoperative blood loss. Resting VAS pain scores improved significantly in the celecoxib group, compared with controls, 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. Active ROM also increased significantly in the patients that received celecoxib, especially 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)]. Opioid requirements decreased about 40% (p = 0.03) in the celecoxib group. Although patients suffering from post-operative nausea/vomiting decreased from 43% in control group to 28% in celecoxib group, this was not significant (p = 0.57). There were no differences in blood loss (intra- and postoperative) between the groups. Celecoxib resulted in no significant increase in the need for blood transfusions.ConclusionPerioperative celecoxib significantly improved postoperative resting pain scores at 48 and 72 hrs, opioid consumption, and active ROM in the first three days after total knee arthroplasty, without increasing the risks of bleeding.Trial registrationClinicaltrials.gov NCT00598234
Highlights
Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management
We aimed to compare the difference in the pain scores at rest and ambulation, along with range of motion (ROM), morphine-sparing effects, postoperative nausea and vomiting (PONV), and perioperative blood loss between patients receiving celecoxib treatment and patients receiving patient-controlled analgesic (PCA) morphine treatment after total knee arthroplasty (TKA) surgeries
The celecoxib group had reduced postoperative pain at ambulation, but did not reach significant difference when compared with controls (Fig 2)
Summary
Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. We evaluated opioid-sparing effects and rehabilitative results after perioperative celecoxib administration for total knee arthroplasty. Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis in the periphery and the spinal cord, decreasing the post-operative hyperalgesic state [2]. NSAIDs have been shown to have opioid-sparing effects [3,4,5,6] and reduce postoperative nausea and vomiting (PONV) by 30% [7]. Some studies suggest that perioperative NSAIDs improve postoperative pain for ambulatory arthroscopic knee [11] or spinal fusion surgery [12]. Few papers have discussed the effectiveness of perioperative NSAID in pain management after total knee arthroplasty (TKA) [13,14,15]. In September 2004, it was withdrawn from the market due to its thromboembolic effects, myocardial infarction
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