Perioperative celecoxib alongwith PCA leads to better postoperative pain control after TKA .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(2):61 BMC Musculoskelet Disord. 2008 Jun 3;9:7780 patients (>60 yr of age) scheduled to undergo total knee arthroplasty were randomized to receive either patient controlled morphine analgesia (PCA) or a combination of PCA and perioperative oral celecoxib. Perioperative celecoxib administration along with PCA, demonstrated better results in terms of visual analog scale (VAS) pain scores, active range of motion (ROM) and total opioid usage.
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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
3/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Many studies have suggested the use of non-steroidal anti-inflammatory drugs (NSAID) for multimodal postoperative pain management. The NSAIDs are a growing family of medications, with newer drugs associated with fewer side effects being developed. This study investigated the effects of NSAIDs on opioid-sparing and rehabilitation outcomes after perioperative celecoxib administration for total knee arthroplasty.
Qual era a principal questão de investigação?
Does the additional perioperative oral celecoxib administration to PCA improve the post-operative pain and active range of motion, while reducing total opioid use compared to PCA alone, as evaluated over 7 days?
- VAS Pain Scores: The intervention patients demonstrated less pain at 48 hrs compared to control group (2.13 ± 1.68 vs. 3.43 ± 1.50, p=0.03)
- VAS Pain Scores: At 72 hrs, the intervention group again demonstrated a reduced score: (1.78 ± 1.66 vs. 3.17 ± 2.01, p=0.02)
- Opioid requirements: Intervention group had a 40% decrease in total consumption compared to the control group (p=0.03)
De que é que me devo lembrar mais?
Perioperative oral celecoxib administration along with PCA improved postoperative resting pain scores at 48 and 72 hrs, and total opioid consumption after TKA compared to PCA alone.
Como é que isto afectará o tratamento dos meus doentes?
Perioperative celecoxib can be a useful addition in multi-modal pain management after total knee arthroplasty along with morphine PCA. Studies with larger populations should be conducted to confirm the findings.
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