Perioperative celecoxib improves postoperative resting pain and active ROM after TKR .
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):48 BMC Musculoskelet Disord. 2008 Jun 3;9:77.80 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.
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)?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
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
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
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.
Qual era la domanda di ricerca principale?
How does oral celecoxib compare to patient controlled analgesia with morphine in post-operative pain management after total knee arthroscopy?
- 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.
Che cosa devo ricordare di più?
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.
Come influenzerà l'assistenza ai miei pazienti?
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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