Preemptive analgesia may improve post-op pain management in ACL reconstruction .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(9):73 BMC Musculoskelet Disord. 2010 Oct 25;11:246102 patients scheduled to undergo arthroscopic ACL reconstruction were randomized to receive etoricoxib 120 mg, celecoxib 400 mg, or placebo, 1 hour prior to operative incision. During the 48 hour post-operative period, pain scores and additional analgesia requirements were recorded to evaluate analgesic efficacy of these two drugs. It was observed that the post-operative pain management at 8 hours was better achieved by using single preemptive dose of etoricoxib than celecoxib or a placebo.
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.
2/4
Randomization
3/4
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?
Selective COX-2 inhibitors offer a pragmatic alternative to conventional NSAIDs and opiates for the relief of postoperative pain. Although both etoricoxib and celecoxib (selective COX-2 inhibitors), have shown to reduce post-operative pain, the comparative efficacy of these agents had not been studied. The current study aimed to investigate the superiority of one drug over the other in anterior cruciate ligament reconstruction surgery.
Qual era a principal questão de investigação?
Does etoricoxib or celecoxib offer the best efficacy as a single-dose preemptive analgesic for post-operative pain relief in patients undergoing arthroscopic ACL reconstruction?
- Postoperative mean pain satisfaction score between all three groups was similar on the VbAPS (Etoricoxib = 78.14, Celecoxib = 80.68, placebo = 72.22)
- Amount of paracetamol and fentanyl used, and the time to first dose of analgesic medication was similar in all groups (all p>0.05)
- Up to 8 hours post-op, the etoricoxib group had significantly less pain (p<0.05) (no differences in any other evaluation points)
- Number of adverse events was similar across all 3 groups. Only fever (p=0.005) and constipation (p=0.025) were significantly higher in the placebo group
- Mean blood loss in all groups was similar (p=0.663)
De que é que me devo lembrar mais?
Etoricoxib was a more effective pre-operative analgesic than celecoxib and placebo in controlling postoperative pain in patients undergoing arthroscopic ACL reconstruction. Etoricoxib and Celecoxib did not reduce analgesic consumption, or time to first analgesic use.
Como é que isto afectará o tratamento dos meus doentes?
In order to improve post-op pain management in patients undergoing arthroscopic ACL reconstruction, etoricoxib may be used as a preemptive analgesic. Larger studies are needed to validate these findings.
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