Effects of celecoxib on blood loss, pain, and recovery of function after total knee replacement: A randomized placebo-controlled trial

Abstract

Background Pain management after surgery has been used as a sales argument for the use of COX-2 inhibitors, but their potential positive and negative effects have not been fully investigated. We thus conducted a controlled evaluation of the effect of celecoxib on perioperative blood loss, pain relief and consumption of analgesics, range of motion, and subjective outcome in conjunction with total knee replacement (TKR).Method 50 patients were randomized to either placebo or celecoxib (200 mg) preoperatively and then twice daily. Total blood loss was calculated by the Hb balance method, taking the patient's pre-and postoperative hemoglobin and blood volume into account. Pain scores (VAS), range of motion, and subjective outcome (KOOS) were monitored postoperatively and during the first year after surgery.Results No differences in total, hidden, or drainage blood loss were found between the groups. There were 30% lower pain scores during the first 4 weeks after surgery and lower morphine consumption after surgery in the celecoxib group, while no effect was seen on pain, range of motion, and subjective outcome at the 1 year follow-up.Interpretation Celecoxib does not increase perioperative blood loss but reduces pain during the postoperative period after TKR. It is not necessary to discontinue celecoxib before surgery. The postoperative use of celecoxib did not increase range of motion or subjective outcome 1 year after TKR.

Pharmacology of cyclooxygenase-2 inhibitors and preemptive analgesia in acute pain management

“…In this trial, celecoxib reduced pain scores by 30% during the first month of surgery, thereby resulting in lower morphine consumption. There were no differences in total, hidden, or drainage of blood loss when the celecoxib group was compared with placebo [42 ].…”

Effect of Preoperative Rectal Indomethacin on Postoperative Pain Reduction After Open Cholecystectomy

“…1,12,[20][21][22] This study reveals that if proper patient selection criteria are used, NSAIDs can be administered before surgery without any serious concerns. Precise hemostasis should be accomplished before wound closure and the patient should receive enough perioperative maintenance fluid to prevent volume depletion.…”

Celecoxib does not appear to affect prosthesis fixation in total knee replacement

“…We recently reported the 1-year follow-up results of the clinical outcome variables (Meunier et al 2007). …”