Evaluation of etoricoxib in patients undergoing total knee replacement surgery in a double-blind, randomized controlled trial

Abstract

BackgroundOptimal postoperative pain management is important to ensure patient comfort and early mobilization.MethodsIn this double-blind, placebo- and active-controlled, randomized clinical trial, we evaluated postoperative pain following knee replacement in patients receiving placebo, etoricoxib (90 or 120 mg), or ibuprofen 1800 mg daily for 7 days. Patients ≥18 years of age who had pain at rest ≥5 (0–10 Numerical Rating Scale [NRS]) after unilateral total knee replacement were randomly assigned to placebo (N = 98), etoricoxib 90 mg (N = 224), etoricoxib 120 mg (N = 230), or ibuprofen 1800 mg (N = 224) postoperatively. Co-primary endpoints included Average Pain Intensity Difference at Rest over Days 1–3 (0- to 10-point NRS) and Average Total Daily Dose of Morphine over Days 1–3. Pain upon movement was evaluated using Average Pain Intensity Difference upon Knee Flexion (0- to 10-point NRS). The primary objective was to demonstrate analgesic superiority for the etoricoxib doses vs. placebo; the secondary objective was to demonstrate that the analgesic effect of the etoricoxib doses was non-inferior to ibuprofen. Adverse experiences (AEs) including opioid-related AEs were evaluated.ResultsThe least squares (LS) mean (95% CI) differences from placebo for Pain Intensity Difference at Rest over Days 1–3 were -0.54 (-0.95, -0.14); -0.49 (-0.89, -0.08); and -0.45 (-0.85, -0.04) for etoricoxib 90 mg, etoricoxib 120 mg, and ibuprofen, respectively (p < 0.05 for etoricoxib vs. placebo). Differences in LS Geometric Mean Ratio morphine use over Days 1–3 from placebo were 0.66 (0.54, 0.82); 0.69 (0.56, 0.85); and 0.66 (0.53, 0.81) for etoricoxib 90 mg, etoricoxib 120 mg, and ibuprofen, respectively (p < 0.001 for etoricoxib vs. placebo). Differences in LS Mean Pain Intensity upon Knee Flexion were -0.37 (-0.85, 0.11); -0.46 (-0.94, 0.01); and -0.42 (-0.90, 0.06) for etoricoxib 90 mg, etoricoxib 120 mg, and ibuprofen, respectively. Opioid-related AEs occurred in 41.8%, 34.7%, 36.5%, and 36.3% of patients on placebo, etoricoxib 90 mg, etoricoxib 120 mg, and ibuprofen, respectively.ConclusionsPostoperative use of etoricoxib 90 and 120 mg in patients undergoing total knee replacement is both superior to placebo and non-inferior to ibuprofen in reducing pain at rest and also reduces opioid (morphine) consumption.Clinical trial registrationNCT00820027

Postoperative Etoricoxib versus Ketoprofen Administration for Pain Management after Total Knee Arthroplasty: A Randomized, Double-Blind Controlled Study

“…The results of a study of Rawal et al showed that etoricoxib 120 mg was administered also postoperatively in patients with TKA effects superior to placebo and equal to ibuprofen 1800 mg to reduce pain at rest and opioid consumption [17]. These results are overlapping investigations by Lin et al recently published in 2013, who showed the benefits of perioperative administration of COX-2 inhibitors [18].…”

Revision Total Knee Arthroplasty Causes of failure, bone loss management and outcomes\

“…One important aspect for a succesful procedure is represented by the post-operative management and rehabilitation protocol. Analgesic models that rely on postoperative pain relief and antiinflamatory medication as well as femoral nerve blocks are implemented in order to provide comfort for the patient and facilitate an early painfree and accelerated rehabilitation [15][16][17][18][19].…”

“…Bone graft was used in 8 cases. The mean Oxford Knee Score was 15 pre-op (12)(13)(14)(15)(16)(17)(18)(19)(20) and 38 postop (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). Implant survival at final follow-up was 100%.…”

The Use of NSAIDs in the Postoperative Period: Advantage and Disadvantages

“…The effectiveness of a selective and a nonselective NSAIDs, Etoricoxib 90-120 mg and ibuprofen 1800 mg compared with placebo in postoperative period after total knee replacement has been confirmed in a randomized study on 713 patients. Adverse effects due to morphine administration was more frequent in placebo group and also the incidence of bleeding was not different among the groups [109].…”