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

Abstract

Objective. This randomized double-blind study compared the analgesic efficacy and tolerability of etoricoxib versus ketoprofen in 165 patients with elective total primary knee arthroplasty. Methods. After ethical committee approval, 165 patients were randomized in 3 groups: the etoricoxib group (E) receiving etoricoxib 120 mg/day, at the end of surgery and in the first postoperative day; the ketoprofen group (K) receiving ketoprofen 2 pills of 100 mg/day, the first at the end of surgery and then 1 pill every 12 hours in the surgery day and the first postoperative day; the placebo group (P). All groups received postoperatively the same analgesia protocol when NRS is over 3 with IV Perfalgan and morphine. The effectiveness was evaluated by the time from the initiation of spinal anesthesia until the first analgesic dose, the total amount of morphine administered in the surgery day and the first postoperative day, and the frequency of patients with side effects and necessary amount of adjuvant medication. Results. The baseline demographic characteristics were similar among the 3 groups. In both study days etoricoxib provided an analgesic effect superior to placebo and to ketoprofen, the total administered morphine being significantly lower in etoricoxib group. There were no statistically significant differences between groups regarding the side effects.

Etoricoxib Can Reduce Post-Operative Morphine Consumption and Pain Score in Patients Undergoing Lumbar Laminectomy Compare to Acetaminophen: A Randomized Trial

“…Pain scores and rescue medication were used by these studies to represent the result. Some recent studies of etoricoxib in orthopedic surgery 13,14,24,31 have yielded results consistent with our study: the etoricoxib group used less morphine and experienced lower pain intensity. Florescu et al 13 reported that etoricoxib reduced morphine requirement and was superior to placebo (mean difference¼ À18, P-value < .0001) and ketoprofen (mean difference¼ À9.8, P-value < .0001) in patients following total knee transplant.…”

“…Some recent studies of etoricoxib in orthopedic surgery 13,14,24,31 have yielded results consistent with our study: the etoricoxib group used less morphine and experienced lower pain intensity. Florescu et al 13 reported that etoricoxib reduced morphine requirement and was superior to placebo (mean difference¼ À18, P-value < .0001) and ketoprofen (mean difference¼ À9.8, P-value < .0001) in patients following total knee transplant. Lakshmi et al 14 evaluated the effect of etoricoxib on post-operative pain relief in patients who had undergone a lumbar laminectomy and found that there was a reduction in visual analog score in the etoricoxib group when compared with placebo.…”

“…According to previous studies by Florescu et al 13 and Kesimci et al 17 the post-operative morphine consumption by patients administered etoricoxib averaged 27 mg (standard deviation (SD) 14.3) whereas patients administered acetaminophen consumed on average 40 mg (SD 10.9) of morphine. Spinal surgery and total knee arthroplasty are both major procedures according to the expected levels of pain.…”

“…10 , 11 The dosage for chronic pain is 30 mg-90 mg per day and the dosage for acute pain is 90-120 mg per day. 12 Florescu et al 13 reported that etoricoxib reduced morphine requirement and was superior to placebo (mean difference= −18, P -value < .0001) and to ketoprofen (mean difference= −9.8, P -value < .0001) among patients who had undergone total knee replacement. Lakshmi et al 14 evaluated the use of etoricoxib for post-operative pain relief in patients that had undergone a lumbar laminectomy and found that there was a reduction in the visual analog score in the etoricoxib group when compared with placebo.…”