Safety and Efficacy of Perioperative Intravenous Meloxicam for Moderate-to-Severe Pain Management in Total Knee Arthroplasty: A Randomized Clinical Trial

Abstract

Objective To evaluate the effect of perioperative meloxicam IV 30 mg on opioid consumption in primary total knee arthroplasty (TKA). Design Multicenter, randomized, double-blind, placebo-controlled trial. Subjects 181 adults undergoing elective primary TKA. Methods Subjects received meloxicam 30 mg or placebo via an IV bolus every 24 hours, the first dose administered prior to surgery as part of a multimodal pain management protocol. The primary efficacy parameter was total opioid use from end of surgery through 24 hours. Results Meloxicam IV was associated with less opioid use versus placebo during the 24 hours after surgery (18.9 ± 1.32 vs 27.7 ± 1.37 mg IV morphine equivalent dose; P < 0.001) and was superior to placebo on secondary endpoints, including summed pain intensity (first dose to 24 hrs postdosing, first dose to first assisted ambulation, and first dose to discharge) and opioid use (48–72 hrs., 0–48 hrs., 0–72 hrs., hour 0 to end of treatment, and the first 24 hours after discharge). Adverse events (AEs) were reported for 69.9% and 92.0% of the meloxicam IV and placebo groups, respectively; the most common AEs were nausea (40% vs. 59%), vomiting (16% vs. 22%), hypotension (14% vs. 15%), pruritus (15% vs. 11%), and constipation (11% vs. 13%). Conclusions Perioperative meloxicam IV 30 mg as part of a multimodal analgesic regimen for elective primary TKA reduced opioid consumption in the 24-hour period after surgery versus placebo and was associated with a lower incidence of AEs typically associated with opioid use.

Association of peri‐operative prescription of non‐steroidal anti‐inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims‐based cohort study

“…We recognise that while continued claims for opioids are undesirable, attempting to avoid them by abolishing peri‐operative NSAIDs altogether may paradoxically lead to the exact same outcome. Indeed, sacrificing the opioid‐sparing effect of NSAIDs, especially in patients with baseline chronic pain or undertreated severe acute postoperative pain, may result in increased immediate postoperative opioid requirements that can over time become persistent [39, 40]. Although the results of the present study create a clinical dilemma, they do identify an important association that has relevance to the clinical problem of long‐term opioid use following TKA [10].…”

Pain management in total knee arthroplasty. A comprehensive review

“…NSAIDs include a range of different analgesics, like commonly used ones: ibuprofen, diclofenac, ketorolac, and parecoxib. NSAIDs are widely used as one of the basic drugs in multimodal analgesia due to its proven reduction of opioid consumption [12][13][14]. Laoruengthana et al, [15] compared the analgesic effect between ketorolac and parecoxib.…”

What’s New in Orthopaedic Rehabilitation

“…In a multicenter, randomized, double-blinded, placebo-controlled trial, Berkowitz et al evaluated the effect of perioperative intravenous 30-mg meloxicam on opioid consumption in primary TKA 27 . The primary outcome parameter was total opioid use from the end of the surgical procedure through 24 hours; there were 181 patients in the study.…”