Perioperative Celebrex for Pain Management After Total Knee Arthroplasty

In This Article

Abstract and Background

Abstract

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. We evaluated opioid-sparing effects and rehabilitative results after perioperative celecoxib administration for total knee arthroplasty.
Methods: This was a prospective, randomized, observer-blind control study. Eighty patients that underwent total knee arthroplasty were randomized into two groups of 40 each. The study group received a single 400 mg dose of celecoxib, one hour before surgery, and 200 mg of celecoxib every 12 hours for five days, along with patient-controlled analgesic (PCA) morphine. The control group received only PCA morphine for postoperative pain management. Visual analog scale (VAS) pain scores, active range of motion (ROM), total opioid use and postoperative nausea/vomiting were analyzed.
Results: Groups were comparable for age, pre-operative ROM, operation duration and intraoperative blood loss. Resting VAS pain scores improved significantly in the celecoxib group, compared with controls, at 48 hrs (2.13 ± 1.68 vs. 3.43 ± 1.50, p = 0.03) and 72 hrs (1.78 ± 1.66 vs. 3.17 ± 2.01, p = 0.02) after surgery. Active ROM also increased significantly in the patients that received celecoxib, especially in the first 72 hrs [40.8° ± 17.3° vs. 25.8° ± 11.5°, p = 0.01 (day 1); 60.7° ± 18.1° vs. 45.0° ± 17.3°, p = 0.004 (day 2); 77.7° ± 15.1° vs. 64.3° ± 16.9°, p = 0.004 (day 3)]. Opioid requirements decreased about 40% (p = 0.03) in the celecoxib group. Although patients suffering from post-operative nausea/vomiting decreased from 43% in control group to 28% in celecoxib group, this was not significant (p = 0.57). There were no differences in blood loss (intra- and postoperative) between the groups. Celecoxib resulted in no significant increase in the need for blood transfusions.
Conclusion: Perioperative celecoxib significantly improved postoperative resting pain scores at 48 and 72 hrs, opioid consumption, and active ROM in the first three days after total knee arthroplasty, without increasing the risks of bleeding.

Background

Surgical trauma induces the synthesis of prostaglandins, which sensitize the peripheral nociceptors.^[1] Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis in the periphery and the spinal cord, therefore decreasing the post-operative hyperalgesic state.^[2] NSAIDs have been shown to have opioid-sparing effects^[3,4,5,6] and reduce postoperative nausea and vomiting (PONV) by 30%.^[7] However, the analgesic effects of perioperative NSAIDs are still uncertain.^[8,9,10] Some studies suggest that perioperative NSAIDs improve postoperative pain for ambulatory arthroscopic knee^[11] or spinal fusion surgery.^[12] However, few papers have discussed the effectiveness of perioperative NSAID in pain management after total knee arthroplasty
(TKA).^[13,14,15] Rofecoxib has been the perioperative coxib in previous studies. However, in September 2004, it was withdrawn from the market due to its thromboembolic effects, particularly myocardial infarction.

Celecoxib is a selective cyclooxygenase (COX)-2 inhibitor and an effective analgesic for acute postoperative pain.^[16] Although pre-operative non-selective NSAID use increases the risks of bleeding,^[10,17] celecoxib (1200 mg daily) has no effects on serum thromboxane or platelet functions.^[16] Celecoxib (400 mg) also has similar analgesic effects in comparison with conventional non-selective NSAID.^[4] To achieve less postoperative pain and better rehabilitation after TKA surgery, especially in the first week, prescription of oral celecoxib preemptively for pain management of TKA patients is reasonable. Although previous studies have evaluated the analgesic efficacy of rofecoxib, few studies to date have evaluated the efficacy of celecoxib for TKA. In this study, we hypothesized that celecoxib provides better efficacy than the use of patient-controlled analgesic (PCA) morphine, which is currently the standard therapy in our institute. We aimed to compare the difference in the pain scores at rest and ambulation, along with range of motion (ROM), morphine-sparing effects, PONV, and perioperative blood loss between patients receiving celecoxib treatment and patients receiving PCA morphine treatment after TKA surgeries.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this: Perioperative Celebrex Administration for Pain Management After Total Knee Arthroplasty — A Randomized, Controlled Study - Medscape - Jun 03, 2008.

Table 1. Patient Demographics and Surgical Data.
There were no significant differences between these groups.
Group	Age (yr)	Pre-OP ROM (degrees)	Pre-OP VAS	Surgery Duration (min)	Tourniquet Duration (min)	Intra-operative blood loss (ml)
Control	70 ± 7	118 ± 17	4.7 ± 1.9	75 ± 17	45 ± 13	177 ± 54
Celecoxib	70 ± 7	116 ± 18	5.1 ± 1.7	77 ± 17	46 ± 17	181 ± 63

Huang et al. BMC Musculoskeletal Disorders 2008 9:77 doi:10.1186/1471-2474-9-77

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