From Sep 2006 to March 2007, ninety-seven patients that fulfilled inclusion criteria received elective TKA surgery by the senior author (Ching-Chuan Jiang) at the author's institute. Fifteen patients were excluded (four with RA, three with ESRD, six with previous CVA, and two with a history of peptic ulcers). Two patients suffered from epigastralgia, without tarry stool, during the study and were also excluded, leaving a total of eighty patients. They were randomized into two groups. There were no significant differences between them in age, preoperative ROM, preoperative pain scores, operation duration, and intraoperative blood loss ( Table 1 ).
VAS Pain Scores
The celecoxib group showed less postoperative VAS pain at rest than the control group at 48 hrs (p = 0.03) and 72 hrs (p = 0.02) after TKA surgery (Figure 1). The celecoxib group had reduced postoperative pain at ambulation, but did not reach significant difference when compared with controls (Figure 2). Repeated measures ANOVA showed that the celecoxib group had significant VAS pain score reduction over the control group at rest (p = 0.023) but not during ambulation (p = 0.51).
Pain scores at rest. The celecoxib group had significantly less pain on Days 2 and 3. *: p value
< 0.05, and error bar indicates standard deviation.
Pain scores at ambulation. There were no differences between the two groups. Error bar indicates standard deviation.
Range of Motion
Celecoxib significantly improved postoperative knee ROM, especially during the first three days (Day1: p = 0.01; Day 2: p = 0.004; Day 3: p = 0.004) (Figure 3). This group also had increased active ROM of 12-15 degrees in comparison with the control group. Repeated measures ANOVA showed that the celecoxib group also had significantly better postoperative ROM improvement than the control group (p = 0.0009).
Results for the postoperative range of motion. The celecoxib group had significantly better active ROM during the first 3 days. *: p value < 0.05, and error bar indicates standard deviation.
Morphine-sparing Effects and Postoperative Nausea and Vomiting
The celecoxib group had significantly less demand for PCA morphine usage (Figure 4). PCA usage during the first 24 hours was significantly lower (15.1 ± 8.7 mg vs 19.7 ± 9.6 mg; p = 0.03). Total PCA morphine usages in the celecoxib group and controls were 17.6 ± 11.9 and 24.6 ± 14.6 mg, respectively (p = 0.03). The celecoxib group used about 40% less morphine. Postoperative nausea and vomiting were at 28% and 43% in the celecoxib group and controls, respectively. However, this did not reach statistical significance (p = 0.57).
PCA morphine use. Mean PCA morphine use was significantly lower at each measurement for the celecoxib group. *: p value < 0.05, and error bar indicates standard deviation.
There were no significant differences in intraoperative blood loss (181 vs 177 ml), postoperative blood loss through Hemovac drain tubes (544 vs 511 ml), and postoperative blood transfusions (3.85 vs 3.93 units) between the celecoxib group and controls.
BMC Musculoskelet Disord © 2008 Huang et al; licensee BioMed Central Ltd.
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Cite this: Perioperative Celebrex Administration for Pain Management After Total Knee Arthroplasty — A Randomized, Controlled Study - Medscape - Jun 03, 2008.