1
|
Tavares IT, Rivero R, Sales‐Luís JP, Vaudano CG, Correia SD, Corbera JA, Jaber JR. Premedication with acetazolamide: Is its use for postoperative pain and stress control after laparoscopic ovariectomy in dogs ruled out? Vet Med Sci 2023; 9:1114-1123. [PMID: 36952262 PMCID: PMC10188092 DOI: 10.1002/vms3.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/19/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Studies in human medicine have concluded that acetazolamide reduces pain associated with carbon dioxide insufflation during laparoscopic surgery. However, there are no published reports regarding the use of acetazolamide for this purpose in companion animals, despite the increasing popularity of laparoscopic techniques in veterinary medicine due to their advantages over open surgeries. OBJECTIVES Thirty mixed-breed female dogs were included in the study and randomly assigned to one of three groups: OVE (median celiotomy ovariectomy; n = 10), OVEL (laparoscopic ovariectomy, n = 10) and OVELA (laparoscopic ovariectomy with acetazolamide preoperative administration; n = 10). Experienced surgeons performed all procedures, and the anaesthetic and analgesic protocols were identical for all animals. Acetazolamide was administered orally (at a dose of 25 mg/kg) 2 h prior to induction in the OVELA group. Postoperative pain was evaluated using serum cortisol, salivary cortisol, and the University of Melbourne Pain Scale (UMPS) Score. RESULTS Any statistical differences were observed in the UMPS scores when the OVELA group was compared to the OVEL group at 1 h after surgery (p = 0.515), 12 h (p = 0.375) and 24 h (p = 0.242). Animals undergoing open surgery (OVE group) had significantly higher pain scores at all times after surgery when compared with OVEL and OVELA groups. A high positive correlation (r = 0.792; p = 0.01) was found between serum and saliva cortisol concentrations. Mean saliva cortisol concentration was not significantly lower for the OVELA group compared to the other groups. CONCLUSIONS This study found evidence that preoperative administration of acetazolamide may be beneficial in managing postoperative pain in dogs after laparoscopic surgeries. However, further research with a larger sample size is needed to confirm this and to determine if acetazolamide should be included in a multimodal postoperative analgesia protocol for laparoscopic ovariectomy in dogs.
Collapse
Affiliation(s)
- Inês T. Tavares
- Faculty of Veterinary MedicineLusófona UniversityLisbonPortugal
| | - Ramón Rivero
- Faculty of Veterinary MedicineUniversidad Autónoma de Ciudad JuárezCiudad JuarezMéxico
| | - José P. Sales‐Luís
- Faculty of Veterinary MedicineUniversidade de LisboaAvenida da Universidade TécnicaLisbonPortugal
| | | | - Sérgio D. Correia
- COPELABSDepartamento de ArquiteturaUniversidade Lusofóna de Humanidades e TecnologiasLisbonPortugal
- VALORIZACentro de Investigação para a Valorização de Recursos EndógenosPolytechnic Institute of PortalegrePortalegrePortugal
| | - Juan Alberto Corbera
- Hospital Clínico Veterinario ULPGCFacultad de VeterinariaInstituto Universitario de Investigaciones Biomédicas y SanitariasUniversidad de Las Palmas de Gran CanariaArucasSpain
| | - Jose Raduan Jaber
- Facultad de VeterinariaDepartamento de MorfologíaUniversidad de Las Palmas de Gran CanariaArucasSpain
| |
Collapse
|
2
|
Mahmoud A, Abuelazm M, Ashraf Salah Ahmed A, Elshinawy M, Ashour T, Abugdida M, Abdelazeem B. Early perioperative versus postoperative meloxicam for pain control in patients undergoing orthopedic surgery: a systematic review and Meta-analysis of randomized controlled trials. Curr Med Res Opin 2023; 39:113-122. [PMID: 36245362 DOI: 10.1080/03007995.2022.2135837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Post-orthopaedic operative pain is a serious concern that often requires the administration of analgesics; however, the optimal time of analgesic administration is still inconclusive. Perioperative analgesia is administrating pre-emptive analgesia before and during the surgery followed by postoperative analgesia to decrease the procedure associated nociceptive response. We aim to assess perioperative meloxicam versus postoperative meloxicam for pain control after orthopaedic operations. METHODS A systematic review and meta-analysis involving randomized controlled trials from PubMed, Embase, Scopus, WOS, and Cochrane until 28th May 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol in PROSPERO with ID: CRD42022336046. RESULTS We included five RCTs with 964 patients. All the included trials showed high risk of performance and detection biases because of lack of blinding. Pooled analysis favored perioperative meloxicam in reducing pain score after six hours (MD: -0.42 with 95% CI [-0.63, -0.21], p = .0001), 12 h (MD: -0.54 with 95% CI [-0.69, -0.39], p = .00001), and 24 h (MD: -0.23 with 95% CI [-0.36, -0.10]. Pooled analysis favored perioperative meloxicam in improving patient global assessment scale after 12 h (MD: -0.66 with 95% CI [-0.86, -0.46], p = .00001), 24 h (MD: -0.30 with 95% CI [-0.49, -0.11, p = .002), and 48 h (MD: -0.17 with 95% CI [-0.33, -0.01], p = .04). Pooled analysis favored perioperative meloxicam in reducing patient-controlled analgesia (MD: -4.25 with 95% CI [-5.96, -2.54], p = .00001). CONCLUSION Short-term pain management after orthopaedic procedures is better accomplished with perioperative meloxicam than postoperative meloxicam. Before recommending perioperative meloxicam for pain control following orthopaedic surgeries, further multicentre trials are still warranted to examine the impact of perioperative meloxicam in different orthopaedic procedures.
Collapse
Affiliation(s)
| | | | | | | | - Toka Ashour
- Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
3
|
Zhang W, Zhao Q, Yang G, Han N, Peng C, Chen H. Efficacy and safety of preoperative versus postoperative NSAIDs on pain relief in patients undergoing hip arthroscopy surgery: A multicentre, randomized, controlled trial. J Clin Pharm Ther 2022; 47:2091-2100. [PMID: 36054477 DOI: 10.1111/jcpt.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/07/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Postoperative pain relief is a critical issue for hip arthroscopy surgery (HAS). This study aimed to investigate the effect of preemptive non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative analgesia in femoroacetabular impingement (FAI) patients receiving HAS. METHODS This multicenter, randomized, controlled study enrolled 204 FAI patients receiving HAS, then assigned them to preoperative (PRE, N = 103) or postoperative (POS, N = 101) group as a 1:1 ratio; the PRE group administrated NSAIDs from 24 h pre-surgery to day 7 (D7) post-surgery, while the POS group administrated NSAIDs from 12 h post-surgery to D7 post-surgery. RESULTS AND DISCUSSION Pain at rest was reduced at D1 (p = 0.016) and D2 (p = 0.023); pain at movement was decreased at D1 (p = 0.002), D2 (p = 0.020), and D3 (p = 0.030) in the PRE group compared with POS group, but not at other time points (all p > 0.05). Patient's satisfaction was increased at D1 (p = 0.013) and D3 (p = 0.029) in the PRE group compared to the POS group, but not at D7 (p = 0.145). Pethidine was less consumed at D3 (p = 0.038) and D7 (p = 0.017) in the PRE group in contrast with the POS group. Harris hip scores were similar at D7 (p = 0.124), month 1 (M1) (p = 0.273), and M3 (p = 0.360) between groups. Adverse events incidence was similar between groups (all p > 0.05). Besides, subgroup analysis discovered that pain was not influenced by the types of NSAID in both groups (all p > 0.05). WHAT IS NEW AND CONCLUSION Starting NSAIDs before HAS provides better short-term pain relief and improves patient's satisfaction compared with its postoperative utilization, while does not induce additional adverse events in FAI patients.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Joint Orthopedics and Sports Medicine, Hengshui People's Hospital, Hengshui, China
| | - Qian Zhao
- Sports Injury Department, Tianjin Hospital, Tianjin, China
| | - Guang Yang
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Nan Han
- Department of Joint Orthopedics, Shuangyashan People's Hospital, Shuangyashan, China
| | - Chao Peng
- Department of Joint Orthopedics and Sports Medicine, Hengshui People's Hospital, Hengshui, China
| | - Hong Chen
- Department of Joint Orthopedics and Sports Medicine, Hengshui People's Hospital, Hengshui, China
| |
Collapse
|
4
|
Hu F, Wu G, Zhao Q, Wu J. Evaluation of analgesic effect, joint function recovery and safety of meloxicam in knee osteoarthritis patients who receive total knee arthroplasty: A randomized, controlled, double-blind study. Medicine (Baltimore) 2021; 100:e26873. [PMID: 34477120 PMCID: PMC8415958 DOI: 10.1097/md.0000000000026873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023] Open
Abstract
Meloxicam is commonly administrated to control postoperative pain in orthopedic surgery, while its efficacy in total knee arthroplasty (TKA) is not clear. Therefore, this study aimed to explore the postoperative analgesic effect and tolerance of meloxicam in knee osteoarthritis (OA) patients undergoing TKA.Totally, 128 knee OA patients scheduled for TKA were enrolled in this randomized, controlled, double-blind study, then randomized into meloxicam group (N = 65) and control group (N = 63) as 1:1 ratio. Patients took meloxicam or placebo from 4 hours (h) to 72 h after TKA. Patients were followed up at 6 h, 12 h, day (D)1, D2, D3, D7, month (M)1, and M3.Pain visual analog scale score at rest was decreased in meloxicam group at 12 h, D1 and D3 compared to control group; pain visual analog scale score at flexion was reduced in meloxicam group at 6 h, 12 h, D1, D2, and D3 compared to control group. Additional and total consumption of patient-controlled analgesia were both attenuated in meloxicam group compared to control group. Furthermore, patient satisfaction score was higher on D1, D2, D3 in meloxicam group compared to control group. However, no difference of hospital for special surgery knee score score at M1 or M3 was found between the 2 groups. Moreover, the occurrence of adverse events was similar between the 2 groups.Meloxicam displays good effect on controlling postoperative pain and improving patient satisfaction, while does not affect long-term knee function recovery or safety profile in knee OA patients undergoing TKA.
Collapse
|
5
|
Berkowitz RD, Steinfeld R, Sah AP, Anupindi VR, Shah D, DeKoven M, Coyle K, McCallum SW, Mack R, Coyle E, Freyer A, Du W, Black LK. Economic Impact of Preoperative Meloxicam IV Administration in Total Knee Arthroplasty: A Randomized Trial Sub-Study. J Pain Palliat Care Pharmacother 2021; 35:150-162. [PMID: 34280067 DOI: 10.1080/15360288.2021.1883789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We evaluated the economic impact associated with preoperative meloxicam IV 30 mg vs placebo administration among adult total knee arthroplasty (TKA) recipients enrolled in Phase IIIB NCT03434275 trial. Data on total hospital costs and length of stay (LOS) obtained from the trial were compared between meloxicam IV 30 mg and placebo groups. Patients in the meloxicam IV 30 mg vs placebo group (n = 93 vs 88) incurred an adjusted $2,266 (95% CI: -$1,035, $5,116; p = 0.1689) lower total hospital costs and an adjusted 8.6% (95% confidence interval [CI]: -2.0%, 18.1%; p = 0.1082) shorter LOS. While statistically non-significant, based on 95% CIs, the results from this sub-study may suggest a favorable impact associated with meloxicam IV 30 mg on hospital costs and LOS.
Collapse
Affiliation(s)
- Richard D Berkowitz
- Richard D. Berkowitz, MD, FAAOS is with University Orthopedic and Joint Replacement Center, University Hospital, Tamarac, FL
| | - Richard Steinfeld
- Richard Steinfeld, MD is with Orthopedic Center of Vero Beach, Vero Beach, FL
| | - Alexander P Sah
- Alexander P. Sah, MD, FAAOS is with Institute for Joint Restoration, Washington Hospital, Fremont, CA
| | - Vamshi Ruthwik Anupindi
- Vamshi Ruthwik Anupindi, MS, Drishti Shah, MS, PhD, Mitch DeKoven, MHSA, and Katharine Coyle, BA are with IQVIA, Falls Church, VA
| | - Drishti Shah
- Vamshi Ruthwik Anupindi, MS, Drishti Shah, MS, PhD, Mitch DeKoven, MHSA, and Katharine Coyle, BA are with IQVIA, Falls Church, VA
| | - Mitch DeKoven
- Vamshi Ruthwik Anupindi, MS, Drishti Shah, MS, PhD, Mitch DeKoven, MHSA, and Katharine Coyle, BA are with IQVIA, Falls Church, VA
| | - Katharine Coyle
- Vamshi Ruthwik Anupindi, MS, Drishti Shah, MS, PhD, Mitch DeKoven, MHSA, and Katharine Coyle, BA are with IQVIA, Falls Church, VA
| | - Stewart W McCallum
- Stewart W. McCallum, MD FACS, Randall Mack, BS, Erin Coyle, BA, BSN, Alex Freyer, PharmD, and Libby K. Black, PharmD are with Baudax Bio, Inc., formerly part of Recro Pharma, Inc, Malvern, PA
| | - Randall Mack
- Stewart W. McCallum, MD FACS, Randall Mack, BS, Erin Coyle, BA, BSN, Alex Freyer, PharmD, and Libby K. Black, PharmD are with Baudax Bio, Inc., formerly part of Recro Pharma, Inc, Malvern, PA
| | - Erin Coyle
- Stewart W. McCallum, MD FACS, Randall Mack, BS, Erin Coyle, BA, BSN, Alex Freyer, PharmD, and Libby K. Black, PharmD are with Baudax Bio, Inc., formerly part of Recro Pharma, Inc, Malvern, PA
| | - Alex Freyer
- Stewart W. McCallum, MD FACS, Randall Mack, BS, Erin Coyle, BA, BSN, Alex Freyer, PharmD, and Libby K. Black, PharmD are with Baudax Bio, Inc., formerly part of Recro Pharma, Inc, Malvern, PA
| | - Wei Du
- Wei Du, PhD is with Clinical Statistics Consulting, Blue Bell, PA
| | - Libby K Black
- Stewart W. McCallum, MD FACS, Randall Mack, BS, Erin Coyle, BA, BSN, Alex Freyer, PharmD, and Libby K. Black, PharmD are with Baudax Bio, Inc., formerly part of Recro Pharma, Inc, Malvern, PA
| |
Collapse
|
6
|
Doleman B, Leonardi-Bee J, Heinink TP, Boyd-Carson H, Carrick L, Mandalia R, Lund JN, Williams JP. Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery. Cochrane Database Syst Rev 2021; 6:CD012978. [PMID: 34125958 PMCID: PMC8203105 DOI: 10.1002/14651858.cd012978.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Postoperative pain is a common consequence of surgery and can have many negative perioperative effects. It has been suggested that the administration of analgesia before a painful stimulus may improve pain control. We defined pre-emptive nonsteroidal anti-inflammatories (NSAIDs) as those given before surgery but not continued afterwards and preventive NSAIDs as those given before surgery and continued afterwards. These were compared to a control group given the NSAIDs after surgery instead of before surgery. OBJECTIVES To assess the efficacy of preventive and pre-emptive NSAIDs for reducing postoperative pain in adults undergoing all types of surgery. SEARCH METHODS We searched the following electronic databases: CENTRAL, MEDLINE, Embase, AMED and CINAHL (up to June 2020). In addition, we searched for unpublished studies in three clinical trial databases, conference proceedings, grey literature databases, and reference lists of retrieved articles. We did not apply any restrictions on language or date of publication. SELECTION CRITERIA We included parallel-group randomized controlled trials (RCTs) only. We included adult participants undergoing any type of surgery. We defined pre-emptive NSAIDs as those given before surgery but not continued afterwards and preventive NSAIDs as those given before surgery and continued afterwards. These were compared to a control group given the NSAIDs after surgery instead of before surgery. We included studies that gave the medication by any route but not given on the skin. DATA COLLECTION AND ANALYSIS We used the standard methods expected by Cochrane, as well as a novel publication bias test developed by our research group. We used GRADE to assess the certainty of the evidence for each outcome. Outcomes included acute postoperative pain (minimal clinically important difference (MCID): 1.5 on a 0-10 scale), adverse events of NSAIDs, nausea and vomiting, 24-hour morphine consumption (MCID: 10 mg reduction), time to analgesic request (MCID: one hour), pruritus, sedation, patient satisfaction, chronic pain and time to first bowel movement (MCID: 12 hours). MAIN RESULTS We included 71 RCTs. Seven studies are awaiting classification. We included 45 studies that evaluated pre-emptive NSAIDs and 26 studies that evaluated preventive NSAIDs. We considered only four studies to be at low risk of bias for most domains. The operations and NSAIDs used varied, although most studies were conducted in abdominal, orthopaedic and dental surgery. Most studies were conducted in secondary care and in low-risk participants. Common exclusions were participants on analgesic medications prior to surgery and those with chronic pain. Pre-emptive NSAIDs compared to post-incision NSAIDs For pre-emptive NSAIDs, there is probably a decrease in early acute postoperative pain (MD -0.69, 95% CI -0.97 to -0.41; studies = 36; participants = 2032; I2 = 96%; moderate-certainty evidence). None of the included studies that reported on acute postoperative pain reported adverse events as an outcome. There may be little or no difference between the groups in short-term (RR 1.00, 95% CI 0.34 to 2.94; studies = 2; participants = 100; I2 = 0%; low-certainty evidence) or long-term nausea and vomiting (RR 0.85, 95% CI 0.52 to 1.38; studies = 5; participants = 228; I2 = 29%; low-certainty evidence). There may be a reduction in late acute postoperative pain (MD -0.22, 95% CI -0.44 to 0.00; studies = 28; participants = 1645; I2 = 97%; low-certainty evidence). There may be a reduction in 24-hour morphine consumption with pre-emptive NSAIDs (MD -5.62 mg, 95% CI -9.00 mg to -2.24 mg; studies = 16; participants = 854; I2 = 99%; low-certainty evidence) and an increase in the time to analgesic request (MD 17.04 minutes, 95% CI 3.77 minutes to 30.31 minutes; studies = 18; participants = 975; I2 = 95%; low-certainty evidence). There may be little or no difference in opioid adverse events such as pruritus (RR 0.40, 95% CI 0.09 to 1.76; studies = 4; participants = 254; I2 = 0%; low-certainty evidence) or sedation (RR 0.51, 95% CI 0.16 to 1.68; studies = 4; participants = 281; I2 = 0%; low-certainty evidence), although the number of included studies for these outcomes was small. No study reported patient satisfaction, chronic pain or time to first bowel movement for pre-emptive NSAIDs. Preventive NSAIDs compared to post-incision NSAIDs For preventive NSAIDs, there may be little or no difference in early acute postoperative pain (MD -0.14, 95% CI -0.39 to 0.12; studies = 18; participants = 1140; I2 = 75%; low-certainty evidence). One study reported adverse events from NSAIDs (reoperation for bleeding) although the events were low which did not allow any meaningful conclusions to be drawn (RR 1.95; 95% CI 0.18 to 20.68). There may be little or no difference in rates of short-term (RR 1.26, 95% CI 0.49 to 3.30; studies = 1; participants = 76; low-certainty evidence) or long-term (RR 0.85, 95% CI 0.52 to 1.38; studies = 5; participants = 456; I2 = 29%; low-certainty evidence) nausea and vomiting. There may be a reduction in late acute postoperative pain (MD -0.33, 95% CI -0.59 to -0.07; studies = 21; participants = 1441; I2 = 81%; low-certainty evidence). There is probably a reduction in 24-hour morphine consumption (MD -1.93 mg, 95% CI -3.55 mg to -0.32 mg; studies = 16; participants = 1323; I2 = 49%; moderate-certainty evidence). It is uncertain if there is any difference in time to analgesic request (MD 8.51 minutes, 95% CI -31.24 minutes to 48.27 minutes; studies = 8; participants = 410; I2 = 98%; very low-certainty evidence). As with pre-emptive NSAIDs, there may be little or no difference in other opioid adverse events such as pruritus (RR 0.56, 95% CI 0.09 to 3.35; studies = 3; participants = 211; I2 = 0%; low-certainty evidence) and sedation (RR 0.84, 95% CI 0.44 to 1.63; studies = 5; participants = 497; I2 = 0%; low-certainty evidence). There is probably little or no difference in patient satisfaction (MD -0.42; 95% CI -1.09 to 0.25; studies = 1; participants = 72; moderate-certainty evidence). No study reported on chronic pain. There is probably little or no difference in time to first bowel movement (MD 0.00; 95% CI -15.99 to 15.99; studies = 1; participants = 76; moderate-certainty evidence). AUTHORS' CONCLUSIONS There was some evidence that pre-emptive and preventive NSAIDs reduce both pain and morphine consumption, although this was not universal for all pain and morphine consumption outcomes. Any differences found were not clinically significant, although we cannot exclude this in more painful operations. Moreover, without any evidence of reductions in opioid adverse effects, the clinical significance of these results is questionable although few studies reported these outcomes. Only one study reported clinically significant adverse events from NSAIDs administered before surgery and, therefore, we have very few data to assess the safety of either pre-emptive or preventive NSAIDs. Therefore, future research should aim to adhere to the highest methodology and be adequately powered to assess serious adverse events of NSAIDs and reductions in opioid adverse events.
Collapse
Affiliation(s)
- Brett Doleman
- Department of Surgery and Anaesthesia, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, Clinical Sciences Building Phase 2, University of Nottingham, Nottingham, UK
| | - Thomas P Heinink
- Department of Anaesthesia, Frimley Health NHS Foundation Trust, Frimley Park Hospital, Frimley, UK
| | - Hannah Boyd-Carson
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Laura Carrick
- Department of Anaesthesia and Intensive care, Royal Derby Hospital, Derby, UK
| | - Rahil Mandalia
- Department of Anaesthesia, University Hospitals of Leicester, Leicester, UK
| | - Jon N Lund
- Division of Health Sciences, School of Medicine, University of Nottingham, Derby, UK
| | - John P Williams
- Department of Surgery and Anaesthesia, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| |
Collapse
|
7
|
Ma L, Zhang L, Wang H, Jiang C. Efficiency and safety: comparison between preoperative analgesia and postoperative analgesia using non-steroidal anti-inflammatory drugs in patients receiving arthroscopic knee surgery in a multicenter, randomized, controlled study. Inflammopharmacology 2021; 29:651-9. [PMID: 33797658 DOI: 10.1007/s10787-021-00792-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aimed to compare the efficiency regarding postoperative pain control, consumption of rescue drug, patients' satisfaction and the safety of preoperative analgesia versus postoperative analgesia using non-steroidal anti-inflammatory drugs (NSAIDs) in patients who received arthroscopic knee surgery (AKS). METHODS Four hundred and sixty-four patients who received AKS were recruited in this multicenter, randomized, controlled study. Subsequently, they were randomized into PRE group (N = 232) and POST group (N = 232). In PRE group, patients received celecoxib, meloxicam or rofecoxib from 2 h pre-operation (Pre (- 2 h)) to 48 h post-operation for analgesia. In POST group, patients received celecoxib, meloxicam or rofecoxib from 4 to 48 h post-operation for analgesia. RESULTS h and 12 h; pain VAS at passive movement was reduced in PRE group than POST group at 6 h, 12 h and 24 h. Additionally, consumption of rescue drug (pethidine) was decreased, while overall satisfaction was increased in PRE group compared to POST group. As for adverse events, the incidences of nausea, vomiting, constipation, drowsiness and dizziness were similar between PRE group and POST group. In subgroup analysis, the pain VAS score at passive movement at 6 h and nausea and constipation incidences were distinctive among subgroups categorized by meloxicam, celecoxib and rofecoxib administration. However, no difference of other assessments was found among subgroups categorized by meloxicam, celecoxib and rofecoxib administration. CONCLUSION Preoperative analgesia using NSAIDs is more efficient and equivalently tolerable compared to postoperative analgesia using NSAIDs in patients who receive AKS.
Collapse
|
8
|
Ren L, Meng L, Yan H, Sun W, Yao D. Preoperative meloxicam versus postoperative meloxicam for pain control, patients' satisfaction and function recovery in hip osteoarthritis patients who receive total hip arthroplasty: a randomized, controlled study. Inflammopharmacology 2020; 28:831-838. [PMID: 32506275 PMCID: PMC7363719 DOI: 10.1007/s10787-020-00718-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/29/2020] [Indexed: 01/01/2023]
Abstract
This study aimed to compare the analgesic effect, patients’ satisfaction, tolerance and hip-joint function recovery by preoperative meloxicam versus postoperative meloxicam in treating hip osteoarthritis (OA) patients receiving total hip arthroplasty (THA). 132 hip OA patients who underwent THA surgery were allocated into postoperative analgesia (POST) and preoperative analgesia (PRE) groups at a 1:1 ratio. In the PRE group, patients took meloxicam 15 mg at 24 h pre-operation, 7.5 mg at 4 h, 24 h, 48 h and 72 h post-operation; in the POST group, patients received meloxicam 15 mg at 4 h post-operation, then 7.5 mg at 24 h, 48 h and 72 h post-operation. Furthermore, postoperative pain, consumption of patient-controlled analgesia (PCA), overall satisfaction and adverse events were evaluated within 96 h post-operation; meanwhile, Harris hip score was assessed within 6 months post-operation. Pain VAS at rest at 6 h, 12 h, 24 h, and pain VAS at passive movement at 6 h, 12 h were decreased in PRE group compared to POST group. In addition, additional consumption of PCA and the total consumption of PCA were both reduced in PRE group compared to POST group. Additionally, overall satisfaction in PRE group was higher at 24 h, 48 h and 72 h compared to POST group. While Harris hip score was of no difference between POST group and PRE group at M3 or M6. Besides, no difference in adverse events incidence was found between the two groups. In conclusion, preoperative meloxicam achieves better efficacy and similar tolerance compared to postoperative meloxicam in hip OA patients post THA.
Collapse
Affiliation(s)
- Lingyun Ren
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, People's Republic of China
| | - Li Meng
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, People's Republic of China
| | - Hong Yan
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, People's Republic of China.
| | - Wei Sun
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, People's Republic of China
| | - Dan Yao
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, People's Republic of China
| |
Collapse
|