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Albuquerque AFM, do Nascimento Costa JJ, Silva JRV, Silva PGDB, Chaves FN, Maferano EFE, Filho ELC, Pereira KMA, Santiago SL, Ribeiro TR, Costa FWG. Does non-steroidal anti-inflammatory drugs-related preemptive analgesia modulate SOCS3/IL-6 pathway in oral surgery? Inflammopharmacology 2024; 32:1017-1024. [PMID: 38347301 DOI: 10.1007/s10787-024-01433-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/08/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | | | - José Roberto Viana Silva
- Biotechnology Nucleus of Sobral-NUBIS, School of Medicine, Federal University of Ceará, Sobral, Brazil
| | | | - Filipe Nobre Chaves
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Ceará, Sobral, Brazil
| | - Eduardo Frederico Eduardo Maferano
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil.
- Department of Dentistry, School of Health Sciences, Zambeze University, Tete, Mozambique.
- Bairro Josina Machel, Enclosure of the Provincial Hospital of Tete, Tete, Mozambique.
| | - Edson Luiz Cetira Filho
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Karuza Maria Alves Pereira
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Sérgio Lima Santiago
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Thyciana Rodrigues Ribeiro
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Fábio Wildson Gurgel Costa
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
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La Rosa GRM, Consoli M, Abiad RS, Toscano A, Pedullà E. Comparing pre- and postoperative etoricoxib administration versus only postoperative on third molar extraction sequelae and oral health quality of life: a prospective quasi-experimental study. Clin Oral Investig 2024; 28:218. [PMID: 38489136 PMCID: PMC10942896 DOI: 10.1007/s00784-024-05614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES This study aimed to compare the impact of pre- and postoperative etoricoxib administration versus only postoperative on third molar extraction sequelae and oral health quality of life. MATERIALS AND METHODS This prospective quasi experimental study involved 56 patients, divided into a study group receiving preemptive etoricoxib 120 mg before surgery and postoperative etoricoxib 120 mg (n = 28), and a control group receiving preemptive placebo before surgery and postoperative etoricoxib 120 mg (n = 28). Follow-up assessments were conducted at 3- and 7-days post-surgery, recording swelling, trismus, and adverse events. Patients rated perceived pain using the visual analog scale (VAS) and completed an oral health-related quality of life (OHRQoL) questionnaire at specified intervals. Statistical analysis employed non-parametric tests (i.e., the Mann-Whitney test, Friedman test, and Wilcoxon sign test) with P < 0.05. RESULTS Significantly lower VAS scores were reported in the study group throughout the follow-up period (P < 0.05). Pharmacological protocol did not have a significant impact on postoperative edema and trismus (P > 0.05). However, double etoricoxib intake significantly improved postoperative quality of life on day 3 after surgery (P < 0.05). CONCLUSIONS Pre- and postoperative etoricoxib 120 mg intake in third molar surgery reduced postoperative pain and enhanced postoperative quality of life on day 3 after surgery. Importantly, it was equally effective in managing swelling and trismus compared to exclusive postoperative intake. CLINICAL RELEVANCE Preemptive etoricoxib use may decrease patient discomfort following impacted mandibular third molar extraction.
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Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
| | - Matteo Consoli
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Roula S Abiad
- Endodontic Division, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon
| | | | - Eugenio Pedullà
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Chen AIH, Lee YH, Perng WT, Chiou JY, Wang YH, Lin L, Wei JCC, Tsou HK. Celecoxib and Etoricoxib may reduce risk of ischemic stroke in patients with rheumatoid arthritis: A nationwide retrospective cohort study. Front Neurol 2022; 13:1018521. [PMID: 36341096 PMCID: PMC9630581 DOI: 10.3389/fneur.2022.1018521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background and purpose Previous studies reported conflicting results about the risk of ischemic stroke associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA). We aimed to investigate two specific COX-2 inhibitors, Celecoxib and Etoricoxib, and their corresponding effects on the risk of ischemic stroke in patients with RA. Patients and methods 10,857 patients newly diagnosed with RA were identified and sampled from the Taiwanese National Health Insurance Research Database during the period from 2001 to 2009. The identification of RA was based on the criteria of ICD-9-CM diagnosis code 714.0. Patients diagnosed with cerebrovascular disease and those receiving RA treatment prior to the first diagnosis of RA were excluded. Study endpoint was ischemic stroke, defined by ICD-9-CM code. Cox proportional hazard models and Kaplan Meier curves were used to reveal covariates and differences by drugs in the risk of ischemic stroke. Dosages for Celecoxib were defined as ≤ 200 and >200 mg/day; those for Etoricoxib were 0 and >0 mg/day. Results Among 7,904 RA patients, 6,669 did not take Celecoxib and 564 (8.46%) of them experienced an ischemic stroke event. Of the 597 individuals who took ≤ 200 mg/day of Celecoxib, 58 (9.72%) had strokes. Of the 638 patients who took >200 mg/day of Celecoxib, 38 (5.96%) eventually experienced a stroke. Among the 7,681 patients who did not take Etoricoxib, 654 (8.51%) experienced an ischemic stroke, while 6 (2.69%) in 223 patients who consumed Etoricoxib had a stroke event. Consuming more than 200 mg of Celecoxib per day for <3.5 years lowered the incidence rate for strokes [hazard ratio (HR) 0.67, 95% Confidence Interval (CI) 0.48–0.93 for dosage and HR 0.22, 95% CI 0.10–0.46 for duration, both p < 0.001], while consuming any dosage of Etoricoxib significantly decreases the possibility (HR 0.35, 95% CI 0.16–0.80, p < 0.001). On the other hand, consuming Etoricoxib for 8 years might have a neutral or even a potentially protective effect compared to at 3.8 years. Conclusion This population-based retrospective cohort study has shown that Celecoxib and Etoricoxib reduce the risk of ischemic stroke in patients with RA in a dose- and time-dependent manner.
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Affiliation(s)
- Acer I-Hung Chen
- Medical Intensive Care Unit, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Heng Lee
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
- Department of Center for General Education, National United University, Miaoli, Taiwan
| | - Wuu-Tsun Perng
- Department of Recreational Sport and Health Promotion, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Lichi Lin
- Department of Statistics, Oklahoma State University, Stillwater, OK, United States
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
- College of Health, National Taichung University of Science and Technology, Taichung, Taiwan
- Department of Post-baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- *Correspondence: Hsi-Kai Tsou
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Yin X, Li X, Zhao P. Comparison of adductor canal block and femoral nerve block for pain management in anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e29295. [PMID: 35758360 PMCID: PMC9276137 DOI: 10.1097/md.0000000000029295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To compare the efficacy of adductor canal block and femoral nerve block for pain management in patients with anterior cruciate ligament reconstruction. METHODS A computerized search was performed in the database of PubMed, Embase, Web of Science and Cochrane Library for randomized controlled trials. The outcome measures included visual analog scale, morphine consumption, quadriceps strength, length of hospitalization and postoperative adverse events. The risk of bias of randomized controlled trials was assessed according to the Cochrane Risk of Bias Tool. All quantitative syntheses were completed using STATA version 14. RESULTS Seven randomized controlled trials involving a total of 643 patients were included in our meta-analysis. The present meta-analysis indicated that there were no significant differences between the 2 groups in terms of postoperative pain score, opioid consumption, length of hospitalization or adverse effects after anterior cruciate ligament reconstruction. However, adductor canal block showed superior quadriceps strength and range of motion in the early postoperative period. CONCLUSION Adductor canal block shows similar and adequate analgesia compared to the femoral nerve block in anterior cruciate ligament reconstruction and adductor canal block can preserve a higher quadriceps strength and better range of motion.
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Chuaychoosakoon C, Parinyakhup W, Wiwatboworn A, Purngpiputtrakul P, Wanasitchaiwat P, Boonriong T. Comparing the Efficacy of Postoperative Pain Control Between Intravenous Parecoxib and Oral Diclofenac in ACL Reconstruction. Orthop J Sports Med 2021; 9:23259671211041660. [PMID: 34692879 PMCID: PMC8532231 DOI: 10.1177/23259671211041660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background: A nonsteroidal anti-inflammatory drug such as oral diclofenac is normally used to relieve postoperative pain after anterior cruciate ligament reconstruction (ACLR), but most patients continue to have moderate-to-severe pain that disturbs their rehabilitation. Some orthopaedists prefer to use intravenous (IV) parecoxib for postoperative pain control. Purpose: To compare the efficacy of IV parecoxib and oral diclofenac for postoperative pain control in ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively collected and analyzed postoperative pain in patients who underwent both single- and double-bundle ACLR; pain was reported on a 10-point visual analog scale (VAS; 10 = worst pain). After the operation, each patient was given either IV parecoxib twice a day or oral diclofenac 3 times a day, and all patients received paracetamol 6 times per day for 24 hours postoperatively. If the patient complained of moderate or severe pain (VAS >3) after surgery, 3 mg of morphine would be given intravenously every 3 hours and 1 mg of morphine as a rescue analgesic every 1 hour for 24 hours postoperatively. Postoperative VAS and morphine consumption were recorded every 4 hours for 24 hours. Data were analyzed using paired t test, analysis of variance, and chi-square test. Results: Overall, 161 patients were included in this study, of whom 47 received IV parecoxib and 114 received oral diclofenac. The mean VAS scores at 4 and 8 hours postoperatively were 3.5 and 3.4, respectively, in the parecoxib group, and 4.4 and 4.7, respectively, in the diclofenac group. The parecoxib group had significantly lower mean VAS than the diclofenac group at 4 hours (P = .047) and 8 hours (P = .005), and the mean cumulative morphine consumption in the parecoxib group was significantly lower than in the diclofenac group at all time points (P < .05) except 4 hours postoperatively. Conclusion: This study found that IV parecoxib was more effective than oral diclofenac in controlling postoperative pain and resulted in lower postoperative morphine consumption within the first 24 hours after ACLR.
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Affiliation(s)
- Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wachiraphan Parinyakhup
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Arnan Wiwatboworn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Pawin Wanasitchaiwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tanarat Boonriong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Xie L, Sang L, Li Z. Does low dose of etoricoxib play pre-emptive analgesic effect in third molar surgery? A randomized clinical trial. BMC Oral Health 2021; 21:462. [PMID: 34556118 PMCID: PMC8459478 DOI: 10.1186/s12903-021-01837-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background How to prevent pain after the extraction of impacted teeth is a serious challenge for all patients. The purpose of this clinical trial was to investigate whether pre-emptive low dose of etoricoxib can reduce postoperative pain in patients undergoing third molars surgery. Methods Patients were randomised to receive etoricoxib 60 mg or placebo 30 min before surgery. Post-operative pain was recorded using a visual analogue scale during 24 h within the post-operative period. The total dose of ibuprofen rescue intake was recorded. Kaplan–Meier curves and log-rank analyses were used to evaluate the proportion of patients without rescue analgesic. Results Scores for the post-operative pain in the etoricoxib group were significantly lower than those in the placebo group during first 12 h (p < 0.05). The number of patients without analgesic rescue medication was significantly lower in the etoricoxib group than in the placebo group. The average amount of rescue medication in the etoricoxib group (0.4 ± 0.9 dose) was lower than that in the placebo group (1.1 ± 0.9 doses, p = 0.004). Etoricoxib resulted in the long-term survival of patients without rescue analgesic (p < 0.001). Conclusions This study revealed that etoricoxib has a substantial pre-emptive analgesic effect, resulting in the reduced use of analgesics after third molar removal. Trial registration: Registered on ChiCTR1900024503. Date of Registration: 13/07/2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01837-0.
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Affiliation(s)
- Long Xie
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, China
| | - Lei Sang
- Department of Stomatology, Suzhou Vocational Health College, Suzhou, China
| | - Zhi Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China. .,Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, China.
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Davey MS, Hurley ET, Anil U, Moses A, Thompson K, Alaia M, Strauss EJ, Campbell KA. Pain Management Strategies After Anterior Cruciate Ligament Reconstruction: A Systematic Review With Network Meta-analysis. Arthroscopy 2021; 37:1290-1300.e6. [PMID: 33515736 DOI: 10.1016/j.arthro.2021.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review randomized controlled trials (RCTs) evaluating various pain control interventions after anterior cruciate ligament reconstruction (ACLR) to determine the best-available evidence in managing postoperative pain and to optimize patient outcomes. METHODS A systematic review of the literature was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A study was included if it was an RCT evaluating an intervention to reduce postoperative pain acutely after ACLR in one of the following areas: (1) nerve blocks, (2) nerve block adjuncts, (3) intra-articular injections, (4) oral medications, (5) intravenous medications, (6) tranexamic acid, and (7) compressive stockings and cryotherapy. Quantitative and qualitative statistics were carried out, and network meta-analysis was performed where applicable. RESULTS Overall, 74 RCTs were included. Across 34 studies, nerve blocks were found to significantly reduce postoperative pain and opioid use, but there was no significant difference among the various nerve blocks in the network meta-analysis. Intra-articular injections consisting of bupivacaine and an adjunct were found to reduce reported postoperative pain scores up to 12 hours after ACLR, with significantly lower postoperative opioid use. CONCLUSIONS Nerve blocks and regional anesthesia are the mainstay treatment of postoperative pain after ACLR, with the commonly used nerve blocks being equally efficacious. Intra-articular injections consisting of bupivacaine and an adjunct were found to reduce reported postoperative pain scores up to 12 hours after ACLR, with significantly lower postoperative opioid use. There was promising evidence for the use of some oral and intravenous medications, tranexamic acid, and nerve block adjuncts, as well as cryotherapy, to control pain and reduce postoperative opioid use. LEVEL OF EVIDENCE Level II, systematic review and meta-analysis of RCTs.
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Affiliation(s)
- Martin S Davey
- Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A.; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A.; Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Utkarsh Anil
- Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A
| | - Akini Moses
- Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A
| | - Kamali Thompson
- Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A
| | - Michael Alaia
- Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A
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Wan R, Li P, Jiang H. The efficacy of celecoxib for pain management of arthroscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e17808. [PMID: 31804304 PMCID: PMC6919475 DOI: 10.1097/md.0000000000017808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The efficacy of celecoxib for pain management of arthroscopy remains controversial. We conduct a systematic review and meta-analysis to assess if celecoxib before the surgery decreases postoperative pain intensity of arthroscopy. METHODS We search PubMed, Embase, Web of science, EBSCO, and Cochrane library databases for randomized controlled trials (RCTs) assessing the effect of celecoxib versus placebo on pain control of arthroscopy. RESULTS Five RCTs are included in the meta-analysis. Celecoxib is administered at 200 mg or 400 mg dosage before the surgery. Overall, compared with control group for arthroscopy, preemptive celecoxib has remarkably positive impact on pain scores at 2 to 6 hours (standard mean difference (SMD) = -0.66; 95% confidence interval (CI) = -0.95 to -0.36; P < .0001) and 24 hours after the surgery (SMD = -1.26; 95% CI = -1.83 to -0.70; P < 0.0001), analgesic consumption (SMD = -2.73; 95% CI = -5.17 to -0.28; P = .03), as well as the decrease in adverse events (risk ratio (RR) = 0.56; 95% CI = 0.39 to 0.79; P = .001), but shows no obvious effect on first time for analgesic requirement (SMD = 0.02; 95% CI = -0.22 to 0.26; P = .87), nausea, or vomiting (RR = 0.70; 95% CI = 0.42 to 1.17; P = .18). CONCLUSION Celecoxib administered at 200 mg or 400 mg dosage before the surgery decreases postoperative pain intensity of arthroscopy.
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Affiliation(s)
| | - Pin Li
- Department of Orthopaedics
| | - Heng Jiang
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, China
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Xu J, Li H, Zheng C, Wang B, Shen P, Xie Z, Qu Y. The efficacy of pre-emptive analgesia on pain management in total knee arthroplasty: a mini-review. ARTHROPLASTY 2019; 1:10. [PMID: 35240765 PMCID: PMC8796433 DOI: 10.1186/s42836-019-0011-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/06/2019] [Indexed: 12/21/2022] Open
Abstract
Total knee arthroplasty (TKA) is considered a cost-effective and efficacious treatment for patients with end-stage knee arthritis. Meanwhile, TKA has been regarded as one of the most painful orthopaedic surgeries. Pain control after TKA remains a challenging task. Many analgesic innovations are used to reduce the level of pain, but none has been proven to be the optimum choice till now. Multimodal analgesia incorporates the use of analgesic adjuncts with different mechanisms of action to enhance postoperative pain management. This approach is a preferable choice in relieving postoperative pain with minimum side effects. This paper aims to review pre-emptive analgesia for pain management in TKA. We reviewed the application of pre-emptive analgesia, its physiological mechanism, and the techniques.
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Affiliation(s)
- Jianda Xu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China
| | - Huan Li
- Department of Arthroplasty, The First People's Hospital of Changzhou, Changzhou, 213003, China
| | - Chong Zheng
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China
| | - Bin Wang
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China
| | - Pengfei Shen
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China
| | - Zikang Xie
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China
| | - Yuxing Qu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China.
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Isola G, Matarese M, Ramaglia L, Cicciù M, Matarese G. Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain, swelling, and mouth opening after surgical removal of impacted third molars: a randomized, controlled clinical trial. Int J Oral Maxillofac Surg 2019; 48:1348-1354. [PMID: 30853212 DOI: 10.1016/j.ijom.2019.02.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/12/2018] [Accepted: 02/12/2019] [Indexed: 02/07/2023]
Abstract
The objective of this study was to compare the efficacy of celecoxib and ibuprofen in reducing postoperative sequelae following the surgical removal of impacted mandibular third molars. Ninety-eight subjects who needed surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly allocated to receive one of the following treatments twice a day for 5days after surgery: placebo (n=32), ibuprofen (n=33), or celecoxib (n=33). The primary outcome chosen was postoperative pain, which was evaluated using the visual analogue scale (VAS) score recorded by each patient. The secondary outcomes chosen were changes in postoperative swelling and maximum mouth opening values compared to preoperative ones. Compared to placebo, treatment with celecoxib and ibuprofen resulted in improvements in the primary outcome. Furthermore, when compared to the other groups, patients in the celecoxib group showed a significant reduction in postoperative pain scores at 6h (P<0.001), 12h (P=0.011), and 24h (P=0.041) after surgery. Regarding swelling and maximum mouth opening values, there were no significant differences between the groups at each follow-up session. This study demonstrated that treatment with celecoxib decreased the incidence and severity of postoperative pain following third molar surgery compared to ibuprofen and placebo.
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Affiliation(s)
- G Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy; Department of Biomedical and Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy.
| | - M Matarese
- Department of Biomedical and Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy
| | - L Ramaglia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - M Cicciù
- Department of Biomedical and Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy
| | - G Matarese
- Department of Biomedical and Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy
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Abstract
OBJECTIVE Dexketoprofen trometamol is a modified non-selective COX inhibitor with a rapid onset of action that is available as both oral and parenteral formulations. The aim of this narrative review was to assess the efficacy and tolerability/safety of dexketoprofen trometamol in acute pain states using the best available published scientific evidence (randomized controlled clinical trials and systematic reviews/meta-analyses). METHODS Literature retrieval was performed via Medline, Embase and the Cochrane Library (from inception up to March 2017) using combinations of the terms "randomized controlled trials", "dexketoprofen", "celecoxib", "etoricoxib", "parecoxib" and "acute pain". RESULTS Single-dose dexketoprofen trometamol provides effective analgesia in the treatment of acute pain, such as postoperative pain (dental and non-dental surgery), renal colic, acute musculoskeletal disorders and dysmenorrhea, and reduces opioid consumption in the postoperative setting. It has a rapid onset of action (within 30 minutes) and is well tolerated during short-term treatment. Direct comparisons with COX-2 inhibitors are lacking; however, the efficacy and tolerability of single-dose dexketoprofen trometamol appears to be consistent with that seen with celecoxib, etoricoxib and parecoxib in the acute pain setting. CONCLUSION In conclusion, dexketoprofen trometamol appears to provide similar analgesic efficacy to COX-2 inhibitors when used to treat acute pain, has a rapid onset of action, is well tolerated, and has an opioid-sparing effect when used as part of a multimodal regimen in the acute pain setting.
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Affiliation(s)
- Magdi Hanna
- a Analgesics and Pain Research (APR) , Beckenham, Kent , UK
| | - Jee Y Moon
- b Department of Anesthesiology and Pain Medicine , Seoul National University Hospital College of Medicine and the Integrated Cancer Management Center, Seoul National University Cancer Hospital , Seoul , Korea
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GluN2B/CaMKII mediates CFA-induced hyperalgesia via HDAC4-modified spinal COX2 transcription. Neuropharmacology 2018; 135:536-546. [DOI: 10.1016/j.neuropharm.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/27/2018] [Accepted: 03/12/2018] [Indexed: 12/15/2022]
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Albuquerque A, Fonteles C, do Val D, Chaves H, Bezerra M, Pereira K, de Barros Silva P, de Lima B, Soares E, Ribeiro T, Costa F. Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-α and IL-1β in third molar surgery: a triple-blind, randomized, placebo-controlled study. Int J Oral Maxillofac Surg 2017; 46:1615-1625. [DOI: 10.1016/j.ijom.2017.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/08/2017] [Accepted: 05/10/2017] [Indexed: 11/29/2022]
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Zhou F, Du Y, Huang W, Shan J, Xu G. The efficacy and safety of early initiation of preoperative analgesia with celecoxib in patients underwent arthroscopic knee surgery: A randomized, controlled study. Medicine (Baltimore) 2017; 96:e8234. [PMID: 29049211 PMCID: PMC5662377 DOI: 10.1097/md.0000000000008234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the efficacy and safety of celecoxib 24 hours preoperative, 1 hour preoperative, and 4 hours postoperative administration in patients with arthroscopic knee surgery (AKS).In all, 206 patients who underwent AKS were consecutively recruited and randomized into 3 groups: (1) early preoperative analgesia group (EPEA), celecoxib 400 mg 24 hours preoperative administration; (2) preoperative analgesia group (PEA), celecoxib 400 mg 1 hour preoperative administration; (3) postoperative analgesia group (POA), celecoxib 400 mg 4 hours postoperative administration. Pain visual analog scale (VAS) scores (at rest and at 90 flexion) and patient global assessment (PGA) score were evaluated before and after operation, and also pethidine consumption and adverse events (AEs).The pain-rest VAS score, percentage of patients with moderate-severe pain at rest, and PGA score in the EPEA and PEA groups were decreased compared with POA group at 8 and 12 hours postoperation. Besides, pain-flexion to 90 VAS score in EPEA and PEA groups were also reduced compared with POA group at 8 hours postsurgery. Interestingly, the percentage of patients with moderate-severe pain at 90 flexion at 8 hours postsurgery in PEA group was fewer compared with POA group, whereas at 4 hours postoperation it was reduced in EPEA group compared with PEA and POA groups. As to consumption of pethidine, it was numerically decreased in EPEA and PEA groups compared with POA group. No difference between each 2 groups was found in AEs.Celecoxib was effective and safe as pre-emptive analgesia in AKS, and 1 hour administration before operation might be an optimal choice.
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Xu Z, Zhang H, Luo J, Zhou A, Zhang J. Preemptive analgesia by using celecoxib combined with tramadol/APAP alleviates post-operative pain of patients undergoing total knee arthroplasty. PHYSICIAN SPORTSMED 2017; 45:316-322. [PMID: 28475475 DOI: 10.1080/00913847.2017.1325312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study was aimed to evaluate the efficacy of preemptive analgesia (PA) by using celecoxib combined with low-dose tramadol/acetaminophen (tramadol/APAP) in treating post-operative pain of patients undergoing unilateral total knee arthroplasty (TKA). METHODS A total of 132 patients scheduled for TKA were included in this study. Three-day pre-operative medication was administrated in PA group with subsequent effective intra- and post-operative multimodal analgesia, while control patients received multimodal analgesia without PA. Visual analog scale (VAS) was utilized to assess the pain intensity at rest and during movement. VAS scores of participants were recorded 3 days before surgery, 1 day, 3 days, 1 week, 3 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Moreover, the length of hospital stay, expense of hospitalization, C-reactive protein (CRP) values during hospitalization, and complications during medication were also recorded. RESULTS PA showed superiority over control at 3 weeks (P = 0.013) and 6 weeks (P = 0.046) in resting pain, and 1 week (P = 0.015), 3 weeks (P = 0.003), 6 weeks (P = 0.003) and 3 months (P = 0.012) postoperatively in movement pain. There was no statistically significant difference in the length of hospital stay, total expense, CRP values, as well as complications. CONCLUSIONS Based on satisfactory intra- and post-operative analgesia, PA by 3-day administration of celecoxib and low-dose tramadol/APAP might be an effective and safe therapy regarding patients undergoing TKA in terms of alleviating post-operative pain.
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Affiliation(s)
- Zhongwei Xu
- a Department of Orthopaedics , the First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Hua Zhang
- a Department of Orthopaedics , the First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Jiao Luo
- b West China School of Public Health , Sichuan University , Chengdu , China
| | - Aiguo Zhou
- a Department of Orthopaedics , the First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Jian Zhang
- a Department of Orthopaedics , the First Affiliated Hospital of Chongqing Medical University , Chongqing , China
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Is there any analgesic benefit from preoperative vs. postoperative administration of etoricoxib in total knee arthroplasty under spinal anaesthesia? Eur J Anaesthesiol 2016; 33:840-845. [DOI: 10.1097/eja.0000000000000521] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Secrist ES, Freedman KB, Ciccotti MG, Mazur DW, Hammoud S. Pain Management After Outpatient Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials. Am J Sports Med 2016; 44:2435-47. [PMID: 26684664 DOI: 10.1177/0363546515617737] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Effective pain management after anterior cruciate ligament (ACL) reconstruction improves patient satisfaction and function. PURPOSE To collect and evaluate the available evidence from randomized controlled trials (RCTs) on pain control after ACL reconstruction. STUDY DESIGN Systematic review. METHODS A systematic literature review was performed using PubMed, Medline, Google Scholar, UpToDate, Cochrane Reviews, CINAHL, and Scopus following PRISMA guidelines (July 2014). Only RCTs comparing a method of postoperative pain control to another method or placebo were included. RESULTS A total of 77 RCTs met inclusion criteria: 14 on regional nerve blocks, 21 on intra-articular injections, 4 on intramuscular/intravenous injections, 12 on multimodal regimens, 6 on oral medications, 10 on cryotherapy/compression, 6 on mobilization, and 5 on intraoperative techniques. Single-injection femoral nerve blocks provided superior analgesia to placebo for up to 24 hours postoperatively; however, this also resulted in a quadriceps motor deficit. Indwelling femoral catheters utilized for 2 days postoperatively provided superior analgesia to a single-injection femoral nerve block. Local anesthetic injections at the surgical wound site or intra-articularly provided equivalent analgesia to regional nerve blocks. Continuous-infusion catheters of a local anesthetic provided adequate pain relief but have been shown to cause chondrolysis. Cryotherapy improved analgesia compared to no cryotherapy in 4 trials, while in 4 trials, ice water and water at room temperature provided equivalent analgesic effects. Early weightbearing decreased pain compared to delayed weightbearing. Oral gabapentin given preoperatively and oral zolpidem given for the first week postoperatively each decreased opioid consumption as compared to placebo. Ibuprofen reduced pain compared to acetaminophen. Oral ketorolac reduced pain compared to hydrocodone-acetaminophen. CONCLUSION Regional nerve blocks and intra-articular injections are both effective forms of analgesia. Cryotherapy-compression appears to be beneficial, provided that intra-articular temperatures are sufficiently decreased. Early mobilization reduces pain symptoms. Gabapentin, zolpidem, ketorolac, and ibuprofen decrease opioid consumption. Despite the vast amount of high-quality evidence on this topic, further research is needed to determine the optimal multimodal approach that can maximize recovery while minimizing pain and opioid consumption. CLINICAL RELEVANCE These results provide the best available evidence from RCTs on pain control regimens after ACL reconstruction.
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Affiliation(s)
- Eric S Secrist
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael G Ciccotti
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Donald W Mazur
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sommer Hammoud
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Levy DM, Frank RM, Bach BR, Verma NN. Perioperative Pain and Swelling Control in Anterior Cruciate Ligament Reconstruction. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2015.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Costa FWG, Soares ECS, Esses DFS, Silva PGD, Bezerra TP, Scarparo HC, Ribeiro TR, Fonteles CSR. A split-mouth, randomized, triple-blind, placebo-controlled study to analyze the pre-emptive effect of etoricoxib 120 mg on inflammatory events following removal of unerupted mandibular third molars. Int J Oral Maxillofac Surg 2015; 44:1166-74. [PMID: 26144571 DOI: 10.1016/j.ijom.2015.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 06/04/2015] [Accepted: 06/12/2015] [Indexed: 11/26/2022]
Abstract
Pain after third molar extraction has been considered the most suitable pharmaceutical model to evaluate acute pain. This study aimed to evaluate the pre-emptive analgesic/anti-inflammatory efficacy of etoricoxib 120 mg following mandibular third molar surgery. A split-mouth, randomized, triple-blind, placebo-controlled study was conducted with patients undergoing the surgical removal of mandibular third molars. All volunteers were allocated randomly to receive either etoricoxib 120 mg or placebo 1h preoperatively, and inflammatory events were evaluated. An estimated sample of 18 surgical units per group was required based on a pilot study (95% confidence level and 80% statistical power). Rescue medication was analyzed by Kaplan-Meier method through log-rank Mantel-Cox test and Pearson linear correlation (P<0.05). Pre-emptive etoricoxib reduced postoperative pain scores significantly in comparison to placebo (P<0.001), with a pain score peak at 6h after surgery (P<0.001). The mean rescue medication consumption was lower in the etoricoxib group compared to the placebo group over the study period (P<0.05). There was no statistically significant difference between groups related to swelling and trismus. The pre-emptive administration of etoricoxib 120 mg significantly reduced the postoperative pain intensity and the need for rescue medication, but did not reduce swelling or trismus.
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Affiliation(s)
- F W G Costa
- Division of Oral Surgery, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | - E C S Soares
- Division of Oral Surgery, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - D F S Esses
- Post-graduate Program in Dentistry, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - P G deB Silva
- Post-graduate Program in Dentistry, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - T P Bezerra
- Division of Oral Surgery, Walter Cantidio University Hospital, Fortaleza, Ceará, Brazil
| | - H C Scarparo
- Division of Oral Surgery, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Clinical Pharmacology, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - T R Ribeiro
- Division of Clinical Dentistry, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - C S R Fonteles
- Division of Clinical Pharmacology, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Paediatrics, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Fleckenstein J, Kohls N, Evtouchenko E, Lehmeyer L, Kramer S, Lang P, Siebeck M, Mussack T, Hatz R, Heindl B, Conzen P, Rehm M, Czerner S, Zwißler B, Irnich D. No effect of the cyclooxygenase-2 inhibitor etoricoxib on pre-emptive and post-operative analgesia in visceral surgery: results of a randomized controlled trial. Eur J Pain 2015; 20:186-95. [DOI: 10.1002/ejp.699] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 11/06/2022]
Affiliation(s)
- J. Fleckenstein
- Department of Anaesthesiology; University of Munich; Germany
| | - N. Kohls
- Division Integrative Health Promotion; University of Applied Sciences and Arts Coburg; Germany
- Brain, Mind & Healing Program; Samueli Institute; Alexandria USA
| | - E. Evtouchenko
- Department of Anaesthesiology; University of Munich; Germany
| | - L. Lehmeyer
- Department of Anaesthesiology; University of Munich; Germany
| | - S. Kramer
- Department of Anaesthesiology; University of Munich; Germany
| | - P.M. Lang
- Department of Anaesthesiology; University of Munich; Germany
| | - M. Siebeck
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery; Ludwig Maximilians University; Munich Germany
| | - T. Mussack
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery; Ludwig Maximilians University; Munich Germany
| | - R. Hatz
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery; Ludwig Maximilians University; Munich Germany
| | - B. Heindl
- Department of Anaesthesiology; University of Munich; Germany
| | - P. Conzen
- Department of Anaesthesiology; University of Munich; Germany
| | - M. Rehm
- Department of Anaesthesiology; University of Munich; Germany
| | - S. Czerner
- Department of Anaesthesiology; University of Munich; Germany
| | - B. Zwißler
- Department of Anaesthesiology; University of Munich; Germany
| | - D. Irnich
- Department of Anaesthesiology; University of Munich; Germany
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Penprase B, Brunetto E, Dahmani E, Forthoffer JJ, Kapoor S. The Efficacy of Preemptive Analgesia for Postoperative Pain Control: A Systematic Review of the Literature. AORN J 2015; 101:94-105.e8. [DOI: 10.1016/j.aorn.2014.01.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 01/02/2014] [Accepted: 01/04/2014] [Indexed: 10/24/2022]
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Baradaran M, Hamidi MR, Moghimi Firoozabad MR, Kazemi S, Ashrafpour M, Moghadamnia AA. Alprazolam role in the analgesic effect of ibuprofen on postendodontic pain. CASPIAN JOURNAL OF INTERNAL MEDICINE 2014; 5:196-201. [PMID: 25489429 PMCID: PMC4247481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/15/2014] [Accepted: 07/07/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postendodontic pain (PEP) has always been a major problem for patients and dentists and NSAIDs are being used to relieve PEP and it is supposed that some benzodiazepines may potentiate facilitate the analgesic effects of the NSAIDs. This study was conducted to evaluate the effect of alprazolam on the analgesic effect of ibuprofen in PEP treatment. METHODS This randomized double-blind clinical trial was conducted on 45 patients aged 20-45 years who were subjected of root canal treatment. A written informed consent was obtained from each patient. The subjects were randomly divided into three groups; placebo, ibuprofen (400 mg) and alprazolam (0.5) mg + ibuprofen (400 mg). The intensity of pain was recorded using visual analog scale (VAS) at 4, 6, 12, 24, 48 and 72 hours after drug administration. RESULTS Of the participants, twenty six (57.8%) were males and 19 patients (42.2%) were females. Four hours after starting treatment, the VAS scores in the placebo and ibuprofen -treated groups were significantly higher than ibuprofen and alprazolam+ibuprofen groups (4.93±1.16, 3.67±1.88 and 2.67±1.11, respectively, p<0.0001). The VAS scores in alprazolam + ibuprofen group (2.33±1.05) were significantly lower at 6 hours after treatment when compared to the other groups (Ibuprofen: 3.00±1.36 and placebo: 3.08±1.74, P=0.002). This decrease in VAS score sustained to 12 hours after the start of alprazolam + ibuprofen treatment when compared to ibuprofen or placebo receiving group alone (p<0.003). The average pain score in female patients who received alprazolam + ibuprofen was significantly lower than males at 12 hours (1.3±0.6 v.s 2.14±0.9, P=0.002) and 24 hours after treatment (0.88±0.6 v.s 1.86±0.9, P=0.003). CONCLUSION According to the results, it can conclude that alprazolam may enhance the analgesic efficacy of ibuprofen in postendodontic pain.
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Affiliation(s)
- Mahmoud Baradaran
- Department of Pharmacology, Babol University of Medical Sciences, Babol, Iran.
| | - Mahmoud Reza Hamidi
- Department of Endodontics, Babol University of Medical Sciences, Babol, Iran.
| | | | - Sohrab Kazemi
- Department of Pharmacology, Babol University of Medical Sciences, Babol, Iran. ,Cellular & Molecular Biology Research Center, Babol University of Medical Sciences, Babol, Iran.
| | - Manouchehr Ashrafpour
- Department of Pharmacology, Babol University of Medical Sciences, Babol, Iran. ,Cellular & Molecular Biology Research Center, Babol University of Medical Sciences, Babol, Iran.
| | - Ali Akbar Moghadamnia
- Department of Pharmacology, Babol University of Medical Sciences, Babol, Iran. ,Cellular & Molecular Biology Research Center, Babol University of Medical Sciences, Babol, Iran. ,Correspondence: Ali Akbar Moghadamnia, Cellular & Molecular Biology Research Center, Babol University of Medical Sciences, Babol, Iran. E-mail:, Tel: 0098 11 32197667, Fax: 0098 11 32197667
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Mardani-Kivi M, Karimi Mobarakeh M, Haghighi M, Naderi-Nabi B, Sedighi-Nejad A, Hashemi-Motlagh K, Saheb-Ekhtiari K. Celecoxib as a pre-emptive analgesia after arthroscopic knee surgery; a triple-blinded randomized controlled trial. Arch Orthop Trauma Surg 2013; 133:1561-6. [PMID: 24043481 DOI: 10.1007/s00402-013-1852-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pre-emptive analgesia not only controls pain but also may result in the reduction of opioid consumption and related side effects following orthopedic surgeries. The purpose of the present study was to examine the therapeutic effects of celecoxib in reducing pain following the arthroscopic knee surgeries: anterior cruciate ligament (ACL) reconstruction and partial meniscectomy. MATERIALS AND METHODS In this triple-blinded, randomized, placebo-controlled clinical trial, celecoxib 400 mg and identical placebo were administered, 2 h prior to operation, to 130 patient candidates for undergoing knee arthroscopic surgery of either isolated meniscectomy or ACL reconstruction. Pain intensity, 24 h opioid consumption and the related side effects were measured at 6 and 24 h post operation. RESULTS The patients in both groups were similar with regards to demographic characteristics such as age, gender and body mass index. The results of the study indicated that the pain intensity and opioid consumption were lower in both subgroups (meniscectomy and ACL-R) in celecoxib group at 6 and 24 h post operation (P < 0.0001). The side effects of analgesics such as nausea and vomiting, sedation, and dizziness were not significantly different between the two groups (P > 0.05). CONCLUSION It seems that celecoxib as a pre-emptive analgesia agent is effective in decreasing acute postoperative pain and 24 h opioid consumption in patients undergoing arthroscopic knee surgery.
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Lee JH, Kim YL, Lee SJ, Yang J, Park JY, Kim EY, Lee D, Khang G. RETRACTED ARTICLE: Preparation/characterization of solid dispersions and enhancement of dissolution rate on celecoxib as BCS II class. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2013. [DOI: 10.1007/s40005-013-0090-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Argoff CE. Recent management advances in acute postoperative pain. Pain Pract 2013; 14:477-87. [PMID: 23945010 DOI: 10.1111/papr.12108] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/09/2013] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Acute postoperative pain remains a major problem, with both undertreatment and overtreatment leading to serious consequences, including increased risk of persistent postoperative pain, impaired rehabilitation, increased length of stay and/or hospital readmission, and adverse events related to excessive analgesic use, such as oversedation. New analgesic medications and techniques have been introduced that target the preoperative, intraoperative, and postoperative periods to better manage acute postoperative pain, with improvements in analgesic efficacy and safety over more traditional pain management approaches. This review provides an overview of these new analgesic medications and techniques. Specific topics that are discussed include the use of preoperative nonsteroidal anti-inflammatory drugs, anxiolytics, and anticonvulsants; intraoperative approaches such as neuraxial analgesia, continuous local anesthetic wound infusion, transversus abdominis plane block, extended-release epidural morphine, intravenous acetaminophen, and intravenous ketamine; and postoperative use of intravenous ibuprofen, new opioids (eg, tapentadol) or opioid formulations (morphine-oxycodone), and patient-controlled analgesia. CONCLUSION New, targeted, analgesic medications and techniques may provide a safer and more effective approach to the management of acute postoperative pain than traditional approaches such as postoperative oral analgesics.
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Kashefi P, Honarmand A, Safavi M. Effects of preemptive analgesia with celecoxib or acetaminophen on postoperative pain relief following lower extremity orthopedic surgery. Adv Biomed Res 2012; 1:66. [PMID: 23459777 PMCID: PMC3587127 DOI: 10.4103/2277-9175.100197] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/13/2012] [Indexed: 12/27/2022] Open
Abstract
Background: Efficacy of preemptive analgesia with nonsteroidal antiinflammatory drugs (NSAIDs) in comparison with acetaminophen is controversial. The present study evaluates the preemptive analgesia efficacy of celecoxib and acetaminophen in comparison with placebo for postoperative pain relief in patients who underwent orthopedic surgery under general anesthesia. Materials and Methods: Ninetypatients eligible for elective distal extremity surgery were categorized in three groups: group C includedpatients who received oral celecoxib 200 mg 2 h before surgery; group A included those who received oral acetaminophen 320 mg 2 h before surgery; and group P included those who received oral placebo 2 h before surgery. Pain scores were recorded at 4, 12, and 24 h after operation. Results: The pain scores 4 h after operation was significantly less in group C than in groups A and P (4.7±1.7 vs. 5±1.5 vs. 6.8±1.7, respectively, P = 0.015). No significant difference was noted in pain scores at 12 h (4.6±2, 4.9±1.9, 4.3±1.4 in group A, group C, group P, respectively P > 0.05) and 24 h (3.1±1.7, 3.0±1.4, 3.3±1.7 in group A, group C, group P, respectively, P > 0.05) after operation among the three groups. Conclusion: Using oral celecoxib 200 mg 2 h before operation is better thanusing oral acetaminophen 320 mg 2 h before the beginning of surgery for control of postoperative pain in patients who underwent lower extremity orthopedic surgery under general anesthesia.
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Affiliation(s)
- Parviz Kashefi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Gandhi R, Jan M, Smith HN, Mahomed NN, Bhandari M. Comparison of published orthopaedic trauma trials following registration in Clinicaltrials.gov. BMC Musculoskelet Disord 2011; 12:278. [PMID: 22151841 PMCID: PMC3266218 DOI: 10.1186/1471-2474-12-278] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 12/07/2011] [Indexed: 11/11/2022] Open
Abstract
Background After the Food and Drug Administration Modernization Act of 1997, the registration of all clinical trials became mandatory prior to publication. Our primary objective was to determine publication rates for orthopaedic trauma trials registered with ClinicalTrials.gov. We further evaluated methodological consistency between registration and publication. Methods We searched Clinical Trials.gov for all trials related to orthopaedic trauma. We excluded active trials and trials not completed by July 2009, and performed a systematic search for publications resulting from registered closed trials. Information regarding primary and secondary outcomes, intervention, study sponsors, and sample size were extracted from registrations and publications. Results Of 130 closed trials, 37 eligible trials resulted in 16 publications (43.2%). We found no significant differences in publication rates between funding sources for industry sponsored studies and nongovernment/nonindustry sponsored studies (p > 0.05). About half the trials (45%) did not include the NCT ID in the publication. Two (10%) publications had major changes to the primary outcome measure and ten (52.6%) to sample size. Conclusions Registration of orthopaedic trauma trials does not consistently result in publication. When trials are registered, many do not cite NCT ID in the publication. Furthermore, changes that are not reflected in the registry of the trial are frequently made to the final publication.
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Affiliation(s)
- Rajiv Gandhi
- Toronto Western Hospital EW 1-439, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
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Tompkins M, Plante M, Monchik K, Fleming B, Fadale P. The use of a non-benzodiazepine hypnotic sleep-aid (Zolpidem) in patients undergoing ACL reconstruction: a randomized controlled clinical trial. Knee Surg Sports Traumatol Arthrosc 2011; 19:787-91. [PMID: 21253706 DOI: 10.1007/s00167-010-1368-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 12/13/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE Previous studies have addressed post-operative pain management after ACL reconstruction by examining the use of intra-articular analgesia and/or modification of anesthesia techniques. To our knowledge, however, no previous studies have evaluated the effect of zolpidem on post-operative narcotic requirements, pain, and fatigue in patients undergoing outpatient arthroscopic ACL reconstruction. The purpose of this prospective, blinded, randomized, controlled clinical study was to evaluate the effect of zolpidem on post-operative narcotic requirements, pain, and fatigue in patients undergoing outpatient arthroscopic ACL reconstruction. METHODS Twenty-nine patients undergoing arthroscopic ACL reconstruction were randomized to a treatment group or placebo group. Both groups received post-operative hydrocodone/acetaminophen bitartrate (Vicodin ES). Patients in the treatment group received a single dose of zolpidem for the first seven post-operative nights. Patients in the placebo group received a gelatin capsule similar in appearance to zolpidem. The amount of Vicodin used in each group, the amount of post-operative pain, and the amount of post-operative fatigue were analyzed. RESULTS Following ACL reconstruction, a 28% reduction was seen in the total amount of narcotic consumed with zolpidem (P = 0.047) when compared to placebo. There were no significant differences in post-operative pain or fatigue levels between zolpidem and placebo. CONCLUSION Adding zolpidem to the post-operative medication regimen after arthroscopic ACL reconstruction helps to lower the amount of narcotic pain medication required for adequate analgesia. LEVEL OF EVIDENCE Randomized controlled clinical trial, Level I.
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Affiliation(s)
- Marc Tompkins
- Department of Orthopaedics, Alpert Brown Medical School/Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
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