Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original articleAnalgesic Efficacy of Perioperative Celecoxib in Ambulatory Arthroscopic Knee Surgery: A Double-Blind, Placebo-Controlled Study
Section snippets
Study Design and Patient Selection
This was a randomized, double-blind, placebo-controlled, parallel-group study that was conducted at 9 sites in the United States. Patients (aged ≥18 years) with meniscal disease who required arthroscopic knee surgery (arthroscopic meniscectomy and partial meniscectomy) were included. Patients were excluded if they had experienced osteoarthritis or inflammatory arthritis affecting the index joint, a previous fracture of the index joint, a required repair of the meniscus, reconstructive
Baseline Demographic Characteristics
Of the 200 patients randomized to the study, 99 (49.5%) received celecoxib and 101 (50.5%) were given placebo. The mITT population (patients who remained in the study and completed the 24-hour assessment) comprised 166 patients (Fig 1). No significant differences between the 2 study groups were observed in any of the baseline characteristics (Table 1).
Efficacy Analyses
Total opioid analgesic (hydrocodone bitartrate/APAP tablets) consumption at 24 hours was significantly lower in patients receiving celecoxib (3.6
Discussion
This study examined the analgesic efficacy and opioid-sparing effects of the COX-2 selective inhibitor, celecoxib, when administered before and after arthroscopic knee surgery. Our findings show that celecoxib plus optional opioids provided improved analgesia and a reduction in opioid use compared with placebo plus optional opioids. Patients who had received celecoxib required 1 less hydrocodone bitartrate/APAP tablet over 24 hours after surgery, and they experienced fewer opioid-related AEs
Conclusions
This multimodal regimen, which uses a COX-2 selective inhibitor perioperatively, is an effective opioid-sparing option for the management of postoperative pain. This study shows that the multimodal approach to pain management with perioperative administration of celecoxib, in addition to hydrocodone/APAP, provides well-tolerated, efficacious postoperative analgesia for patients undergoing arthroscopic knee surgery while reducing opioid utilization.
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Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures
2019, Heart RhythmCitation Excerpt :Oral gabapentin (600 or 1200 mg) or pregabalin (150 or 300 mg) administered 1–2 hours before the procedure has been associated with reduced opioid requirements postsurgery.22,23 Similarly, preoperative oral celecoxib 200 to 400 mg administered 30 minutes to 1 hour before the procedure has been associated with reduced opioid requirements.22,24 However, celecoxib may not be appropriate for many patients undergoing device implantation who often have significant cardiovascular history.
Perioperative Celecoxib and Postoperative Opioid Use in Hand Surgery: A Prospective Cohort Study
2018, Journal of Hand SurgeryEfficacy of Celecoxib for Early Postoperative Pain Management in Hip Arthroscopy: A Prospective Randomized Placebo-Controlled Study
2017, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :At 1 hour before hip arthroscopy surgery, all patients received 2 pills containing either a lactose-based placebo in both pills or 200 mg celecoxib in each pill, for a total dosage of 400 mg celecoxib. The dose of 400 mg of celecoxib was chosen because it was previously used for perioperative pain management in knee arthroscopy, as reported by Ekman et al.9 All patients then underwent hip arthroscopy performed by the senior author and were subsequently taken to the recovery room and discharged from the surgery center on the day of surgery. Patient demographics, including age, gender, and specific procedures performed during hip arthroscopy surgery, were collected from the medical record.
American College of Foot and Ankle Surgeons<sup>®</sup> Clinical Consensus Statement: Perioperative Management
2017, Journal of Foot and Ankle SurgeryCitation Excerpt :Although many agree with respect to the use of a multimodal approach, little consensus has been reached with respect to which combination of specific interventions should be used for specific clinical situations. Several broad considerations that foot and ankle surgeons should consider include preoperative education with respect to postoperative expectations (306,308), the preoperative administration of agents, including nonsteroidal anti-inflammatory drugs and alpha-2-delta ligands (301,304,307,309–314), and maximization of long-term agents with regional anesthesia (302,303,305,310,311). Another challenging aspect of postoperative pain management is the duration of opioid use.
Management of postoperative pain: A clinical practice guideline from the American pain society, the American society of regional anesthesia and pain medicine, and the American society of anesthesiologists' committee on regional anesthesia, executive committee, and administrative council
2016, Journal of PainCitation Excerpt :The panel recommends that clinicians consider use of preoperative celecoxib in patients who undergo major surgery. Celecoxib is associated with reduced opioid requirements after surgery, and some studies reported lower postoperative pain scores.74,138,146,161,239,275,303 The most common doses of celecoxib in the trials were 200 to 400 mg, administered 30 minutes to 1 hour preoperatively.
New modalities of pain treatment after outpatient orthopaedic surgery
2016, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :Preventative administration of certain agents on the day of surgery may be beneficial: Cox2-selective NSAIDs (400 mg celecoxib) have been shown to have an extended analgesic benefit, without increasing the risk of bleeding after ambulatory knee arthroscopy [9]; gabapentin (Neurontin®) (or pregabalin) reduces postoperative pain, opiate intake and the risk of developing chronic postoperative pain [10].
Supported by Pfizer Global Pharmaceuticals, New York, New York.