Huang Yu-Min, Wang Chiu-Meng, Wang Chen-Ti, Lin Wei-Peng, Horng Lih-Ching, Jiang Ching-Chuan
Department of Orthopaedic Surgery, National Taiwan University Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
BMC Musculoskelet Disord. 2008 Jun 3;9:77. doi: 10.1186/1471-2474-9-77.
Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. We evaluated opioid-sparing effects and rehabilitative results after perioperative celecoxib administration for total knee arthroplasty.
This was a prospective, randomized, observer-blind control study. Eighty patients that underwent total knee arthroplasty were randomized into two groups of 40 each. The study group received a single 400 mg dose of celecoxib, one hour before surgery, and 200 mg of celecoxib every 12 hours for five days, along with patient-controlled analgesic (PCA) morphine. The control group received only PCA morphine for postoperative pain management. Visual analog scale (VAS) pain scores, active range of motion (ROM), total opioid use and postoperative nausea/vomiting were analyzed.
Groups were comparable for age, pre-operative ROM, operation duration and intraoperative blood loss. Resting VAS pain scores improved significantly in the celecoxib group, compared with controls, at 48 hrs (2.13 +/- 1.68 vs. 3.43 +/- 1.50, p = 0.03) and 72 hrs (1.78 +/- 1.66 vs. 3.17 +/- 2.01, p = 0.02) after surgery. Active ROM also increased significantly in the patients that received celecoxib, especially in the first 72 hrs [40.8 degrees +/- 17.3 degrees vs. 25.8 degrees +/- 11.5 degrees , p = 0.01 (day 1); 60.7 degrees +/- 18.1 degrees vs. 45.0 degrees +/- 17.3 degrees , p = 0.004 (day 2); 77.7 degrees +/- 15.1 degrees vs. 64.3 degrees +/- 16.9 degrees , p = 0.004 (day 3)]. Opioid requirements decreased about 40% (p = 0.03) in the celecoxib group. Although patients suffering from post-operative nausea/vomiting decreased from 43% in control group to 28% in celecoxib group, this was not significant (p = 0.57). There were no differences in blood loss (intra- and postoperative) between the groups. Celecoxib resulted in no significant increase in the need for blood transfusions.
Perioperative celecoxib significantly improved postoperative resting pain scores at 48 and 72 hrs, opioid consumption, and active ROM in the first three days after total knee arthroplasty, without increasing the risks of bleeding.
Clinicaltrials.gov NCT00598234.
非甾体类抗炎药（NSAIDs）被推荐用于多模式术后疼痛管理。我们评估了全膝关节置换术围手术期使用塞来昔布后的阿片类药物节省效果和康复结果。
这是一项前瞻性、随机、观察者盲法对照研究。80例行全膝关节置换术的患者被随机分为两组，每组40例。研究组在手术前1小时接受单次400mg塞来昔布剂量，术后每12小时接受200mg塞来昔布，共5天，同时给予患者自控镇痛（PCA）吗啡。对照组仅接受PCA吗啡用于术后疼痛管理。分析视觉模拟量表（VAS）疼痛评分、主动活动范围（ROM）、阿片类药物总用量和术后恶心/呕吐情况。
两组在年龄、术前ROM、手术时间和术中失血量方面具有可比性。与对照组相比，塞来昔布组术后48小时（2.13±1.68 vs. 3.43±1.50，p = 0.03）和72小时（1.78±1.66 vs. 3.17±2.01，p = 0.02）时静息VAS疼痛评分显著改善。接受塞来昔布治疗的患者主动ROM也显著增加，尤其是在最初72小时内[第1天：40.8度±17.3度 vs. 25.8度±11.5度，p = 0.01；第2天：60.7度±18.1度 vs. 45.0度±17.3度，p = 0.004；第3天：77.7度±15.1度 vs. 64.3度±16.9度，p = 0.004]。塞来昔布组阿片类药物需求量减少约40%（p = 0.03）。虽然术后恶心/呕吐患者从对照组的43%降至塞来昔布组的28%，但差异无统计学意义（p = 0.57）。两组间（术中及术后）失血量无差异。塞来昔布并未导致输血需求显著增加。
全膝关节置换术后围手术期使用塞来昔布可在48和72小时显著改善术后静息疼痛评分、阿片类药物消耗量，并在术后三天内显著增加主动ROM，且不增加出血风险。
Clinicaltrials.gov NCT00598234
