Clarke Rachel, Derry Sheena, Moore R Andrew, McQuay Henry J
Pain Research and Nuffield Department of Anaesthetics, University of Oxford, West Wing (Level 6), John Radcliffe Hospital, Oxford, Oxfordshire, UK, OX3 9DU.
Cochrane Database Syst Rev. 2009 Apr 15(2):CD004309. doi: 10.1002/14651858.CD004309.pub2.
Etoricoxib is a selective cyclo-oxygenase-2 (COX-2) inhibitor prescribed for the relief of chronic pain in osteoarthritis and rheumatoid arthritis, and acute pain. The drug is believed to be associated with fewer upper gastrointestinal adverse effects than conventional non-steroidal anti-inflammatory drugs (NSAIDs). A number of studies in acute postoperative pain have now been published.
To assess the analgesic efficacy and adverse effects of a single oral dose of etoricoxib for moderate to severe postoperative pain.
We searched Cochrane CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Database, and reference lists of articles. Date of the most recent search: December 2008.
Randomised, double-blind, placebo-controlled clinical trials of single dose, oral etoricoxib for acute postoperative pain in adults.
Two review authors independently assessed trials for inclusion in the review and quality, and extracted data. The area under the pain relief versus time curve was used to derive the proportion of participants prescribed etoricoxib or placebo with at least 50% pain relief over six hours, using validated equations. Relative risk (RR) and number needed to treat to benefit (NNT) were calculated. Information on use of rescue medication was used to calculate the proportion of participants requiring rescue medication and the weighted mean of the median time to use. Information on adverse effects was also collected.
Five studies (880 participants) were included in the review. All five studies reported on 120 mg, with 655 participants in a comparison with placebo. At least 50% pain relief was reported by 64% with etoricoxib 120 mg and 10% with placebo (NNT 1.9 (1.7 to 2.1)). For dental studies only the NNT was 1.6 (1.5 to 1.8). Two studies also reported on higher doses of 180 and 240 mg, with 249 participants. At least 50% pain relief was reported by 79% with etoricoxib 120 mg and 12% with placebo (NNT 1.5 (1.3 to 1.7)).Significantly fewer participants used rescue medication when taking etoricoxib 120 mg than those taking placebo (NNT to prevent remedication 2.4 (2.1 to 2.9)), and the median time to use of rescue medication was 20 hours. Adverse events were reported at a similar rate to placebo, with no serious events.
AUTHORS' CONCLUSIONS: Single dose oral etoricoxib produces high levels of good quality pain relief after surgery. The 120 mg dose is as effective as, or better than, other commonly used analgesics.
依托考昔是一种选择性环氧化酶 -2（COX -2）抑制剂，用于缓解骨关节炎和类风湿关节炎的慢性疼痛以及急性疼痛。据信，与传统非甾体抗炎药（NSAIDs）相比，该药物引起的上消化道不良反应较少。目前已发表了多项关于急性术后疼痛的研究。
评估单剂量口服依托考昔治疗中度至重度术后疼痛的镇痛效果及不良反应。
我们检索了Cochrane中心对照试验注册库、医学期刊数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）和牛津疼痛数据库以及文章的参考文献列表。最近一次检索日期为2008年12月。
单剂量口服依托考昔治疗成人急性术后疼痛的随机、双盲、安慰剂对照临床试验。
两名综述作者独立评估纳入综述的试验及其质量，并提取数据。使用经过验证的公式，通过疼痛缓解程度与时间曲线下的面积来计算服用依托考昔或安慰剂的参与者在6小时内疼痛缓解至少50%的比例。计算相对危险度（RR）和需治疗获益人数（NNT）。使用急救药物的信息用于计算需要急救药物的参与者比例以及使用急救药物的中位时间的加权平均值。还收集了不良反应的信息。
该综述纳入了5项研究（880名参与者）。所有5项研究均报告了120毫克剂量的情况，其中655名参与者与安慰剂进行了比较。服用120毫克依托考昔的参与者中有64%报告疼痛缓解至少50%，而服用安慰剂的为10%（NNT为1.9（1.7至2.1））。仅针对牙科研究，NNT为1.6（1.5至1.8）。两项研究还报告了180毫克和240毫克的更高剂量情况，涉及249名参与者。服用120毫克依托考昔的参与者中有79%报告疼痛缓解至少50%，而服用安慰剂的为12%（NNT为1.5（1.3至1.7））。服用120毫克依托考昔时使用急救药物的参与者明显少于服用安慰剂的参与者（预防使用急救药物的NNT为2.4（2.1至2.9）），使用急救药物的中位时间为20小时。不良反应报告率与安慰剂相似，未出现严重事件。
单剂量口服依托考昔术后能产生高质量的良好疼痛缓解效果。120毫克剂量与其他常用镇痛药效果相当或更佳。
