In the name of God

Celecoxib as a pre-emptive analgesia in arthroscopic knee

surgery; a triple blinded randomized controlled trial

Mohsen Mardani-Kivi, M.D. Orthopedic

Department, Guilan University Of Medical

Sciences

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.

Background

• COX-2 inhibitors inhibitory effects in PG synthesis, & reduce hyperalgesia status following surgical traumas

• Celecoxib no side effects such as anti-PLT function, increased risk of GIB, Increased risk of CAD

The purpose of the study

• To examine the effects of celecoxib celecoxib in reducing pain following the arthroscopic knee surgeriesarthroscopic knee surgeries: ACL reconstruction and partial meniscectomy.

Methods and Materials:

Methods and Materials:

Variables were assessed at: 6 hour post-op, and 24 hour post-op

Flowchart of the study

Results

• The patients were similar in both groups with respect to demographic characteristics (such as age, gender, operation time, weight and BMI) (P>0.05).

 ACL

Reconstructionmeniscectomy

  Celecoxib PlaceboCelecoxi

bPlacebo

No. 34 33 31 32

Age (mean ±SD) 25.8±7.7 26.7±4.9 32.7±8 32.2±9.8

Gender (Male/Female)

6/28 8/25 9/22 12/20

Operation time 40±7 36.7±7 30.3±7 31.7±4

Weight (Kg) 76.6±9.4 74.3±9.9 78.3±6.4 76.2±7.7

BMI 24±2.6 23.6±3.5 24±2.7 23±2.6

Results:

• Patients in Celecoxib group experienced less pain than Placebo group (p<0.0001).

• Such significant difference was also observed in both ACL and M subgroups.

Follow-up

6hr 24hr

GroupMeniscectom

y(n=57)

ACL(n=60)

Meniscectomy(n=57)

ACL(n=60)

Subgroup

C(n=2

8)

P(n=29

)

C(n=29

)

P(n=31

)

C(n=28

)

P(n=29

)

C(n=29

)

P(n=31

)VAS 4.3 5.6 5.7 7.5 3.8 6.3 5.3 6.9

Median

4 7 5 7 4 7 5 7

P value

<0.0001 <0.0001 <0.0001 <0.0001

Table2. Pain intensity in subgroups at 6hr and 24hr according to VAS

Results:

C: Celecoxib groupP: Placebo group

Results: Opioid consumption

• analgesics used in celecoxib group was significantly lower than in placebo group (P<0.05).

Results: Opioid consumption

Follow-up 6hr 24hr

GroupMeniscectomy

(n=57)ACL

(n=60)Meniscectomy

(n=57)ACL

(n=60)

SubgroupC

(n=28)

P(n=29

)

C(n=29)

P(n=31

)

C(n=28

)

P(n=29)

C(n=29

)

P(n=31

)

Pethidine(mg/24hr)

19.2 42 23 35.8 11.4 28.4 26 39.2

Median 25 37 25 42 10 25 30 42

P value <0.0001 0.004 0.001 0.02

Table3. The comparison of opioid consumption between subgroups

Results: adverse effects

• All of the observed adverse effects were similar in both groups.– Nausea was observed among 12 cases

(21.1%) in Celecoxib and 21 patients (35%) in placebo group at 24hr follow-up (p=0.11).

– The drowsiness and dizziness scores were not significantly different between the two groups.

Discussion

Discussion

• Celecoxib effect is dose related dose related and clinical trial studies recommend celecoxib 400 mg celecoxib 400 mg to control acute pain (as we applied).

Discussion

• The results of the present study celecoxib may decrease pain and opioid consumption.

• Ekman et al. / 2006 / partial meniscectomy / 200 patients / significantly reduce morphine consumption

• Huang et al. / 2008 / 40 patients / TKA / decreased pain and opioids and side effects.

Discussion

• On the contrary:• Boonriong et al. / 102 patients / ACL /

reported no no significant differences in pain reduction and analgesic consumption between the celecoxib and placebo groups.

Discussion

• Celecoxib potential adverse effects on bone growth by interfering in bone morphogenetic protein (BMP) signaling system.

• BMP may also plays certain role in early tendon formation and any interference in its signaling system during post operation time may also delay tendon repair.

Discussion

recommendation• a larger population• vast range of different side effects • further long term follow-up research

studies investigating the conclusive evidence of the effects of COX-2 inhibitors on bone formation and tendon repair

Any suggestions?