Etoricoxib as a Pre-emptive Analgesic in Therapeutic Arthroscopy
Condition: Pain
Study type: Observational

Summary: 
      The aim of this study is to demonstrate that compared to placebo the preoperative
      administration of a single dose of 120 mg etoricoxib can provide adequate pain relief in the
      postoperative phase while reducing the need for systemic opioids. The primary endpoint is the
      decrease of systemic opioid use.
    

Detailed description: 
      Depending on the pain intensity, various analgesics are used in the prevention of surgical
      wound pain. For severe pain, opioids like piritramide and morphine are used. These can be
      given at fixed intervals, continuously, as required or by patient-controlled analgesia (PCA).
      The method used depends on the equipment and supervision available and on the patient's
      cooperation. However, with all the methods of administration mentioned there is a risk of
      respiratory depression because strong opioids are used. Weak opioids like tramadol can be
      given as alternatives to piritramide and morphine, a combination of tramadol and metamizol
      having proven effective. Often an antiemetic is given as well, as many patients who receive
      the combination experience nausea and vomiting. For mild pain metamizol or a nonsteroidal
      anti-inflammatory drug (NSAID) is often sufficient on its own.

      As some controversy is attached to the use of metamizol because of the risk of
      agranulocytosis (metamizol was withdrawn from the Scandinavian market in 1999), some
      hospitals do not use the drug. The use of NSAIDs is likewise problematic. They can cause, for
      example, gastric ulcers in predisposed patients. In the setting of the stress accompanying
      surgery, however, even previously unremarkable patients can quickly develop stress ulcers.
      Another problem with NSAIDs is that they affect blood clotting to various extents by
      inhibiting platelet aggregation. This aspect is particularly crucial in the early treatment
      of postoperative pain when intact blood clotting is essential. An ideal analgesic for
      postoperative pain would not induce respiratory depression nor affect blood clotting nor
      cause gastric ulcers. Because inhibiting the enzyme cyclooxygenase-1 (COX-1) increases the
      effects on the gastric mucosa and on platelet aggregation, an analgesic should selectively
      inhibit only the enzyme cyclooxygenase-2 (COX-2), which mediates inflammatory processes. This
      is the rationale behind using COX-2 inhibitors in the treatment of acute pain. With selective
      COX-2-inhibiting analgesics it is possible to inhibit inflammatory processes without favoring
      the occurrence of clotting disturbances or gastric mucosal lesions. Such an analgesic is
      available in the form of etoricoxib, which exhibits greater COX-2 selectivity than other
      coxibs so far approved. Etoricoxib has mainly been used for the treatment of pain associated
      with osteoarthritis and rheumatoid arthritis pain and for chronic pain (lower back pain).
      However, coxibs have also been used with impressive results in the treatment of acute peri-
      and postoperative pain. Thus, a 50 mg preoperative dose of rofecoxib not only significantly
      decreased the postoperative need for analgesics but also reduced postoperative pain.

      Etoricoxib exhibits similar properties to rofecoxib. It is already approved for the treatment
      of acute pain in Australia, Latin America (except Argentina), Mexico, Hong Kong, Singapore,
      Malaysia, the Philippines, Thailand, and Indonesia. The preoperative use of Etoricoxib could
      provide reliable analgesia in the postoperative phase with a potency comparable to that of
      NSAIDs and other coxibs but without affecting blood clotting processes or favoring the
      occurrence of gastric ulcers
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        66 pat. with knee arthrosocpy
      
Keywords: morphine; consumption; postoperative; pain; Pain during 24h postoperative; Morphine consumption in 24h postoperative