Recent randomized controlled trials comparing the efficacy between intraoperative methadone and other opioids on postoperative outcomes have been limited by their small sample sizes and conflicting results. We performed a meta-analysis on randomized controlled trials which investigated outcomes between methadone and an opioid control group. Primary outcome data included postoperative opioid consumption, number of patients who received postoperative opioids, time to first analgesic, and pain scores. Secondary outcomes included time to extubation and incidence of nausea, vomiting, and respiratory depression. Statistical analysis was performed using RevMan. A P < 0.05 was considered statistically significant. Nine studies comprising 632 patients were included. There was no statistically significant reduction in opioid consumption postoperatively between the groups. Forty-seven percentage of patients in the methadone group received a dose of opioid postoperatively compared with 55% in the other opioids control group, which was not statistically significant. (P = 0.25) There was no difference in average time to receiving first postoperative analgesic among the groups. Pain scores within 24 hours were significantly lower in the methadone group when compared with other opioids (8 studies, n = 622, −0.49 [−0.74, −0.23], P = 0.002). However, there was no difference between 24 and 72 hours. There was no difference among the groups with respect to extubation time, nausea, vomiting, or respiratory depression. This meta-analysis concludes that there is currently insufficient evidence for the use of intraoperative methadone, when compared with other opioids. Although there was a decrease in average pain scores with methadone when compared with controls at 24 hours, there was no difference between 24 and 72 hours.
Background: Osteoarthritis (OA) is most common form of arthritis; also referred as degenerative joint disease or “wear and tear” arthritis. Cyclooxygenase-2 (COX-2) inhibitors are effective for pain and inflammation in OA and gained importance over conventional non-steroidal anti-inflammatory agents (NSAIDs), as causes significantly less toxicity, particularly, in gastrointestinal tract. The objective of the present research was to study the short-term comparative clinical efficacy of aceclofenac and etoricoxib in patients with osteoarthritis and to compare the safety profile of the two drugs i.e. aceclofenac and etoricoxib.Methods: The present study was a prospective, open label, parallel, intention to treat 80 patients out of 102 screened for osteoarthritis in the Department of Orthopaedics, Guru Nanak Dev Hospital attached to the Government Medical College, Amritsar. Patients were randomly divided in two groups with 40 patients each. Group A patients received Tab etoricoxib 60mg once daily and Group B patients received Tab. Aceclofenac 100mg twice daily. Patients were followed up after three weeks and at six weeks for clinical efficacy and safety.Results: Both the groups found to have significant improvement in signs and symptoms of osteoarthritis. However, aceclofenac was superior to etoricoxib in terms of change in visual analogue scale score, osteoarthritic severity index, patients’ and physicians’ global assessment while, etoricoxib was superior in terms of WOMAC osteoarthritic index and safety parameters in terms of ADR.Conclusions: Etoricoxib was better than conventional NSAIDs for the symptomatic management of osteoarthritis in terms of safety profile and clinical efficacy.
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