Influence of diclofenac (group of nonsteroidal anti-inflammatory drugs) on fracture healing

Beck, Alexander; Krischak, Gert; Sorg, Tobias; Augat, Peter; Farker, K; Merkel, Ute; Kinzl, L.; Claes, Lutz

doi:10.1007/s00402-003-0537-5

Cited by 122 publications

(90 citation statements)

References 20 publications

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“…6 It has an analgesic, antipyretic and antiinflammatory effects. 7 Therefore, it could have an influence on fracture healing. The action of this drug is based on the inhibition of cyclo-oxygenase (COX) which converts the arachidonic acid that is set free from the cell wall into prostaglandin, prostacycline and thromboxane.…”

Section: Introductionmentioning

confidence: 99%

“…The action of this drug is based on the inhibition of cyclo-oxygenase (COX) which converts the arachidonic acid that is set free from the cell wall into prostaglandin, prostacycline and thromboxane. 7 However, NSAIDs have been reported to be associated with various complications such as upper gastrointestinal complication, platelet function inhibition, increase in perioperative bleeding and nephrotoxicity in patients with and without pre-existing renal insufficiency. 5,8 The search for appropriate drugs to treat patients with moderate-to-severe pain has led to the development of tramadol hydrochloride.…”

Section: Introductionmentioning

confidence: 99%

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Comparative evaluation of analgesic efficacy of tramadol and diclofenac-sodium in post-operative orthopedic patients

Paudel

Deka

Gupta

et al. 2017

Int J Basic Clin Pharmacol

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Background: Post-operative pain management is an important consideration in the orthopedic department. The purpose of this study was to compare the analgesic efficacy of tramadol with diclofenac sodium in patients with postoperative orthopedic pain.Methods: A hospital based, prospective, observational study was undertaken in Department of Orthopedics for a period of one year. A group of 60 patients having post-operative pain intensity assessed as 6cm or more on a 10cm visual analogue scale (VAS) were assigned to receive either tramadol thrice a day (n=30) or diclofenac sodium thrice a day (n=30). Both drugs were administered parenterally for initial 24hr, then orally for next 96 hr. The primary efficacy outcome measures were pain intensity difference assessed at 2hr, 4hr, 8hr, 16hr, 24hr, 32hr, 40hr, 48hr, 56hr, 64hr, 72hr, 80hr, 96hr, 104hr, 112hr and 120hr using a VAS and sum of pain intensity differences assessed at 8hr, 24hr, 48hr, 72hr, 96hr and 120hr whereas secondary efficacy measures included maximum fall in pain intensity, number of patients who required rescue medication and their quality of sleep in the night.Results: Mean pain intensity differences assessed on 10cm VAS were significantly better for tramadol group compared to diclofenac group at all the time points except 88 hr. Sum of pain intensity differences over 8hr, 24hr, 48hr, 72hr, 96hr and 120 hr for the tramadol group was significantly superior than diclofenac group. Maximum fall in pain intensity score was also significantly superior in the tramadol group as compared to the diclofenac group. However, no patients required rescue medication in either of the groups. Patient’s quality of sleep improved with both drugs but tramadol produced significantly better quality of sleep every night than did diclofenac. Both the study medications produced effective analgesia and were well tolerated with no incidence of serious adverse effects throughout the study.Conclusions: Tramadol has a more pronounced analgesic effect than diclofenac. Thus, tramadol can be considered as an effective alternative to traditional NSAIDs in the treatment of post-operative pain.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative evaluation of analgesic efficacy of tramadol and diclofenac-sodium in post-operative orthopedic patients

Paudel

Deka

Gupta

et al. 2017

Int J Basic Clin Pharmacol

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“…Results from multiple studies in various species are variable and show conflicting results on the degree and effects of these agents. For example, treatment with ns-NSAIDs (e.g., aspirin, diclofenac, ibuprofen, indomethacin, and tenoxicam) was associated with impaired bone healing in rats and rabbits (Allen et al 1980;Altman et al 1995;Beck et al 2003;Brown et al 2004;Giordano et al 2003;Jaffré et al 2003;Keller et al 1987;Lindholm and Tornkvist 1981;Pablos et al 2008). In contrast, quantitative histomorphometric indices of bone formation and resorption, as well as cartilage histology, were not significantly different between indomethacin-treated and nontreated rats (Boiskin et al 1988).…”

Section: Effects Of Cox Inhibitors On Bone Tendon and Ligament Healingmentioning

confidence: 99%

Pathophysiology of Cyclooxygenase Inhibition in Animal Models

Radi

2009

Toxicol Pathol

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Cyclooxygenase (COX) catalyzes the conversion of arachidonic acid into prostaglandins (PGs), which play a significant role in health and disease in the gastrointestinal tract (GI) and in the renal, skeletal, and ocular systems. COX-1 is constitutively expressed and found in most normal tissues, whereas COX-2 can be expressed at low levels in normal tissues and is highly induced by pro-inflammatory mediators. Inhibitors of COX activity include: (1) conventional nonselective, nonsteroidal anti-inflammatory drugs (ns-NSAIDs) and (2) COX-2 selective nonsteroidal antiinflammatory drugs (COX-2 s-NSAIDs). Inhibition of COX-1 often elicits GI toxicity in animals and humans. Therefore, COX-2 s-NSAIDs were developed to provide a selective COX-2 agent, while minimizing the attendant COX-1-mediated GI toxicities. Rats and dogs overpredict COX inhibition for renal effects such as renal handling of electrolytes in humans. COX inhibitors are shown to have both beneficial and detrimental effects, such as on healing of ligament or tendon tears, on the skeletal system in animal models. Certain ophthalmic conditions such as glaucoma and keratitis are associated with increased COX-2 expression, suggesting a potential role in their pathophysiology.

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“…Zentrales Be handlungsziel ist die Wiederherstellung der objektiven und subjektiven Funktions fähigkeit ("functional restoration") mit nachhaltiger Steigerung der Kontrollfä higkeit, des Kompetenzerlebens und der Selbstwirksamkeit des Betroffenen [36] In NSAR können tierexperimentell die Frakturheilung hemmen [6] was bei ei nem frakturierten Wirbelkörper durch aus relevant sein kann. In großen Studi en ist aber keine Frakturhäufung durch den Einsatz von NSAR beschrieben [47].…”

Section: Interdisziplinäre Multimodale Schmerztherapieunclassified

Risikoabschätzung in der Schmerztherapie

Schoeffel

Casser

Bach³

et al. 2008

Schmerz

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Influence of diclofenac (group of nonsteroidal anti-inflammatory drugs) on fracture healing

Abstract: Oral application of diclofenac significantly delayed fracture healing in rats. This effect might be comparable to other NSAR and fracture healing in humans.

Cited by 122 publications

References 20 publications

Comparative evaluation of analgesic efficacy of tramadol and diclofenac-sodium in post-operative orthopedic patients

Comparative evaluation of analgesic efficacy of tramadol and diclofenac-sodium in post-operative orthopedic patients

Pathophysiology of Cyclooxygenase Inhibition in Animal Models

Risikoabschätzung in der Schmerztherapie

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