Parecoxib Provides Analgesic and Opioid-Sparing Effects Following Major Orthopedic Surgery: A Subset Analysis of a Randomized, Placebo-Controlled Clinical Trial

Abstract

IntroductionOrthopedic surgeries are among the most common and most painful surgeries performed. A multimodal analgesic approach is recommended to reduce opioid consumption, provide effective pain relief, and improve outcomes following surgery. This study examined the efficacy and opioid-sparing effects of parecoxib following major orthopedic surgery.MethodsThis subset analysis of a large, multicenter, randomized, double-blind, placebo-controlled study of parecoxib examined treatment effects on postoperative pain severity, pain interference with function, opioid consumption, occurrence of opioid-related symptoms, safety, and patient satisfaction following major orthopedic surgery.ResultsPain scores were significantly lower in the parecoxib group (n = 142) compared with placebo (n = 139) on day 2 (−22%; p < 0.001) and day 3 (−17%; p = 0.004). Pain interference with function scores were also significantly lower in the parecoxib group on day 2 (−32%; p < 0.001) and day 3 (−27%; p = 0.003) relative to placebo. Additionally, significantly less supplemental morphine was required in the parecoxib group relative to placebo through 24 h (−28%; p = 0.008) and 48 h (−33%; p < 0.001). Patients in the parecoxib group had a reduced risk of experiencing opioid-related symptoms including fatigue, drowsiness, inability to concentrate, confusion, nausea, constipation, and confusion on day 2 and/or day 3. Finally, more patients receiving parecoxib (42%) rated treatment as “excellent” compared to those receiving placebo (21%).ConclusionsThese findings support the use of parecoxib for the management of pain following major orthopedic surgery.

<p>A cost-consequence analysis of parecoxib and opioids vs opioids alone for postoperative pain: Chinese perspective</p>

“…A recent comprehensive review of all parecoxib trials reported consistent outcomes across all trials, regardless of the populations or comparators included 26. Analyses of subpopulations of the main trial also showed very similar outcomes regardless of surgery type 23–25. The trial that the present analysis was based on included 113 centers from 14 different countries.…”

“…Recently, subpopulation analyses have confirmed that these results are consistently observed across subpopulations defined according to surgery types too 23–25…”

Do Narcotic Use, Physical Therapy Location, or Payer Type Predict Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction?

“…As narcotic use was not associated with KOOS subscale scores or HSS Pedi-FABS scores, patients should be switched to an analgesic with less addictive potential as soon as their pain levels permit. Previous studies have identified ways to decrease opioid use after orthopaedic surgery, such as through acetominophen 52 , 60 or parecoxib 11 , 23 , 34 administration. With opioid-related deaths increasing 17 and documented negative effects of opioids after surgery, 20 providers should attempt to use a multimodal pain-management strategy to reduce opioid addiction burden on patients.…”

Structural Modification in Anesthetic Drug Development for Prodrugs and Soft Drugs

“…A pooled analysis of 28 randomized, placebo-controlled clinical trials with 9287 patients has shown that skin rash and cardiac complications occur infrequently with parecoxib administration, which highlight its safety in patients (Schug et al, 2017). Currently, it is approved in over 80 countries for perioperative pain control and may help reduce opioid use (Diaz-Borjon et al, 2017).…”