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Evidence summaries

Single Dose Coxibs for Postoperative Pain

Coxibs are effective as single-dose treatments of postoperative pain. However, the benefits must be weighed against the possibility of adverse cardiovascular outcomes at least in some of the coxibs. Level of evidence: "A"

A Cochrane review 1 (review [Abstract]) included 27 studies on oral rofecoxib in postoperative pain with a total of 2 636 subjects. The NNT for at least 50% pain relief over 4 to 6 hours with rofecoxib 50 mg was 2.2 (2.0 to 2.3) in all studies combined, 1.9 (1.8 to 2.0) in dental studies, and 6.8 (4.6 to 13) in other types of surgery. Rofecoxib (Vioxx® ) was withdrawn from the market at the end of September 2004 after it was shown that its use increases the risk of heart attack and stroke.

A Cochrane review 2 (review [Abstract]) included six studies on oral etoricoxib in postoperative pain with a total of 1 214 subjects. All six studies reported on 120 mg, with 798 participants in a comparison with placebo. At least 50% pain relief was reported by 66% with etoricoxib 120 mg and 12% with placebo, NNT 1.8 (1.7 to 2.0). For dental studies only the NNT was 1.6 (1.5 to 1.8).

A Cochrane review 1 (review[Abstract]) included 10 studies on oral celecoxib in postoperative pain with a total of 1 785 subjects. The NNT for celecoxib 200 mg and 400 mg compared with placebo for at least 50% pain relief over four to six hours was 4.2 (CI 3.4 to 5.6) and 2.6 (2.3 to 3.0) respectively. The median time to use of rescue medication was 6.6 hours with celecoxib 200 mg, 8.4 hours with celecoxib 400 mg, and 2.3 hours with placebo. The proportion of participants requiring rescue medication over 24 hours was 74% with celecoxib 200 mg, 63% for celecoxib 400 mg, and 91% for placebo. The NNT to prevent one patient using rescue medication was 4.8 (95% CI 3.5 to 7.7) and 3.5 (95% CI 2.9 to 4.6) for celecoxib 200 mg and 400 mg respectively. Adverse events were generally mild to moderate in severity, and were experienced by a similar proportion of participants in the celecoxib and placebo groups. One serious adverse event that was probably related to celecoxib was reported

A Cochrane review 4 (review [Abstract]) included 7 studies on intramuscular or intravenous parecoxib in postoperative pain with a total of 1 446 subjects. There was no significant difference between doses, or between intravenous and intramuscular administration for 50% pain relief over 6 hours: NNTs compared with placebo were 3.1 (2.4 to 4.5), 2.4 (2.1 to 2.8), and 1.8 (1.5 to 2.3) for 10, 20, and 40 mg parecoxib respectively.

    References

    • Bulley S, Derry S, Moore RA, McQuay HJ. Single dose oral rofecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev 2009 Oct 7;(4):CD004604. [PubMed]
    • Clarke R, Derry S, Moore RA. Single dose oral etoricoxib for acute postoperative pain in adults. Cochrane Database Syst Rev 2012;(4):CD004309. [PubMed].
    • Derry S, Moore RA. Single dose oral celecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev 2013;(10):CD004233. [PubMed]
    • Lloyd R, Derry S, Moore RA, McQuay HJ. Intravenous or intramuscular parecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev 2009 Apr 15;(2):CD004771. [PubMed]

Primary/Secondary Keywords