Single dose oral etoricoxib for acute postoperative pain in adults

 

Abstract

Background

Etoricoxib is a selective cyclo-oxygenase-2 (COX-2) inhibitor prescribed for the relief of chronic pain in osteoarthritis and rheumatoid arthritis, and acute pain. The drug is believed to be associated with fewer upper gastrointestinal adverse effects than conventional non-steroidal anti-inflammatory drugs (NSAIDs). A number of studies in acute postoperative pain have now been published.

Objectives

To assess the analgesic efficacy and adverse effects of a single oral dose of etoricoxib for moderate to severe postoperative pain.

Search methods

We searched Cochrane CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Database, and reference lists of articles. Date of the most recent search: December 2008.

Selection criteria

Randomised, double-blind, placebo-controlled clinical trials of single dose, oral etoricoxib for acute postoperative pain in adults.

Data collection and analysis

Two review authors independently assessed trials for inclusion in the review and quality, and extracted data. The area under the pain relief versus time curve was used to derive the proportion of participants prescribed etoricoxib or placebo with at least 50% pain relief over six hours, using validated equations. Relative risk (RR) and number needed to treat to benefit (NNT) were calculated. Information on use of rescue medication was used to calculate the proportion of participants requiring rescue medication and the weighted mean of the median time to use. Information on adverse effects was also collected.

Main results

Five studies (880 participants) were included in the review. All five studies reported on 120 mg, with 655 participants in a comparison with placebo. At least 50% pain relief was reported by 64% with etoricoxib 120 mg and 10% with placebo (NNT 1.9 (1.7 to 2.1)). For dental studies only the NNT was 1.6 (1.5 to 1.8). Two studies also reported on higher doses of 180 and 240 mg, with 249 participants. At least 50% pain relief was reported by 79% with etoricoxib 120 mg and 12% with placebo (NNT 1.5 (1.3 to 1.7)).

Significantly fewer participants used rescue medication when taking etoricoxib 120 mg than those taking placebo (NNT to prevent remedication 2.4 (2.1 to 2.9)), and the median time to use of rescue medication was 20 hours. Adverse events were reported at a similar rate to placebo, with no serious events.

Authors' conclusions

Single dose oral etoricoxib produces high levels of good quality pain relief after surgery. The 120 mg dose is as effective as, or better than, other commonly used analgesics.

 

Plain language summary

Single dose oral etoricoxib for acute pain relief in adults experiencing moderate or severe pain following a surgical procedure

Etoricoxib is a non-steroidal anti-inflammatory drug (NSAID) which produces relief of pain in a number of different painful conditions. This review looked at how good etoricoxib was in relieving moderate or severe pain after surgery. Five studies provided information. Etoricoxib 120 mg provided effective pain relief for two thirds of participants for over 20 hours, compared with only one in ten participants for two hours with placebo, making it one of the most effective oral analgesics in acute pain. Adverse events occurred at similar rates with etoricoxib and placebo. There were no serious adverse events or withdrawals due to adverse events with etoricoxib.

 

摘要

背景

單一劑量口服etoricoxib於成人急性手術後疼痛

Etoricoxib是一種選擇性環氧化脢−2 (COX  2的)抑制劑用於慢性疼痛如骨關節炎及類風濕關節炎和急性疼痛。該藥物被認為與傳統的非類固醇抗炎藥相比是較少與上消化道副作用。一些在手術後急性疼痛現研究已發表。

目標

評估單一劑量口服etoricoxib對中度至重度手術後疼痛的止痛效果及不良反應。

搜尋策略

我們搜查Cochrane CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Database, and reference lists of articles。最近搜索日期：2008年12月。

選擇標準

單一劑量，口服etoricoxib在成人急性手術後疼痛的隨機，雙盲，安慰劑對照組的臨床試驗。

資料收集與分析

兩位獨立審查者評估列入審查的試驗和品質，並擷取數據。使用驗證方程式與疼痛緩解隨時間曲線的區域下用於計算使用etoricoxib或安慰劑至少有50 ％的疼痛緩解持續6小時的比例。計算相對風險率(RR)和需要治療病人數(NNT)。使用救援藥品報告是用來計算受試者要求使用救援藥品和加權平均中位數的時間的比例。不良反應的報告也收集。

主要結論

五項研究(880人)被列入這項回顧。這5項研究報告中含有655位受試者口服劑量120毫克與使用安慰劑比較。至少50％的疼痛緩解效果，64％是使用etoricoxib 120毫克與和10％是使用安慰劑(需要治療病數1.9 (1.7 to 2.1)。在牙科病人的需要治療病數只有1.6 (1.5 to 1.8) 。其中兩項研究也報告在較高劑量的180和240毫克，共249個受試者。至少50 ％的疼痛緩解效果，79 ％是使用etoricoxib 120毫克和12 ％ ，是使用安慰劑(需要治療病數1.5 (1.3 to 1.7)。使用etoricoxib 120毫克與那些服用安慰劑相比，需再使用救援藥物明顯下降(NNT to prevent remedication 2.4(2.1到2.9)，使用救援藥品的中位數是20小時。和安慰劑組類似，沒有任何嚴重不良事件報告。

作者結論

單一劑量口服etoricoxib產生高品質水準的手術後疼痛緩解。120毫克的劑量是一樣有效，或優於其他常用的止痛藥。

翻譯人

本摘要由三軍總醫院詹舜名翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Etoricoxib是一種非類固醇消炎藥用於減輕在不同狀況下的痛苦。本次是回顧etoricoxib在中度或重度手術後疼痛的減輕程度有多好。五項研究提供了資料。Etoricoxib 120毫克在三分之二受試者提供了超過20小時有效的緩解疼痛，而在使用安慰劑受試者只有十分之一有2個小時的緩解疼痛緩解，使它成為在急性疼痛是最有效的口服止痛藥之一。不良事件的發生率在etoricoxib和安慰劑是差不多的。沒有發生任何嚴重不良事件或由於因etoricoxib不良反應而撤回 。