Single dose oral celecoxib for postoperative pain
Abstract
Background
Celecoxib is a selective cyclooxygenase‐2 (COX‐2) inhibitor prescribed for the relief of chronic pain in osteoarthritis and rheumatoid arthritis. The drug is believed to be associated with fewer adverse effects than conventional non‐steroidal anti‐inflammatory drugs (NSAIDs). However, the effectiveness of celecoxib in the treatment of acute pain has not yet been assessed by systematic review.
Objectives
To assess the analgesic efficacy and adverse effects of a single oral dose of celecoxib for moderate to severe postoperative pain.
Search methods
We searched the Cochrane Library Controlled Trials Register, MEDLINE, Biological Abstracts, PubMed and the Oxford Pain database. Date of the most recent search: May 2002.
Selection criteria
Randomised controlled trials (RCTs) of adults prescribed any dose of oral celecoxib or placebo for acute postoperative pain were included.
Data collection and analysis
Two trials (418 subjects) met the inclusion criteria for this review. The trials were assessed for quality and the data extracted by two independent reviewers. Summed pain relief (TOTPAR) or pain intensity difference (SPID) was extracted and converted into dichotomous information yielding the number of patients with at least 50% pain relief over 4‐6 hours. These derived results were used to calculate the relative benefit (RB) and number‐needed‐to‐treat (NNT) for one patient to achieve at least 50% pain relief.
Main results
The number‐needed‐to‐treat for celecoxib 200 mg compared with placebo was 4.5 (CI 3.3 to 7.2). For every 4.5 patients experiencing moderate to severe acute pain treated with celecoxib 200 mg one more will experience at least 50% pain relief that would not have done had they received placebo. The median time to remedication over 24 hours was 5.1 hours with celecoxib 200 mg and 1.5 hours with placebo. Quantitative analysis of adverse effects was not possible but no serious or unexpected adverse effects were reported.
Authors' conclusions
Single dose oral celecoxib is an effective means of postoperative pain relief, similar in efficacy to aspirin 600/650 mg, and paracetamol 1000 mg. The two trials included used celecoxib 200 mg, a dose 50% less than is recommended for acute pain. More trials are needed to estimate efficacy for recommended dose of 400 mg, and to reinforce current findings for 200 mg, and provide data for pooled quantitative estimates of adverse effects.
PICOs
Plain language summary
Single dose oral celecoxib 200 mg is effective for treating moderate to severe postoperative pain
Celecoxib is one of a new generation of non‐steroidal anti‐inflammatory drugs (NSAIDs). Compared with conventional NSAIDs celecoxib may have fewer gastrointestinal side effects with long‐term use. It is recommended for the relief of chronic pain caused by osteoarthritis and rheumatoid arthritis. This review examined the efficacy of celecoxib in relieving acute pain. Two trials provided data and showed that a 200 mg dose of celecoxib was at least as effective as aspirin 600/650 mg and paracetamol (acetaminophen) 1000 mg for relieving postoperative pain. No serious adverse effects were reported but there was insufficient information for quantitative analysis of these.
