Perioperative use of etoricoxib in patients undergoing total abdominal hysterectomy
Perioperative use of etoricoxib, a selective COX-2 inhibitor, in patients undergoing total abdominal hysterectomy significantly reduces both resting and elicited pain and opioid (morphine) consumption compared with placebo, according to results presented at the American Pain Society's 30th Annual Scientific Meeting.
Nonsteroidal anti-inflammatory drugs (NSAIDs) have demonstrated analgesic efficacy with concurrent reduction in opioid use in some acute pain settings, but their perioperative use is limited by concerns of excessive intraoperative and postoperative bleeding related to inhibition of platelet aggregation through cyclooxygenase (COX)-1.
Eugene Viscusi, MD, of Thomas Jefferson University Hospital, Philadelphia, and colleagues conducted this double-blind, placebo-controlled, randomized trial to evaluate postoperative pain following total abdominal hysterectomy in patients receiving preoperative placebo or etoricoxib. Patients were randomly assigned to placebo (n=144), etoricoxib 90mg (n=142), or etoricoxib 120mg (n=144) 1-2 hours preoperatively, and then daily for 4 days postoperatively (total of 5 doses).
The primary endpoint—the average pain intensity at rest over Days 1 to 3 measured by the 0–10 point numerical rating scale (NRS)—had least square means of 3.26, 2.46, and 2.40 for placebo, etoricoxib 90mg, and etoricoxib 120mg, respectively, demonstrating a significant difference for both etoricoxib doses vs. placebo (95% CI, P<0.001).
One of the secondary endpoints, average total daily dose of morphine over Days 1 to 3, achieved statistically significant reduction (P<0.001) for patients on etoricoxib 90mg and 120mg, who required 30 to 31% less morphine per day vs. placebo. Another secondary endpoint, average elicited pain upon sitting over Days 1-3, also resulted in a significant reduction for both doses of etoricoxib doses vs. placebo.
Reduced opioid utilization led to more rapid bowel recovery. The authors also assessed elicited pain upon standing and walking (0–10 point NRS and pain scores of <3 (mild pain intensity) on movement, which optimizes functional recovery. The proportion of patients achieving mild pain at rest and with movement was higher with etoricoxib 120mg for all days compared with etoricoxib 90mg or placebo.
The most common adverse events in all patients were nausea, pyrexia, and constipation. The study authors concluded that the reduction in opioid consumption demonstrated by these results with the perioperative use of etoricoxib 90mg and 120mg in patients undergoing total abdominal hysterectomy is “clinically meaningful,” as evidenced by acceleration of the recovery of bowel function in the etoricoxib groups vs. placebo.