Effects of celecoxib on blood loss, pain, and recovery of function after total knee replacement: A randomized placebo-controlled trial

Background Pain management after surgery has been used as a sales argument for the use of COX-2 inhibitors, but their potential positive and negative effects have not been fully investigated. We thus conducted a controlled evaluation of the effect of celecoxib on perioperative blood loss, pain relief and consumption of analgesics, range of motion, and subjective outcome in conjunction with total knee replacement (TKR). Method 50 patients were randomized to either placebo or celecoxib (200 mg) preoperatively and then twice daily. Total blood loss was calculated by the Hb balance method, taking the patient's pre- and postoperative hemoglobin and blood volume into account. Pain scores (VAS), range of motion, and subjective outcome (KOOS) were monitored postoperatively and during the first year after surgery. Results No differences in total, hidden, or drainage blood loss were found between the groups. There were 30% lower pain scores during the first 4 weeks after surgery and lower morphine consumption after surgery in the celecoxib group, while no effect was seen on pain, range of motion, and subjective outcome at the 1 year follow-up. Interpretation Celecoxib does not increase perioperative blood loss but reduces pain during the postoperative period after TKR. It is not necessary to discontinue celecoxib before surgery. The postoperative use of celecoxib did not increase range of motion or subjective outcome 1 year after TKR.

[1]  Richard Beasley,et al.  Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis. , 2006, Journal of the Royal Society of Medicine.

[2]  R. Moore,et al.  Correction: Tolerability and adverse events in clinical trials of celecoxib in osteoarthritis and rheumatoid arthritis: systematic review and meta-analysis of information from company clinical trial reports , 2005, Arthritis Research & Therapy.

[3]  T. Schnitzer,et al.  Efficacy of rofecoxib, celecoxib, and acetaminophen in patients with osteoarthritis of the knee. A combined analysis of the VACT studies. , 2005, The Journal of rheumatology.

[4]  G. Eisen,et al.  Meta‐analysis: upper gastrointestinal tolerability of valdecoxib, a cyclooxygenase‐2‐specific inhibitor, compared with nonspecific nonsteroidal anti‐inflammatory drugs among patients with osteoarthritis and rheumatoid arthritis , 2005, Alimentary pharmacology & therapeutics.

[5]  J. Newman,et al.  Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. , 2004, The Journal of bone and joint surgery. British volume.

[6]  A Gibofsky,et al.  Patient Preference for Placebo, Acetaminophen (paracetamol) or Celecoxib Efficacy Studies (PACES): two randomised, double blind, placebo controlled, crossover clinical trials in patients with knee or hip osteoarthritis , 2004, Annals of the rheumatic diseases.

[7]  R. Dirksen,et al.  COX 2 selectivity of non-steroidal anti-inflammatory drugs and perioperative blood loss in hip surgery. A randomized comparison of indomethacin and meloxicam , 2003, European journal of anaesthesiology.

[8]  A. Rosenberg,et al.  Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor on pain management and recovery of function after knee replacement: a randomized controlled trial. , 2003, JAMA.

[9]  R. Makuch,et al.  Cardiovascular thrombotic events in arthritis trials of the cyclooxygenase-2 inhibitor celecoxib. , 2003, The American journal of cardiology.

[10]  L. Good,et al.  Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. , 2003, British journal of anaesthesia.

[11]  R. Dirksen,et al.  Does ibuprofen increase perioperative blood loss during hip arthroplasty? , 2002, European journal of anaesthesiology.

[12]  Evans,et al.  How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. , 2000, The Knee.

[13]  P. Isakson,et al.  Effects of Celecoxib, a Novel Cyclooxygenase‐2 Inhibitor, on Platelet Function in Healthy Adults: A Randomized, Controlled Trial , 2000, Journal of clinical pharmacology.

[14]  C. Ekdahl,et al.  Knee injury and Osteoarthritis Outcome Score (KOOS) ‐ validation of a Swedish version , 1998, Scandinavian journal of medicine & science in sports.

[15]  M. Vegfors,et al.  Giving both enoxaparin and dextran increases the need for transfusion in revision hip arthroplasty. , 1996, The European journal of surgery = Acta chirurgica.

[16]  P. Faunø,et al.  Increased blood loss after preoperative NSAID. Retrospective study of 186 hip arthroplasties. , 1993, Acta orthopaedica Scandinavica.

[17]  P. Flordal,et al.  Blood loss in total hip replacement , 1991, Archives of Orthopaedic and Trauma Surgery.

[18]  R. Friedman,et al.  Blood loss in total knee arthroplasty. , 1991, Clinical orthopaedics and related research.

[19]  S. Nadler,et al.  Prediction of blood volume in normal human adults. , 1962, Surgery.

[20]  R. Krushell,et al.  Evaluation of the safety and efficacy of the perioperative administration of rofecoxib for total knee arthroplasty. , 2002, The Journal of arthroplasty.

[21]  R. Krushell,et al.  RETRACTED: Evaluation of the safety and efficacy of the perioperative administration of rofecoxib for total knee arthroplasty , 2002 .

[22]  F. Mercuriali,et al.  Proposal of an algorithm to help the choice of the best transfusion strategy. , 1996, Current medical research and opinion.