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Etoricoxib as a Pre-emptive Analgesic in Therapeutic Arthroscopy

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00738608
Recruitment Status : Completed
First Posted : August 20, 2008
Last Update Posted : September 18, 2009
Information provided by:
Marienkrankenhaus Soest

Brief Summary:
The aim of this study is to demonstrate that compared to placebo the preoperative administration of a single dose of 120 mg etoricoxib can provide adequate pain relief in the postoperative phase while reducing the need for systemic opioids. The primary endpoint is the decrease of systemic opioid use.

Condition or disease

Detailed Description:

Depending on the pain intensity, various analgesics are used in the prevention of surgical wound pain. For severe pain, opioids like piritramide and morphine are used. These can be given at fixed intervals, continuously, as required or by patient-controlled analgesia (PCA). The method used depends on the equipment and supervision available and on the patient's cooperation. However, with all the methods of administration mentioned there is a risk of respiratory depression because strong opioids are used. Weak opioids like tramadol can be given as alternatives to piritramide and morphine, a combination of tramadol and metamizol having proven effective. Often an antiemetic is given as well, as many patients who receive the combination experience nausea and vomiting. For mild pain metamizol or a nonsteroidal anti-inflammatory drug (NSAID) is often sufficient on its own.

As some controversy is attached to the use of metamizol because of the risk of agranulocytosis (metamizol was withdrawn from the Scandinavian market in 1999), some hospitals do not use the drug. The use of NSAIDs is likewise problematic. They can cause, for example, gastric ulcers in predisposed patients. In the setting of the stress accompanying surgery, however, even previously unremarkable patients can quickly develop stress ulcers. Another problem with NSAIDs is that they affect blood clotting to various extents by inhibiting platelet aggregation. This aspect is particularly crucial in the early treatment of postoperative pain when intact blood clotting is essential. An ideal analgesic for postoperative pain would not induce respiratory depression nor affect blood clotting nor cause gastric ulcers. Because inhibiting the enzyme cyclooxygenase-1 (COX-1) increases the effects on the gastric mucosa and on platelet aggregation, an analgesic should selectively inhibit only the enzyme cyclooxygenase-2 (COX-2), which mediates inflammatory processes. This is the rationale behind using COX-2 inhibitors in the treatment of acute pain. With selective COX-2-inhibiting analgesics it is possible to inhibit inflammatory processes without favoring the occurrence of clotting disturbances or gastric mucosal lesions. Such an analgesic is available in the form of etoricoxib, which exhibits greater COX-2 selectivity than other coxibs so far approved. Etoricoxib has mainly been used for the treatment of pain associated with osteoarthritis and rheumatoid arthritis pain and for chronic pain (lower back pain). However, coxibs have also been used with impressive results in the treatment of acute peri- and postoperative pain. Thus, a 50 mg preoperative dose of rofecoxib not only significantly decreased the postoperative need for analgesics but also reduced postoperative pain.

Etoricoxib exhibits similar properties to rofecoxib. It is already approved for the treatment of acute pain in Australia, Latin America (except Argentina), Mexico, Hong Kong, Singapore, Malaysia, the Philippines, Thailand, and Indonesia. The preoperative use of Etoricoxib could provide reliable analgesia in the postoperative phase with a potency comparable to that of NSAIDs and other coxibs but without affecting blood clotting processes or favoring the occurrence of gastric ulcers

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Study Type : Observational
Estimated Enrollment : 66 participants
Observational Model: Case-Control
Time Perspective: Prospective
Official Title: Etoricoxib as a Pre-emptive Analgesic in Therapeutic Arthroscopy
Study Start Date : June 2006
Actual Primary Completion Date : August 2009
Actual Study Completion Date : September 2009

33 pat. with verum
33 Pat. with placebo

Primary Outcome Measures :
  1. Pain [ Time Frame: 24h ]

Secondary Outcome Measures :
  1. Pain drugs [ Time Frame: 24h ]

Information from the National Library of Medicine

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Ages Eligible for Study:   19 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
66 pat. with knee arthrosocpy

Inclusion Criteria:

  • Knee arthroscopy

Exclusion Criteria:

  • Opiate addiction
  • Pregnancy or breast-feeding
  • Known hypersensitivity to the active substance or to any of the excipients of the film tablet
  • Active peptic ulcer or active gastrointestinal bleeding, inflammatory bowel disease, severe hepatic dysfunction (serum albumin <25 g/l or Child-Pugh score ≥10).
  • Further exclusion criteria are congestive heart failure (NYHA II-IV), hypertension with not adequately controlled blood pressure, established ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00738608

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Soest, Germany, 59494
Sponsors and Collaborators
Marienkrankenhaus Soest
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Study Chair: Peter Lierz, MD Marienkrankenhaus Soest
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Responsible Party: Dr. Lierz, Marienkrankenhaus Soest Identifier: NCT00738608    
Other Study ID Numbers: 2006-000451-17
First Posted: August 20, 2008    Key Record Dates
Last Update Posted: September 18, 2009
Last Verified: September 2009
Keywords provided by Marienkrankenhaus Soest:
Pain during 24h postoperative
Morphine consumption in 24h postoperative