Single dose oral celecoxib for acute postoperative pain in adults

Abstract

Background: This is an update of a review published in The Cochrane Library 2008, Issue 4. Celecoxib is a selective cyclo-oxygenase-2 (COX-2) inhibitor usually prescribed for the relief of chronic pain in osteoarthritis and rheumatoid arthritis. Celecoxib is believed to be associated with fewer upper gastrointestinal adverse effects than conventional non-steroidal anti-inflammatory drugs (NSAIDs). Its effectiveness in acute pain was demonstrated in the earlier reviews.

Objectives: To assess analgesic efficacy and adverse effects of a single oral dose of celecoxib for moderate to severe postoperative pain.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Oxford Pain Database, and ClinicalTrials.gov. The most recent search was to 3 January 2012.

Selection criteria: We included randomised, double-blind, placebo-controlled trials (RCTs) of adults prescribed any dose of oral celecoxib or placebo for acute postoperative pain.

Data collection and analysis: Two review authors assessed studies for quality and extracted data. We converted summed pain relief (TOTPAR) or pain intensity difference (SPID) into dichotomous information, yielding the number of participants with at least 50% pain relief over four to six hours, and used this to calculate the relative benefit (RB) and number needed to treat to benefit (NNT) for one patient to achieve at least 50% of maximum pain relief with celecoxib who would not have done so with placebo. We used information on use of rescue medication to calculate the proportion of participants requiring rescue medication and the weighted mean of the median time to use.

Main results: Eight studies (1380 participants) met the inclusion criteria. We identified five potentially relevant unpublished studies in the most recent searches, but data were not available at this time. The number of included studies therefore remains unchanged.The NNT for celecoxib 200 mg and 400 mg compared with placebo for at least 50% of maximum pain relief over four to six hours was 4.2 (95% confidence interval (CI) 3.4 to 5.6) and 2.5 (2.2 to 2.9) respectively. The median time to use of rescue medication was 6.6 hours with celecoxib 200 mg, 8.4 with celecoxib 400 mg, and 2.3 hours with placebo. The proportion of participants requiring rescue medication over 24 hours was 74% with celecoxib 200 mg, 63% for celecoxib 400 mg, and 91% for placebo. The NNT to prevent one patient using rescue medication was 4.8 (3.5 to 7.7) and 3.5 (2.9 to 4.6) for celecoxib 200 mg and 400 mg respectively. Adverse events were generally mild to moderate in severity, and were experienced by a similar proportion of participants in celecoxib and placebo groups. One serious adverse event probably related to celecoxib was reported.

Authors' conclusions: Single-dose oral celecoxib is an effective analgesic for postoperative pain relief. Indirect comparison suggests that the 400 mg dose has similar efficacy to ibuprofen 400 mg.

Figure 5. L’Abbé plot of celecoxib 200 mg versus placebo for at least 50% pain relief. Size of circle is proportional to size of study (inset scale). Cream circles - dental studies; pink circle - orthopaedic study

Figure 6. L’Abbé plot of celecoxib 400 mg versus placebo for at least 50% pain relief. Size of circle is proportional to size of study (inset scale). Cream circles - dental studies

Figure 1. ‘Risk of bias’ graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies

Figure 2. ‘Risk of bias’ summary: review authors’ judgements about each risk of bias item for each included study

Figure 3. Forest plot of comparison: 1 Celecoxib 200 mg versus placebo, outcome: 1.1 At least 50% pain relief over 4-6 hours

Figure 4. Forest plot of comparison: 2 Celecoxib 400 mg versus placebo, outcome: 2.1 At least 50% pain relief over 4-6 hours dental pain