Perioperative pain: otherEtoricoxib, a selective NSAID, reduces opioid use after knee or hip replacement surgery

The goal was to assess whether etoricoxib provides clinically important analgesic effect over several days to patients after knee or hip replacement surgery. Two double-blind, placebo-controlled studies randomized 264 (study 1) and 228 (study 2) patients with moderate or severe pain, within 72 hours after surgery, to etoricoxib 120mg, NAPRELAN™ 1000mg, and placebo (Day 1). On Days 2 to 7, etoricoxib patients received 60 or 120mg (study 1), or 120mg (study 2); placebo and NAPRELAN™ patients received placebo. On Day 1, patients reported pain relief, pain intensity, and a Global Evaluation at prespecified timepoints. On Days 2 to 7 patients reported rescue medication (LORTAB™) use, a Global Evaluation and worst, least, and average pain (study 2 only). The primary endpoint in Part I was total pain relief over 8 hours (TOPAR8) and the key endpoint in Part II was opioid use. On Day 1, compared with placebo, etoricoxib 120mg provided numerically greater (p=0.135; study 1) and significantly greater (p<0.001; study 2) overall analgesic effect (TOPAR8). Etoricoxib 120mg provided similar analgesic effect to NAPRELAN™ in both studies. On Days 2 to 7, compared with placebo, etoricoxib 120mg decreased opioid use significantly (p<0.001) in both studies; 41% (study 1) and 35% (study 2). Patients also rated etoricoxib superior to placebo on Patient Global Evaluation thus confirming that etoricoxib 120mg provided significantly greater (p<0.001) clinical benefit than placebo. Etoricoxib 60mg significantly decreased opioid use but the Global Evaluation was not different from placebo. Furthermore, etoricoxib 120mg significantly (p<0.001) decreased patients' worst and average pain (study 2). Etoricoxib was generally safe and well tolerated for 7 days. Etoricoxib 120mg provided pain relief and significantly reduced opioid use vs. placebo in patients after knee or hip replacements, and thus was identified as the optimal dose for the treatment of acute pain over several days.