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AMBULATORY ANESTHESIA

The Preemptive Analgesic Effect of Rofecoxib After Ambulatory Arthroscopic Knee Surgery

Department of Anesthesiology, Baystate Medical Center, Springfield, Massachussetts; and *New England Orthopedic Surgeons, P.C., Baystate Medical Center, Springfield, Massachussetts

Address correspondence and reprint requests to Scott S. Reuben, MD, Department of Anesthesiology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199. Address e-mail to scott.reuben{at}bhs.org

	Abstract

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Nonsteroidal antiinflammatory drugs (NSAIDs) provide effective postoperative analgesia after arthroscopic knee surgery. Some investigators have suggested that the preemptive administration of NSAIDs may reduce postoperative analgesic requirements and hypersensitivity. We evaluated the analgesic effect of administering rofecoxib either before or after surgical incision in patients undergoing arthroscopic knee surgery under local anesthesia. Sixty patients undergoing arthroscopic meniscectomy were randomized into three groups. All patients received intraarticular bupivacaine 0.25% pre- and postsurgery together with IV sedation using midazolam and propofol. The Preincisional group received a single 50 mg dose of rofecoxib 1 h before surgery, the Postincisional group received rofecoxib 50 mg after the completion of surgery, and the Placebo group received a placebo tablet before surgery. Pain scores, the time to first opioid use, and 24-h analgesic use were recorded. Analgesic duration, defined as the time from completion of surgery until first opioid use, was significantly longer in those patients receiving pre- (803 ± 536 min) versus postincisional (461 ± 344 min) rofecoxib or placebo (318 ± 108 min). The 24 h acetaminophen/oxycodone use was less in the Preincisional group (1.5 ± 0.6 pills) versus the Postincisional group (3.3 ± 1.3 pills) or the Placebo group (5.5 ± 1.6 pills). Pain scores with movement were lower in the Preincisional group at all postoperative time intervals. We conclude that rofecoxib provides effective postoperative analgesia for arthroscopic meniscectomy. Further, the administration of rofecoxib 50 mg before surgery provides a longer duration of postoperative analgesia, less 24 h opioid use, and lower incidental pain scores compared with administering the drug after the completion of surgery.

IMPLICATIONS: The administration of rofecoxib 50 mg before arthroscopic knee surgery provides a longer duration of analgesia, less 24-h opioid use, and lower pain scores than administering the drug after the completion of surgery.

	Introduction

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It is currently recommended that nonsteroidal antiinflammatory drugs (NSAIDs) be used in the management of pain after arthroscopic meniscectomy (1). The perioperative administration of NSAIDs decreases the inflammatory response associated with arthroscopic knee surgery, resulting in diminished pain and facilitating earlier ambulation and faster rehabilitation (1–3). Several studies have examined the analgesic efficacy of administering perioperative NSAIDs for arthroscopic knee surgery (1–9). The administration of NSAIDs before surgery may be more effective by inhibiting the early production of prostanoids before the onset of tissue trauma, thus preventing the development of hyperalgesia.

Clinical evidence suggests that surgical trauma may induce prolonged changes in both the peripheral and central nervous systems that together amplify postoperative pain (10). Surgical trauma results in the induction of cyclooxygenase-2 (COX-2), leading to the release of prostaglandins, which sensitize peripheral nociceptors and produce localized hyperalgesia (primary hyperalgesia) (11). In addition, the resultant increase in the excitability of spinal neurons (central sensitization) may produce pain hypersensitivity in the surrounding uninjured tissue (secondary hyperalgesia) (10). Therefore, administering NSAIDs before surgical trauma may be more effective in preventing the development of both peripheral and central sensitization after arthroscopic knee surgery. Although NSAIDs have been administered in either the pre- or postoperative period, no study has examined a NSAID regimen given preoperatively compared with the same dose administered postoperatively to patients undergoing ambulatory knee arthroscopy.

Rofecoxib, an oral COX-2 inhibitor, is effective when administered before major orthopedic surgery (12). The goal of our study was to evaluate the analgesic efficacy of administering rofecoxib either pre- or postoperatively to patients undergoing ambulatory arthroscopic meniscectomy.

	Materials and Methods

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After approval by our local IRB, informed consent was obtained from 60 patients scheduled to undergo elective arthroscopic meniscectomy of the knee. By the use of a table of random numbers, patients were randomly allocated into one of three equally sized groups. The anesthesiologist (SB) who provided the anesthesia and one of the investigators (HM) participating in the pain assessments were unaware of the type of medication administered. Patients were also blinded to their group assignment. Patients in the first group received rofecoxib 50 mg 1 h before surgery and a placebo tablet 15 min after surgery (Preincisional group), patients in the second group received a placebo tablet 1 h before surgery and rofecoxib 50 mg 15 min after surgery (Postincisional group), and patients in the third group received a placebo tablet both 1 h before and 15 min after surgery (Control group). All surgical procedures were performed under local anesthesia using 30 mL intraarticular bupivacaine 0.25%. Intraoperatively, patients received IV sedation with propofol (10–100 µg · kg^-1 · min^-1) and midazolam (1–3 mg), and an additional 30 mL bupivacaine 0.25% was injected through the arthroscope at the end of the case. Opioids were not a component of the intraoperative sedation.

Postoperative pain was assessed using an 11-point verbal analog pain score, with 0 corresponding to "no pain" and 10 to "the worst imaginable pain." Pain scores were recorded both at rest and with movement at 1, 2, and 24 h after the completion of surgery. Pain scores with movement were recorded immediately after the patient actively flexed the operative knee to 90°. Patients were instructed to take 1–2 acetaminophen 325 mg/oxycodone 5 mg tablets every 3 h as needed for a verbal analog pain score 3 while at home. When contacted by telephone at 24 h, patients were asked about their time to first analgesic use as well as their 24-h total requirement. Analgesic duration was defined as the time from completion of surgery until the first request for acetaminophen/oxycodone. Patients were discharged from the hospital when they were oriented to time and place, were able to void, had stable vital signs, and could ambulate with the assistance of crutches. Discharge time was classified as the time from the end of surgery until the patients were able to meet the discharge criteria.

Demographic data and times (duration of procedure, time to discharge, and analgesic duration) were assessed by analysis of the variance. Pain scores and amount of postoperative analgesics were analyzed by the Kruskal-Wallis test. If a significant result was obtained, the Mann-Whitney U-test was performed to determine between which groups there was significance; a Bonferroni adjustment was made for multiple comparisons. Significance was determined at the P < 0.05 level. Initial sample size estimation showed that 20 patients should be included in each group to ensure a power of 0.90 to detect a clinically relevant minimal 33% increase in analgesic duration. Using pooled data from our previous arthroscopic meniscectomy studies (12), yielding a mean analgesic duration of 300 min with a standard deviation of 90 min, an error of 0.05 was used for this study. Data are presented as mean ± SD.

	Results

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Intraoperative local anesthesia provided satisfactory conditions for all patients undergoing surgery. No patients required the administration of general anesthesia. There were no significant differences among the three study groups with respect to age, sex, height, weight, duration of surgery, or the time to discharge (Table 1). There was no significant difference among the three groups with respect to pain scores recorded at rest at 1 h (Table 2). There was a significant difference between the two treatment (rofecoxib) and placebo groups with regard to pain scores at rest at 2 h (P = 0.002), 24 h (P = 0.005), and movement at 1 h (P = 0.02), 2 h (P = 0.009), and 24 h (P = 0.005) postoperatively. Pain scores at rest were not significantly different between the Preincisional and Postincisional rofecoxib groups. However, pain scores with movement were significantly lower in the Preincisional rofecoxib group at 1 h (P < 0.02), 2 h (P < 0.02), and 24 h (P < 0.01) compared with the Postincisional group (Table 2).

The 24-h consumption of acetaminophen/oxycodone tablets was also significantly different among the three groups (P < 0.001). Patients in the Preincisional rofecoxib group required fewer acetaminophen/oxycodone tablets (1.5 ± 0.6) compared with the Postincisional rofecoxib (3.3 ± 1.3) or the Control (5.5 ± 1.6) groups. In addition, more patients in the Preincisional rofecoxib group (7/20, 35%) reported not using opioid analgesics in the 24-h postoperative period compared with either the Postincisional rofecoxib (2/20, 10%) or Control (0/20, 0%) groups (P < 0.05).

	Discussion

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Arthroscopy of the knee joint is a common procedure that has been routinely performed on an outpatient basis for over a decade. Arthroscopy of the knee has spared the patient large incisions and decreased the morbidity of various procedures, but has not eliminated pain (13). Although the degree of superficial trauma is less with these procedures, the internal surgical site of repair, including the synovial tissue, the anterior fat pad, and the joint capsule, have free nerve endings that are capable of sensing painful stimuli and producing severe pain (14). Arthroscopic meniscectomy may cause enough pain and swelling to delay rehabilitation and return to work for up to two weeks after surgery (15,16). Patients unable to complete a rehabilitation program after arthroscopic knee surgery may be at an increased risk for developing postoperative complications (delay in strength recovery, prolonged knee stiffness, anterior knee pain) (15–17). Therefore, aggressive pain management in the early postoperative period is essential and can enhance postarthroscopic convalescence (18).

The postoperative administration of NSAIDs can significantly decrease synovitis and effusion resulting in diminished pain and improved rate of recovery after arthroscopic knee surgery (1–3). In a randomized, double-blinded study of 139 patients undergoing arthroscopic meniscectomy, Ogilvie-Harris et al. (1) reported more rapid return of movement and quadriceps function with less time to return to work and sport when a NSAID was administered after surgery. In contrast to the administration of NSAIDs after surgery, the administration of NSAIDs before surgery may be more effective. Operative procedures produce an initial afferent barrage of pain signals and generate a secondary inflammatory response, both of which contribute substantially to postoperative pain. The signals have the capacity to initiate prolonged changes in both the peripheral and the central nervous system that will lead to the amplification and prolongation of postoperative pain (10). Peripheral sensitization, a reduction in the threshold of nociceptor afferent peripheral terminals, is a result of inflammation at the site of surgical trauma (19). Central sensitization, an activity-dependent increase in the excitability of spinal neurons, is a result of persistent exposure to nociceptive afferent input from the peripheral neurons (20). Taken together, these two processes contribute to the postoperative hypersensitivity state ("spinal wind-up") that is responsible for a decrease in the pain threshold, both at the site of injury (primary hyperalgesia) and in the surrounding uninjured tissue (secondary hyperalgesia) (10). Therefore, by administering an analgesic before surgical stimulus, the development of pain hypersensitivity may be reduced or abolished, resulting in less postoperative pain.

The preemptive analgesic effect of NSAIDs has been previously studied after a wide variety of surgical procedures demonstrating equivocal results (10,21). Unfortunately, many methodological problems have been encountered in these studies. Many clinical investigations have compared a NSAID regimen administered before surgery with no intervention at all. This merely represents an enhanced analgesic effect in the treatment group. This methodological flaw was evident in the only three clinical studies (6–8) that examined a preemptive analgesic effect of NSAIDs after arthroscopic knee surgery. In contrast, our study is the first clinical investigation to examine the analgesic effects of administering the same dose of a NSAID either before or after arthroscopic knee surgery.

The results of our study demonstrate that a single dose of 50 mg rofecoxib is more effective in reducing postoperative pain and analgesic use after arthroscopic meniscectomy in the pre- rather than the postoperative period. This was evidenced by a longer analgesic duration as well as a smaller consumption of acetaminophen/oxycodone tablets during the first 24 h after surgery in the Preincisional group. In addition, pain scores with movement were significantly lower at 1, 2, and 24 h postoperatively in those patients receiving preemptive rofecoxib.

The results of our study contribute to the debate over the analgesic efficacy of preemptive NSAID administration. Many studies that have failed to demonstrate a preemptive analgesic effect may be attributed to either insufficient perioperative nociceptive afferent blockade or the development of central sensitization once the pharmacological action of the preemptive analgesic has worn off (22). For these reasons it may be more important to administer analgesics whose duration of action extends well into the postoperative period (23). Perhaps the combination of rofecoxib, a long-acting NSAID, with bupivacaine, a long-acting local anesthetic, more effectively prevented the development of central sensitization by reducing the afferent barrage of pain signals from reaching the spinal cord for a prolonged period of time. This may have been the reason for the improved analgesic effects observed in our study, in contrast to the lack of clinically significant effects found in other studies using preemptive NSAIDs. A recent review (21) of 18 randomized, single- or double-blinded studies that used a NSAID as the target intervention revealed that only six studies (33%) demonstrated a preemptive analgesic effect. Furthermore, the beneficial effects of preemptive NSAIDs observed in most studies were minimal. Interestingly, two studies (24,25) that demon-strated a significant preemptive analgesic effect used tenoxicam, a long-acting NSAID, with bupivacaine for wound infiltration in patients undergoing a procedure of short duration (breast biopsy) involving primarily somatic afferent pain transmission. The similarities in study design may explain the impressive preemptive analgesic effects observed in both our study and those involving breast biopsy (24,25).

The administration of rofecoxib possesses a more favorable pharmacokinetic profile than other NSAIDs administered orally during the preoperative period. Unlike conventional NSAIDs, rofecoxib may be administered without food to the fasting preoperative patient (26). This NSAID provides onset of clinical analgesia within 27 minutes (27), and with an elimination half-life of 17.5 hours, rofecoxib needs to be dosed only once daily (26). Although the preoperative administration of nonspecific NSAIDs may provide effective analgesia, their ability to decrease platelet aggregation and increase bleeding time (28) may increase the risk of perioperative bleeding (29,30). We have observed increased perioperative bleeding with the preemptive administration of ibuprofen for ambulatory arthroscopic anterior cruciate ligament reconstruction and have since discontinued its use (31). Because rofecoxib has no effect on platelet aggregation or bleeding time, even in doses of 1000 mg per day (32), it may be a safer preemptive analgesic. We have previously demonstrated that the perioperative administration of rofecoxib resulted in no significant increase in the incidence of perioperative bleeding when administered either before spinal fusion surgery (12) or total joint arthroplasty (33).

In conclusion, rofecoxib provides effective postoperative analgesia for arthroscopic meniscectomy. Further, the administration of rofecoxib 50 mg before surgery provides a longer duration of postoperative analgesia, less 24-h opioid use, and lower incidental pain scores compared with administering the drug after the completion of surgery.

	References

Top Abstract Introduction Materials and Methods Results Discussion References

 

1. Ogilvie-Harris DJ, Bauer M, Corey P. Prostaglandin inhibition and the rate of recovery after arthroscopic meniscectomy: a randomised double-blind prospective study. J Bone Joint Surg 1985; 67: 567–71.
2. Vander-Schilden JL. Improvements in rehabilitation of the postmenisectomized or meniscal repair patient. Clin Orthop 1990; 252: 73–9.
3. Pedersen P, Nielsen KD, Jensen PE. The efficacy of Na-naproxen after diagnostic and therapeutic arthroscopy of the knee joint. Arthroscopy 1993; 9: 170–3.[ISI][Medline]
4. Drez D, Ritter M, Rosenberg TD. Pain relief after arthroscopy: naproxen sodium compared to propoxyphene napsylate with acetaminophen. South Med J 1987; 80: 440–3.[ISI][Medline]
5. Indelicato PA. Efficacy of diflunisal versus acetaminophen with codeine in controlling mild to moderate pain after arthroscopy. Clin Ther 1986; 8: 164–9.[ISI][Medline]
6. Code WE, Yip RW, Rooney ME, et al. Preoperative naproxen sodium reduces postoperative pain following arthroscopic knee surgery. Can J Anaesth 1994; 41: 98–101.[Abstract/Free Full Text]
7. Van Lancker P, Vandekerckhove B, Cooman F. The analgesic effect of preoperative administration of propacetamol, tenoxicam or a mixture of both in arthroscopic, outpatient knee surgery. Acta Anaesthesiol Belg 1999; 50: 65–9.[Medline]
8. Morrow BC, Milligan KR, Murthy BVS. Analgesia following day-case knee arthroscopy-the effect of piroxicam with or without bupivacaine infiltration. Anaesthesia 1995; 50: 461–3.[ISI][Medline]
9. Smith I, Shively RA, White PF. Effects of ketorolac and bupivacaine on recovery after outpatient arthroscopy. Anesth Analg 1992; 75: 208–12.[Abstract/Free Full Text]
10. Woolf CJ, Chong MS. Preemptive analgesia: treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77: 362–79.[ISI][Medline]
11. Samad TA, Moore KA, Sapirstein A, et al. Interleukin-1B-mediated induction of Cox-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature 2001; 410: 471–5.[Medline]
12. Reuben SS, Connelly NR. Postoperative analgesic effects of celecoxib or rofecoxib after spinal fusion surgery. Anesth Analg 2000; 91: 1221–5.[Abstract/Free Full Text]
13. Highgenboten CL, Jackson AW, Meske NB. Arthroscopy of the knee: ten day pain profiles and corticosteroids. Am J Sports Med 1993; 21: 503–6.[Abstract/Free Full Text]
14. Dye SF, Vaupel GL, Dye CC. Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesia. Am J Sports Med 1998; 26: 773–7.[Abstract/Free Full Text]
15. Durand A, Richards CL, Malouin F. Strength recovery and muscle activation of the knee extensor and flexor muscles after arthroscopic meniscectomy: a pilot study. Clin Orthop 1991; 262: 210–26.
16. St-Pierre DM. Rehabilitation following arthroscopic meniscectomy. Sports Med 1995; 10: 338–47.
17. Moffet H, Richards CL, Malouin F, et al. Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: results of a randomized controlled study. Arch Phys Med Rehab 1994; 75: 415–26.[ISI][Medline]
18. Rasmussen S, Larsen AS, Thomsen ST, Kehlet H. Intra-articular glucocorticoid, bupivacaine and morphine reduces pain, inflammatory response and convalescence after arthroscopic men- iscectomy. Pain 1998; 78: 131–4.[ISI][Medline]
19. Raja SN, Meyer RA, Campbell JN. Peripheral mechanisms of somatic pain. Anesthesiology 1988; 68: 571–90.[ISI][Medline]
20. Woolf CJ. Evidence for a central component of post-injury pain hypersensitivity. Nature 1983; 306: 686–8.[Medline]
21. Katz J. Pre-emptive analgesia: importance of timing. Can J Anaesth 2001; 48: 105–14.[Free Full Text]
22. Kissin I. Preemptive analgesia: why its effect is not always obvious. Anesthesiology 1996; 84: 1015–9.[ISI][Medline]
23. Kissin I, Lee SS, Bradley EL. Effect of prolonged nerve block on inflammatory hyperalgesia in rats: prevention of late hyperalgesia. Anesthesiology 1998; 88: 224–32.[ISI][Medline]
24. Colbert ST, O’Hanlon DM, McDonnell C, et al. Analgesia in day case breast biopsy: the value of pre-emptive tenoxicam. Can J Anaesth 1998; 45: 217–22.[Abstract/Free Full Text]
25. O’Hanlon DM, Thambipillai T, Colbert ST, et al. Timing of pre-emptive tenoxicam is important for postoperative analgesia. Can J Anaesth 2001; 48: 162–6.[Abstract/Free Full Text]
26. Vioxx^® [package insert]. Whitehouse Station, NJ: Merck & Co., 1998.
27. Chang DJ, Christensen KS, Bulloch SE, et al. Rofecoxib was more effective than codeine with acetaminophen for acute postoperative pain. Poster #800, 20th Annual Meeting of the American Pain Society, Phoenix, AZ, April 20, 2001.
28. Schafer AI. Effects of nonsteroidal anti-inflammatory therapy on platelets. Am J Med 1999; 106: 25S-35S.[Medline]
29. Souter AJ, Fredman B, White PF. Controversies in the perioperative use of nonsteroidal anti-inflammatory drugs. Anesth Analg 1994; 79: 1178–90.[Free Full Text]
30. Connelly CS, Panush RS. Should nonsteroidal anti-inflammatory drugs be stopped before elective surgery? Arch Intern Med 1991; 151: 1963–6.[Abstract]
31. Reuben SS, Sklar J. Pain management in patients who undergo outpatient arthroscopic surgery of the knee. J Bone Joint Surg 2000; 82: 1754–66.[Free Full Text]
32. Ehrich EW, Dallob A, DeLepeleire I, et al. Characterization of rofecoxib as a cyclooxygenase-2 isoform inhibitor and demonstration of analgesia in the dental pain model. Clin Pharmacol Ther 1999; 65: 336–47.[ISI][Medline]
33. Reuben SS, Maciolek H, Vieira P, et al. Evaluation of the safety and efficacy of the perioperative administration of rofecoxib for total knee arthroplasty. Reg Anesth Pain Med 2001; 26: 48.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999