Preoperative administration of etoricoxib in patients undergoing hip replacement causes inhibition of inflammatory mediators and pain relief

Research output: Contribution to journalReview articleContributedpeer-review

Contributors

  • B. Renner - , Institute of Clinical Pharmacology, Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • G. Walter - , HELIOS Klinikum Berlin-Buch (Author)
  • J. Strauss - , HELIOS Klinikum Berlin-Buch (Author)
  • M. F. Fromm - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • J. Zacher - , HELIOS Klinikum Berlin-Buch (Author)
  • K. Brune - , Friedrich-Alexander University Erlangen-Nürnberg (Author)

Abstract

Objective: Administering cyclooxygenase-2 inhibitors preoperatively appears attractive since these drugs reduce post-operative pain, but do not increase the risk of post-operative bleeds, asthmatic attacks and stress-related gastrointestinal ulcers. In a former investigation, we could show that post-operative administration of etoricoxib reduces prostaglandin production in wound fluid, but the onset of action is variable due to delayed post-operative absorption. Methods: In this study, we investigated the preoperative administration of etoricoxib in patients undergoing hip replacement. They received 120 mg etoricoxib or placebo 2 h before surgery and 1 day after in a double-blinded, randomized, parallel group design. Results: A total of 11 patients were randomized (placebo n = 5; verum n = 6). We found high and constant levels of the drug in blood, central nervous system and wound fluid already at the end of surgery (tmax < 2 h). This was accompanied by inhibition of prostaglandin production in the wound tissue (treatment p < 0.05), suppression of interleukin 6 increase in plasma (treatment p < 0.01), and - despite existing standard pain relief procedures - higher satisfaction with analgesics (time vs. treatment p < 0.05) and less demand for opioids (treatment p < 0.01) and intrathecal bupivacaine (treatment p = 0.05) administration. Conclusion: Administration of etoricoxib 2 h before surgery allows for an effective drug concentration in critical tissues, a reduction of the production of pro-inflammatory mediators and for better pain relief.

Details

Original languageEnglish
Pages (from-to)838-848
Number of pages11
JournalEuropean Journal of Pain (United Kingdom)
Volume16
Issue number6
Publication statusPublished - Jul 2012
Peer-reviewedYes

External IDs

PubMed 22337568
ORCID /0000-0003-0845-6793/work/139025220

Keywords

ASJC Scopus subject areas