Preemptive Anti-Inflammatory Use of Celecoxib in Knee Arthroplasty Surgery: a Double Blinded, Placebo-Controlled Study.

Abstract:

This double blinded, placebo controlled, study seeks to determine the efficacy of preoperative anti-inflammatory therapy on the reduction of postoperative pain in knee arthroplasty surgery. Pre-emptive use of NSAIDS has demonstrated only modest reduction in post-operative pain in previous studies. However, the short duration of dosing in those studies did not capitalized on the anti-inflammatory properties of NSAIDS. Short-term use of NSAIDS only provides pain relief and does not address inflammation. Traditional NSAIDS cannot be used preoperatively due to platelet effects. Celecoxib, however, is both an analgesic and anti-inflammatory, but does not interfere with bleeding. It can therefore be safely used before surgery. This study hypothesizes that the use of celecoxib for seven days preoperatively reduces postoperative inflammation and consequently pain. A detailed Medline search has not identified any studies into the preoperative use of an NSAID at a dosing level that achieves anti-inflammatory effects.If effective in reducing postoperative pain, this research could lead to a new understanding of the role inflammation plays in orthopedic procedures and other elective procedures and thus improve patient outcomes in the future.

Purpose and Significance:

It is commonly accepted that inflammation significantly increases pain. To date, no study has examined the potential benefits of preemptively treating inflammation before surgery. While the analgesic effects of NSAIDs have a rapid onset, the maximal anti-inflammatory effect can take one to three weeks to be realized. Due to bleeding concerns, traditional NSAIDS such as naprosyn or ibuprofen cannot, and have not, been used preoperatively. Following surgery, the inflammatory cascade of cells and chemical mediators inundates the surgical wound and creates acute inflammation. Once this has happened NSAIDs have missed the opportunity to treat this acute inflammation. Post-operative and single dose preoperative use of NSAIDs act exclusively as analgesics. Since celecoxib has no impact on postoperative bleeding, it can be safely administered preoperatively. With adequate time before an elective operation, one has the opportunity to reach steady state pharmacokinetics and a sufficient serum level to prevent inflammation -- and therefore pain

Aims of Study: