Meloxicam versus Celecoxib for Postoperative Analgesia after Total Knee Arthroplasty: Safety, Efficacy and Cost

Amer Haffar, Yale A. Fillingham, Leigham Breckenridge, D’Andrew Gursay, J. Lonner
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引用次数: 3

Abstract

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as part of multimodal analgesia in total knee arthroplasty (TKA). Selective cyclooxygenase (COX)-2 inhibitors (e.g., celecoxib) are believed to have fewer gastrointestinal (GI) adverse effects than nonselective NSAIDS. Meloxicam is less selective for COX-2 than celecoxib is and partially inhibits COX-1 at higher doses. Nonetheless, some surgeons prefer using nonselective NSAIDs because of their lower expense. Methods: Four thousand nine hundred ninety-four patients who underwent TKA between January 2015 and February 2020 and took either celecoxib (n = 3,174), meloxicam 15 mg/d (n = 1,819), or meloxicam 7.5 mg/d (n = 451) were studied. Mutlimodal postoperative analgesia protocols were otherwise similar. GI bleeding and wound complication incidence were determined, as well as average 30-day prescription costs. Results: GI bleeding incidence was similar in the three cohorts (P = 0.4). The incidence of wound complications did not significantly differ between the groups: 0.06%, 0.07%, and 0.22% in the celecoxib, meloxicam 15 mg/d, and meloxicam 7.5 mg/d groups, respectively (P = 0.06). Subsituting meloxicam for celecoxib results in an average savings of $183 per prescription. Discussion: Meloxicam used at higher doses (15 mg/d) does not markedly increase the risk of GI or wound complications associated with COX-1 inhibition and is less costly for multimodal analgesia after TKA.
美洛昔康与塞来昔布用于全膝关节置换术后镇痛:安全性、有效性和成本
简介:非甾体类抗炎药(NSAIDs)通常作为全膝关节置换术(TKA)中多模式镇痛的一部分。选择性环氧合酶(COX)-2抑制剂(如塞来昔布)被认为比非选择性非甾体抗炎药具有更少的胃肠道(GI)不良反应。美洛昔康对COX-2的选择性低于塞来昔布,并且在高剂量时部分抑制COX-1。尽管如此,一些外科医生还是喜欢使用非选择性非甾体抗炎药,因为费用较低。方法:研究了2015年1月至2020年2月期间接受TKA并服用塞来昔布(n = 3,174),美洛昔康15 mg/d (n = 1,819)或美洛昔康7.5 mg/d (n = 451)的4,994例患者。多模式术后镇痛方案在其他方面相似。确定胃肠道出血和伤口并发症的发生率,以及平均30天的处方费用。结果:三组患者消化道出血发生率相似(P = 0.4)。塞来昔布组、美洛昔康15 mg/d组和美洛昔康7.5 mg/d组伤口并发症发生率无显著差异,分别为0.06%、0.07%和0.22% (P = 0.06)。用美洛昔康代替塞来昔布平均每份处方可节省183美元。讨论:高剂量(15mg /d)使用美洛昔康不会显著增加与COX-1抑制相关的胃肠道或伤口并发症的风险,并且对于TKA后的多模式镇痛成本更低。
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