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Acute Pain | Chronic Pain | General

Single dose oral etoricoxib in postoperative pain

Clinical bottom line

Etoricoxib is an effective treatment for acute postoperative pain. The NNT for at least 50% pain relief over four to six hours with etoricoxib 100 or 120 mg was 1.6 (1.5 to 1.8).


Reference

Updated review prepared summer 2007, with planned publication 2008.


Systematic review

Inclusion criteria were single oral dose, randomised, placebo-controlled, double-blind trials of etoricoxib in acute postoperative pain with sufficient data to calculate the area under the curve for pain relief (TOTPAR). Baseline pain was moderate to severe. The 6 hour TOTPAR was calculated for each patient, and the data were converted to the percent of maximum total pain relief from categorical pain scales (%maxTOTPAR), and then to dichotomous information to generate a number-needed-to-treat for at least 50% pain relief. Relative benefit was calculated to provide an assessment of how much more likely an individual given a particular treatment is to have at least 50% pain relief than someone given no treatment. Adverse effects frequency data were used to calculate numbers-needed-to-harm and relative risk.

Findings

Information from 872 patients in four trials was available for using doses of 60 mg, 120 mg, and 180-240 mg. Results are given in Table 1, with limited evidence for a useful dose-response.

Table 1: NNT for etoricoxib in acute pain compared with placebo

Number of
Percent with at least 50% pain relief
Dose
(mg)
Trials
Patients
Etoricoxib
Placebo
Relative benefit
(95% CI)
NNT
(95% CI)
60
1
124
53
8
6.5 (2.5 to 17)
2.2 (1.7 to 3.2)
120
4
500
70
8
9.1 (5.4 to 15)
1.6 (1.5 to 1.8)
180-240
2
248
77
8
9.5 (4.9 to 19)
1.5 (1.3 to 1.7)

 

Pooled analysis of duration of analgesia was possible only for etoricoxib 120 mg and placebo. The weighted median time to remedication with etoricoxib was about 24 hours and with placebo 1.8 hours. Results for other doses were extracted from a trial report. The median time to remedication with etoricoxib 60 mg was 12.1 (9.8 to about 24) hours, average times for both etoricoxib 180 mg and 240 mg exceeded 24 hours (Figure 1).

Figure 1: Time to remedication


Adverse events

Pooled analysis against placebo was only possible for etoricoxib 120 mg. The frequency of 'any adverse effect', 'dizziness', 'nausea', 'vomiting', 'alveolitis', 'headache' and 'somnolence' following a single dose of etoricoxib 120 mg was compared with frequencies reported following placebo. No statistically significant relative differences were found in the incidence of particular events.

Comment

Etoricoxib is an effective treatment for acute postoperative pain with a long duration of action.