1
|
Zhou Y, Wang B, Duan K, Bai Z, Hu X, Xu M, Li X, Gao Y, Li J, Yang M, Zhang Y, Zhang W, Dai R, Shen Y, Wu Z, Jiang Y, Yu S, Ouyang W, Wang S. Preemptive QP001, a fast-acting meloxicam formulation, provides analgesia and reduces opioid consumption following abdominal surgery: a randomized controlled trial. Inflammopharmacology 2023; 31:2401-2410. [PMID: 37646897 DOI: 10.1007/s10787-023-01322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND QP001, a novel meloxicam formulation, has been developed to manage moderate to severe postoperative pain. This study aimed to evaluate the efficacy and safety of QP001 injections for moderate to severe pain following abdominal surgery. METHOD This prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial enlisted patients experiencing moderate to severe pain following abdominal surgery. These patients were randomized to receive either QP001 injections (30 mg or 60 mg) or a placebo pre-surgery. The primary efficacy endpoint was the total morphine consumption within 24 h after the first administration. RESULTS A total of 108 patients were enrolled, and 106 patients completed the study. The total morphine consumption in the QP001 30 mg group and 60 mg group, versus placebo group, were significantly lower over the following 24 h (5.11[5.46] vs 8.86[7.67], P = 0.011; 3.11[3.08] vs 8.86[7.67], P < 0.001), respectively. The total morphine consumption in the QP001 30 mg and 60 mg groups, versus placebo group, was also significantly decreased over the following 48 h, including the 24-48 h period (P ≤ 0.001). The QP001 30 mg and 60 mg groups, versus placebo, showed a significant decrease in the area under the curve for pain intensity-time as well as a significant decrease in the effective pressing times of the analgesic pump over the 24 h and 48 h periods (P < 0.05). The QP001 groups, versus placebo, show no significant different in Adverse Events or Adverse Drug Reactions (P > 0.05). CONCLUSION Preoperative/preemptive QP001 provides analgesia and reduces opioid consumption in patients with moderate to severe pain following abdominal surgery, while maintaining a favorable safety profile.
Collapse
Affiliation(s)
- Yingyong Zhou
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Bin Wang
- General Surgery, Guiyang Baijun Taikang Hospital, Chenzhou, China
| | - Kaiming Duan
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhihong Bai
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xianwen Hu
- Department of Anesthesiology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Mingjun Xu
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Li
- Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yuanli Gao
- Department of Anesthesiology, Maanshan People's Hospital, Ma'anshan, China
| | - Jiangang Li
- Department of Anesthesiology, Qujing No.1 Hospital, Qujing, China
| | - Mengchang Yang
- Department of Anesthesiology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Ying Zhang
- Department of Anesthesiology, The Affiliated Traditional Chinese Medical Hospital of Southwest Medical University, Luzhou, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruping Dai
- Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yufei Shen
- Gynecology Department, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Ziteng Wu
- Nanjing Delova Biotech Co., Ltd, Nanjing, China
| | - Yan Jiang
- Nanjing Delova Biotech Co., Ltd, Nanjing, China
| | - Sen Yu
- Nanjing Delova Biotech Co., Ltd, Nanjing, China
| | - Wen Ouyang
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Saiying Wang
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China.
| |
Collapse
|
2
|
Luo M, Zhao X, Deng M, Hu Y, Yang X, Mei Z, Meng L, Wang Y. Scalp Nerve Block, Local Anesthetic Infiltration, and Postoperative Pain After Craniotomy: A Systematic Review and Network Meta-analysis of Randomized Trials. J Neurosurg Anesthesiol 2023; 35:361-374. [PMID: 36040025 DOI: 10.1097/ana.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022]
Abstract
The most efficacious methods for controlling postoperative pain in craniotomy remain unknown. A systematic review and network meta-analysis were performed to compare the efficacies of different strategies of scalp nerve block (SNB), scalp infiltration (SI), and control in patients undergoing craniotomy. MEDLINE, Embase, and CENTRAL databases were searched for randomized controlled trials. The primary outcome was postoperative 24-hour pain score, and the secondary outcome was opioid consumption within the first 24 hour after surgery. The effect was estimated using the between-group mean difference and ranked using the surface under the cumulative ranking curve (SUCRA) score. Twenty-four randomized trials were identified for inclusion. SNB using ropivacaine reduced postoperative 24-hour pain score when compared with control (mean difference [95% credible interval], -2.04 [-3.13, -0.94]; low quality), and when compared with SI using ropivacaine (-1.77 [-3.04, -0.51]; low quality) or bupivacaine (-1.96 [-3.65, -0.22]; low quality). SNB using ropivacaine was likely the most efficacious method for pain control (SUCRA, 91%), and also reduced opioid consumption within the first postoperative 24 hours as compared with control (mean difference [95% credible interval], -11.91 [-22.42, -1.4]; low quality). SNB using bupivacaine, lidocaine, and epinephrine combined, and SNB using ropivacaine, were likely the most efficacious methods for opioid consumption reduction (SUCRA, 88% and 80%, respectively). In summary, different methods of SNB / SI seem to have different efficacies after craniotomy. SNB using ropivacaine may be superior to other methods for postcraniotomy pain control; however, the overall quality of evidence was low.
Collapse
Affiliation(s)
- Mengqiang Luo
- Department of Anesthesiology, Huashan Hospital, Fudan University
| | - Xu Zhao
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Meng Deng
- Department of Anesthesiology, Huashan Hospital, Fudan University
| | - Yue Hu
- Department of Anesthesiology, Huashan Hospital, Fudan University
| | - Xiaoyu Yang
- Department of Anesthesiology, Huashan Hospital, Fudan University
| | - Zubing Mei
- Anorectal Disease Institute of Shuguang Hospital, Shanghai
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingzhong Meng
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yingwei Wang
- Department of Anesthesiology, Huashan Hospital, Fudan University
| |
Collapse
|
3
|
Shao Z, Bi S. Patient satisfaction after total hip arthroplasty: Influencing factors. Front Surg 2023; 9:1043508. [PMID: 36793514 PMCID: PMC9922864 DOI: 10.3389/fsurg.2022.1043508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/28/2022] [Indexed: 01/31/2023] Open
Abstract
It is reported that the dissatisfaction rate after primary total hip arthroplasty (THA) is between 7% and 20%. Patient satisfaction has already become a public health problem that puzzles the world, and it is a problem to be solved that cannot be ignored in the development of global public health. The purpose of this paper is to conduct a narrative review of the literature to answer the following questions: what are the main factors leading to high patient satisfaction or dissatisfaction after THA? The literature on patient satisfaction after THA was reviewed. As far as we know, there is no such detailed and timely overview of THA satisfaction as this article, and the purpose articles we use search engines to search are all RCT (Randomized Controlled Trial) type works, excluding cross-sectional studies and other experiments with low evidence level. Hence, the quality of this article is high. The search engines used are MEDLINE (PubMed) and EMBASE. The keywords used are "THA" and "satisfaction." The main preoperative, perioperative, and postoperative factors that affect patient satisfaction are summarized in detail below.
Collapse
|
4
|
Mahmoud A, Abuelazm M, Ashraf Salah Ahmed A, Elshinawy M, Ashour T, Abugdida M, Abdelazeem B. Early perioperative versus postoperative meloxicam for pain control in patients undergoing orthopedic surgery: a systematic review and Meta-analysis of randomized controlled trials. Curr Med Res Opin 2023; 39:113-122. [PMID: 36245362 DOI: 10.1080/03007995.2022.2135837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Post-orthopaedic operative pain is a serious concern that often requires the administration of analgesics; however, the optimal time of analgesic administration is still inconclusive. Perioperative analgesia is administrating pre-emptive analgesia before and during the surgery followed by postoperative analgesia to decrease the procedure associated nociceptive response. We aim to assess perioperative meloxicam versus postoperative meloxicam for pain control after orthopaedic operations. METHODS A systematic review and meta-analysis involving randomized controlled trials from PubMed, Embase, Scopus, WOS, and Cochrane until 28th May 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol in PROSPERO with ID: CRD42022336046. RESULTS We included five RCTs with 964 patients. All the included trials showed high risk of performance and detection biases because of lack of blinding. Pooled analysis favored perioperative meloxicam in reducing pain score after six hours (MD: -0.42 with 95% CI [-0.63, -0.21], p = .0001), 12 h (MD: -0.54 with 95% CI [-0.69, -0.39], p = .00001), and 24 h (MD: -0.23 with 95% CI [-0.36, -0.10]. Pooled analysis favored perioperative meloxicam in improving patient global assessment scale after 12 h (MD: -0.66 with 95% CI [-0.86, -0.46], p = .00001), 24 h (MD: -0.30 with 95% CI [-0.49, -0.11, p = .002), and 48 h (MD: -0.17 with 95% CI [-0.33, -0.01], p = .04). Pooled analysis favored perioperative meloxicam in reducing patient-controlled analgesia (MD: -4.25 with 95% CI [-5.96, -2.54], p = .00001). CONCLUSION Short-term pain management after orthopaedic procedures is better accomplished with perioperative meloxicam than postoperative meloxicam. Before recommending perioperative meloxicam for pain control following orthopaedic surgeries, further multicentre trials are still warranted to examine the impact of perioperative meloxicam in different orthopaedic procedures.
Collapse
Affiliation(s)
| | | | | | | | - Toka Ashour
- Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
5
|
Pu C, Jiang X, Sun Y, Lin H, Li S. Efficacy and safety between early use and late use of celecoxib in hip osteoarthritis patients who receive total hip arthroplasty: a randomized, controlled study. Inflammopharmacology 2021; 29:1761-1768. [PMID: 34727277 DOI: 10.1007/s10787-021-00880-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/02/2021] [Indexed: 10/19/2022]
Abstract
Celecoxib is commonly used for pain management after total hip arthroplasty (THA), while the optimal timing of analgesic celecoxib remains unclear. This randomized, controlled study aimed to investigate the pain control efficacy and safety of preoperative celecoxib versus postoperative celecoxib in osteoarthritis (OA) patients undergoing THA. Totally, 192 hip OA patients about to undergo THA were randomized into pre-treatment group (N = 96) and post-treatment group (N = 96). The former was given 400 mg celecoxib at 4 h before THA, 200 mg at 4 h after THA, and then 200 mg every 12 h until 72 h post-operation. The latter was given 400 mg celecoxib at 4 h after THA, and then 200 mg every 12 h until 72 h post-operation. Pain at rest visual analog scale (VAS) score at 6 h, and pain at flexion VAS scores at 6 h, 12 h, and on D1, D2 were decreased in pre-treatment group compared to post-treatment group (all P < 0.05). Furthermore, additional consumption of patient-controlled analgesia (PCA) (P = 0.006) and total consumption of PCA (P = 0.006) were both reduced in pre-treatment group compared to post-treatment group. Meanwhile, compared to post-treatment group, patient satisfaction in pre-treatment group was higher on D1 (P = 0.010) and D2 (P = 0.039). While, Harris hip score showed no difference between pre-treatment group and post-treatment group on M1 or M3 (both P > 0.05). In conclusion, preoperative celecoxib exhibits better analgesic efficacy and patients' satisfaction management with similar tolerance compared to postoperative celecoxib in hip OA patients undergoing THA.
Collapse
Affiliation(s)
- Chunxue Pu
- Department of Anesthesiology, Daqing Oilfield General Hospital, No. 9 Zhongkang Street, Sartu District, Daqing, 163000, Heilongjiang, China
| | - Xue Jiang
- Department of Anesthesiology, Daqing Oilfield General Hospital, No. 9 Zhongkang Street, Sartu District, Daqing, 163000, Heilongjiang, China.
| | - Yuanxin Sun
- Department of Orthopaedics, Daqing Oilfield General Hospital, Daqing, Heilongjiang, China
| | - Hui Lin
- Department of Anesthesiology, Daqing Oilfield General Hospital, No. 9 Zhongkang Street, Sartu District, Daqing, 163000, Heilongjiang, China
| | - Shaochen Li
- Department of Anesthesiology, Daqing Oilfield General Hospital, No. 9 Zhongkang Street, Sartu District, Daqing, 163000, Heilongjiang, China
| |
Collapse
|
6
|
Hu F, Wu G, Zhao Q, Wu J. Evaluation of analgesic effect, joint function recovery and safety of meloxicam in knee osteoarthritis patients who receive total knee arthroplasty: A randomized, controlled, double-blind study. Medicine (Baltimore) 2021; 100:e26873. [PMID: 34477120 PMCID: PMC8415958 DOI: 10.1097/md.0000000000026873] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023] Open
Abstract
Meloxicam is commonly administrated to control postoperative pain in orthopedic surgery, while its efficacy in total knee arthroplasty (TKA) is not clear. Therefore, this study aimed to explore the postoperative analgesic effect and tolerance of meloxicam in knee osteoarthritis (OA) patients undergoing TKA.Totally, 128 knee OA patients scheduled for TKA were enrolled in this randomized, controlled, double-blind study, then randomized into meloxicam group (N = 65) and control group (N = 63) as 1:1 ratio. Patients took meloxicam or placebo from 4 hours (h) to 72 h after TKA. Patients were followed up at 6 h, 12 h, day (D)1, D2, D3, D7, month (M)1, and M3.Pain visual analog scale score at rest was decreased in meloxicam group at 12 h, D1 and D3 compared to control group; pain visual analog scale score at flexion was reduced in meloxicam group at 6 h, 12 h, D1, D2, and D3 compared to control group. Additional and total consumption of patient-controlled analgesia were both attenuated in meloxicam group compared to control group. Furthermore, patient satisfaction score was higher on D1, D2, D3 in meloxicam group compared to control group. However, no difference of hospital for special surgery knee score score at M1 or M3 was found between the 2 groups. Moreover, the occurrence of adverse events was similar between the 2 groups.Meloxicam displays good effect on controlling postoperative pain and improving patient satisfaction, while does not affect long-term knee function recovery or safety profile in knee OA patients undergoing TKA.
Collapse
|