The analgesic efficacy of valdecoxib vs. oxycodone acetaminophen after oralsurgery

Background. The authors conducted studies to compare the analgesic efficacy and safety 71 of the cyclooxygenase, or COX, -2-specific inhibitor, valdecoxib, with oxycodone/-acetaminophen in patients who have undergone oral surgery. Methods. In total, 205 eligible subjects in Study A and 201 in Study B were randomized to receive a single oral dose of valdecoxib (20 or 40 milligrams), a combination of oxycodone 10 mg/acetaminophen 1,000 mg or placebo. Eligible subjects experienced moderate-to-severe pain within six hours of surgery during which two or more impacted third molars were extracted. Analgesic efficacy was assessed over 24 hours or until the patient required rescue analgesia. Results. In both studies, subjects receiving either dose of valdecoxib experienced a rapid onset of analgesia and (among those who received valdecoxib, 40 mg) a level of pain relief comparable with that of those who received oxycodone/acetaminophen. Both valdecoxib doses had a significantly longer duration of analgesic than did oxycodone/acetaminophen. Pooled safe data demonstrated that each valdecoxib dose had a tolerability profile superior to that of oxycodone/acetaminophen and similar to that of placebo. Conclusions. Orally administered valdecoxib is as rapidly acting and effective as oxycodone/acetaminophen, and it has a superior duration of analgesic effect in patients after oral surgery. Valdecoxib has a tolerability profile superior to that of oxycdone/acetaminophen. Clinical Implications. The current 7 standard of care for alleviating acute pain after oral surgery has rested largely on conventional nonsteroidal anti-inflammatory drugs or opioid/analgesic combination products. The studies reported here suggest that the COX-2--specific inhibitor valdecoxib offers an efficacious and safe alternative to other analgesics used to treat pain after oral surgery.