Single-dose rofecoxib for acute postoperative pain in adults: A quantitative systematic review

被引:33
作者
Barden J. [1 ]
Edwards J.E. [1 ]
McQuay H.J. [1 ]
Moore R.A. [1 ]
机构
[1] Pain Res./Nuffield Dept. of Anaesth., University of Oxford, Oxford Radcliffe Hospital, Oxford OX3 7LJ, The Churchill, Headington
关键词
Ibuprofen; Pain Relief; Rofecoxib; Acute Pain; Adverse Event Profile;
D O I
10.1186/1471-2253-2-4
中图分类号
学科分类号
摘要
Background: Rofecoxib is a cyclo-oxygenase 2 selective inhibitor. This systematic review of rofecoxib in acute pain examined studies in adults of analgesic efficacy over six hours, the amount and quality of the evidence on extended duration of analgesia, and the quality and quantity of evidence on adverse events. Methods: Cochrane Library (issue 4, 2001), Biological Abstracts (March 2002), MEDLINE (March 2002) and PubMed (March 2002) were searched using rofecoxib as a free text term. The area under the pain relief versus time curve was dichotomized using validated equations to derive the proportion of patients on rofecoxib 50 mg or placebo with at least 50% pain relief over six hours. This was used to calculate the number needed to treat for at least 50% pain relief over six hours for rofecoxib compared with placebo. Information on duration of analgesia and adverse events was also collected. Results: Five included trials investigated 1,118 patients, of whom 211 received placebo and 464 received rofecoxib 50 mg. The NNT for rofecoxib 50 mg was 2.3 (95% confidence interval 2.0 to 2.6). The weighted mean remedication time was 1.9 hours for placebo (126 patients), 7.4 hours for ibuprofen 400 mg (97 patients) and 13.6 hours for rofecoxib 50 mg (322 patients). Conclusion: Rofecoxib at 2-4 times the standard daily dose for chronic pain is an effective single dose oral analgesic in acute pain. Limitations in trial reporting constrain conclusions about longer duration of analgesia and adverse event profile. © 2002 Barden et al; licensee BioMed Central Ltd.
引用
收藏
页数:6
相关论文
共 45 条
[1]  
Beecher H.K., Keats A.S., Mosteller F., Et al., The effectiveness of oral analgesics (morphine, codeine, acetylsalicylic acid) and the problem of placebo "reactors" and "nonreactors, J. Pharmacol., 109, pp. 393-400, (1953)
[2]  
Beecher H.K., The measurement of pain, Pharmacological Reviews, 9, pp. 59-210, (1957)
[3]  
Houde R.W., Wallenstein S.L., Beaver W.T., Clinical measurement of pain, Analgetics New York and London Academic Press, pp. 75-122, (1965)
[4]  
Moore R.A., Gavaghan D., Tramer M.R., Et al., Size is everything-large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects, Pain, 78, pp. 209-216, (1998)
[5]  
Ioannidis J.P.A., Lau J., Evolution of treatment effects over time: Empirical insight from recursive cumulative metaanalyses, PNAS, 98, pp. 831-836, (2001)
[6]  
McQuay H.J., Moore R.A., An evidence-based resource for pain relief, (1998)
[7]  
Bullingham R.E., McQuay H.J., Dwyer D., Et al., Sublingual buprenorphine used postoperatively: Clinical observations and preliminary pharmacokinetic analysis, Br. J. Clin. Pharmacol., 12, pp. 117-122, (1981)
[8]  
Gibbs J.M., Johnson H.D., Davis F.M., Patient administration of iv buprenorphine for postoperative pain relief using "Cardiff" demand analgesic apparatus, Br. J. Anaesth., 54, pp. 279-284, (1982)
[9]  
Savarese J.J., Thomas G.B., Homesley H., Et al., Rescue factor: A design for evaluating long-acting analgesics, Clin. Pharmacol. Ther., 43, pp. 376-380, (1988)
[10]  
Farrar J.T., Portenoy R.K., Berlin J.A., Et al., Defining the clinically important difference in pain outcome measures, Pain, 88, pp. 287-294, (2000)