Rationale for preoperative (versus postoperative) administration of meloxicam for acute pain management and assessment of satisfaction in patients with femoroacetabular impingement who underwent hip arthroscopy
Keywords:Meloxicam, femoroacetabular impingement, hip arthroscopy, efficacy, safety
Objective: This study is aimed to compare the analgesic effect and safety of preoperative (versus postoperative) meloxicam administration in femoroacetabular impingement (FAI) patients who underwent hip arthroscopy (HA).
Methods: Totally, 136 FAI patients who scheduled for HA were recruited, then they were randomly assigned to preoperative administration (PREA) group (orally meloxicam 7.5 mg in 12h, 24h before operation, then orally 7.5 mg/d from 12h to Day 7 after operation; N=68) or postoperative administration (POSA) group (orally meloxicam 7.5 mg/d from 12h to Day 7 after operation; N=68) in 1:1 ratio. Furthermore, pain visual analog scale (VAS) score, patient satisfaction score, Harris hip score (HHS) and adverse events were assessed. Besides, the accumulated pethidine consumption for rescuing analgesia was calculated.
Results: Acute pain VAS score at rest (Day1 – Day2) and pain VAS score at motion (Day1 – Day3) were decreased, meanwhile short-term patient satisfaction score (Day1–Day3) was increased in PREA group compared with POSA group; however, these scores in long-term period were of no difference between PREA group and POSA group (Day3–Month3). Furthermore, accumulated pethidine consumption on Day3 and Day7 were attenuated in PREA group compared with POSA group. Additionally, HHS at any assessed time points (Day7–Month3) did not differ between two groups. Besides, no difference in the incidence of adverse events was found between two groups.
Conclusions: Preoperative meloxicam administration displays superior efficacy in short-term pain control, patient satisfaction improvement and attenuated consumption of rescue analgesia over postoperative meloxicam administration in FAI patients who underwent HA.
Egger AC, Frangiamore S, Rosneck J. Femoroacetabular Impingement: A Review. Sports Medicine and Arthroscopy Review [Internet]. Ovid Technologies (Wolters Kluwer Health); 2016 Dec;24(4):e53–e58. Available from: https://doi.org/10.1097/jsa.0000000000000126
Ghaffari A, Davis I, Storey T, Moser M. Current Concepts of Femoroacetabular Impingement. Radiologic Clinics of North America [Internet]. Elsevier BV; 2018 Nov;56(6):965–82. Available from: https://doi.org/10.1016/j.rcl.2018.06.009
Pun S, Kumar D, Lane NE. Review: Femoroacetabular Impingement. Arthritis & Rheumatology [Internet]. Wiley; 2014 Dec 27;67(1):17–27. Available from: https://doi.org/10.1002/art.38887
Papalia R, Del Buono A, Franceschi F, Marinozzi A, Maffulli N, Denaro V. Femoroacetabular impingement syndrome management: arthroscopy or open surgery? International Orthopaedics [Internet]. Springer Science and Business Media LLC; 2011 Dec 22;36(5):903–14. Available from: https://doi.org/10.1007/s00264-011-1443-z
Khan M, Bedi A, Fu F, Karlsson J, Ayeni OR, Bhandari M. New perspectives on femoroacetabular impingement syndrome. Nature Reviews Rheumatology [Internet]. Springer Science and Business Media LLC; 2016 Mar 10;12(5):303–10. Available from: https://doi.org/10.1038/nrrheum.2016.17
Jamil M, Dandachli W, Noordin S, Witt J. Hip arthroscopy: Indications, outcomes and complications. International Journal of Surgery [Internet]. Elsevier BV; 2018 Jun;54:341–4. Available from: https://doi.org/10.1016/j.ijsu.2017.08.557
Colvin LA, Bull F, Hales TG. Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia. The Lancet [Internet]. Elsevier BV; 2019 Apr;393(10180):1558–68. Available from: https://doi.org/10.1016/s0140-6736(19)30430-1
Bekker A, Kloepping C, Collingwood S. Meloxicam in the management of post-operative pain: Narrative review. Journal of Anaesthesiology Clinical Pharmacology [Internet]. Medknow; 2018;34(4):450. Available from: https://doi.org/10.4103/joacp.joacp_133_18
Chen Y, Jobanputra P, Barton P, Bryan S, Fry-Smith A, Harris G, et al. Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation. Health Technology Assessment [Internet]. National Institute for Health Research; 2008 Apr;12(11). Available from: https://doi.org/10.3310/hta12110
Ahmed M, Khanna D, Furst DE. Meloxicam in rheumatoid arthritis. Expert Opinion on Drug Metabolism & Toxicology [Internet]. Informa Healthcare; 2005 Nov 30;1(4):739–51. Available from: https://doi.org/10.1517/17425255.1.4.739
Yuan Y, Cui D, Zhang Y. Preemptive meloxicam achieves a better effect on postoperative pain control and similar tolerance compared with postoperative meloxicam in patients receiving arthroscopic knee surgery. Inflammopharmacology [Internet]. Springer Science and Business Media LLC; 2019 Jun 28;27(6):1091–100. Available from: https://doi.org/10.1007/s10787-019-00614-4
Hou J, Li W, Chen Y, Yang L, Li L, Zhao L. Early preoperative versus postoperative administration of meloxicam in pain control, patient global status improvement, knee function recovery of arthroscopic knee surgery. Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2019 Oct;98(40):e17133. Available from: https://doi.org/10.1097/md.0000000000017133
Domb B, Hanypsiak B, Botser I. Labral Penetration Rate in a Consecutive Series of 300 Hip Arthroscopies. The American Journal of Sports Medicine [Internet]. SAGE Publications; 2012 Feb 28;40(4):864–9. Available from: https://doi.org/10.1177/0363546512437152
Banaszkiewicz PA. Traumatic Arthritis of the Hip After Dislocation and Acetabular Fractures: Treatment by Mold Arthroplasty: An End-Result Study Using a New Method of Result Evaluation. Classic Papers in Orthopaedics [Internet]. Springer London; 2013 Dec 7;13–7. Available from: https://doi.org/10.1007/978-1-4471-5451-8_3
Zhu X. Efficacy of preemptive analgesia versus postoperative analgesia of celecoxib on postoperative pain, patients’ global assessment and hip function recovery in femoroacetabular impingement patients underwent hip arthroscopy surgery. Inflammopharmacology [Internet]. Springer Science and Business Media LLC; 2019 Oct 8;28(1):131–7. Available from: https://doi.org/10.1007/s10787-019-00648-8
Turck D, Roth W, Busch U. A Review of the Clinical Pharmacokinetics of Meloxicam. Rheumatology [Internet]. Oxford University Press (OUP); 1996 Apr 1;35(suppl 1):13–6. Available from: https://doi.org/10.1093/rheumatology/35.suppl_1.13
Penprase B, Brunetto E, Dahmani E, Forthoffer JJ, Kapoor S. The Efficacy of Preemptive Analgesia for Postoperative Pain Control: A Systematic Review of the Literature. AORN Journal [Internet]. Wiley; 2015 Jan;101(1):94–105.e8. Available from: https://doi.org/10.1016/j.aorn.2014.01.030
Grape S, Tramèr MR. Do we need preemptive analgesia for the treatment of postoperative pain? Best Practice & Research Clinical Anaesthesiology [Internet]. Elsevier BV; 2007 Mar;21(1):51–63. Available from: https://doi.org/10.1016/j.bpa.2006.11.004
Gates BJ, Nguyen TT, Setter SM, Davies NM. Meloxicam: a reappraisal of pharmacokinetics, efficacy and safety. Expert Opinion on Pharmacotherapy [Internet]. Informa Healthcare; 2005 Oct;6(12):2117–40. Available from: https://doi.org/10.1517/14656518.104.22.1687
How to Cite
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License