For patients with moderate pain after foot surgery, the cyclo-oxygenase 2 (COX-2) inhibitor drug etoricoxib provides better pain relief with fewer side effects than the opioid drug tramadol, concludes a study in the August issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).
The study also helps to alleviate concerns that COX-2 inhibitors and other nonsteroidal anti-inflammatory drugs (NSAIDs) may interfere with bone healing after surgery. The study was led by Dr. Metha Brattwall of University Hospital Möndal in Gothenburg, Sweden.
Etoricoxib Improves Pain Relief after Bunion Surgery
The researchers compared two different pain-relieving drugs in 100 women undergoing surgery for bunions (hallux valgus). One group received the COX-2 inhibitor etoricoxib, while the other group received tramadol, an opioid (narcotic-like) drug similar to codeine.
Although both drugs were effective in controlling pain in the week after surgery, pain scores were significantly lower in the etoricoxib group. Women assigned to etoricoxib had an average pain score of 12.5 (on a 100-point scale), compared to 17 in those receiving tramadol.
Patients in the etoricoxib group had lower maximum pain scores throughout the week after surgery. They also had better pain relief on the second and third days after surgery, when pain scores were highest. "Etoricoxib was also associated with fewer side effects and thus overall patient satisfaction with pain medication," the researchers write.
No Evidence of Impaired Bone Healing
On computed tomography (CT) scans performed twelve weeks after surgery, there was no difference in bone healing between the etoricoxib and tramadol groups. Previous studies had raised concerns that NSAIDs, including COX-2 inhibitors, might cause problems with bone healing. The new results show no evidence of impaired healing in patients taking NSAIDs, at least after a relatively minor operation like bunion surgery.
The COX-2 inhibitor drugs were developed to provide pain relief without the adverse effects—such as reduced blood clotting and a risk of stomach ulcers—of conventional NSAIDs (like aspirin and ibuprofen). However, COX-2 inhibitors like rofecoxib (Vioxx) were pulled from the market in the United States when research suggested an increased risk of cardiovascular complications. Etoricoxib is not currently approved for use in the United States, but is available in other countries.
More recently, an influential series of studies supporting the use of NSAIDs for postoperative pain management were retracted when it was discovered that a prominent researcher had falsified data. "We lost much of our data on NSAIDs for postoperative pain management when we learned that much of Scott Reuben's work was fabricated," comments Dr. Steven L. Shafer of Columbia University, Editor-in-Chief of Anesthesia & Analgesia. "This study helps to rebuild the case for the utility of NSAIDs for moderate to severe postoperative pain following bone surgery."
NSAIDs are generally considered much safer than opioid drugs. "The results suggest that NSAIDs can provide superior analgesia for patients with moderate pain after bone surgery, with reduced risk," Dr. Shafer adds.