人工膝関節置換術後に対するトラマドール塩酸塩とセレコキシブ術後用量による鎮痛効果の比較

抄録

Objective: The management of postoperative pain from total knee arthroplasty (TKA) is very important for improving patient function and to shorten the length of hospital stay. Safety and effectiveness are required for postoperative pain management. Non-steroidal anti-inflammatory drugs (NSAIDs), especially loxoprofen and diclofenac, are commonly used for postoperative pain. However, gastric mucosa disorders and renal dysfunction caused by such therapies are problematic. Tramadol, a synthetic opioid, has a different mechanism of action compared with NSAIDs. Celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, has fewer gastrointestinal adverse effects than traditional NSAIDs. This study aimed to compare the analgesic effect of tramadol and celecoxib after TKA.

Methods: Sixty-one patients with osteoarthritis underwent TKA in our institution and were enrolled into this study. Thirty patients were treated with tramadol (Group T), and 31 patients were treated with celecoxib (Group C), respectively. Group T patients received 450 mg tramadol per day, and Group C patients received 400 mg celecoxib per day, beginning on the day after surgery until day 14. The primary outcome was a visual analog scale (VAS) pain score measured on postoperative day 1, day 4, and day 7. Secondary outcomes included range of motion (ROM) on postoperative day 21, creatinine clearance and the rates of adverse effects.

Results: There was no significant change of the VAS score, ROM or creatinine clearance between the two groups. Three (10%) patients from Group T stopped oral analgesia because of nausea and vomiting. Three (10%) patients from Group C stopped oral analgesia because of drug rash or drug-induced liver dysfunction. There were no patients with new-onset acute renal dysfunction.

Conclusion: There was no significant differences between the analgesic effect of tramadol and celecoxib in the postoperative period following TKA.