Patch transdermique de buprénorphine versus Celecoxib oral pour la gestion de la douleur après une arthroplastie totale du genou : essai contrôlé randomisé ouvert en simple aveugle - 04/08/20

Transdermal buprenorphine patch versus oral celecoxib for pain management after total knee arthroplasty: An open-label, randomized controlled trial

Doi : 10.1016/j.rcot.2020.06.009

Xinxian Xu ^a, Linghui Xie ^b, Haixiao Liu ^a, Yuezheng Hu ^a,^⁎
^a The Osteopathy Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Chine
^b The Radiology Department of Wenzhou Seventh Hospital, Hospital of Wenzhou Medical University, Wenzhou, Chine

^⁎Auteur correspondant. The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, Chine.The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhou, Zhejiang ProvinceChine

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Abstract

Background

This study was performed to evaluate the analgesic efficacy and safety of transdermal buprenorphine (TDB) patched for postoperative pain control after total knee arthroplasty (TKA). The hypothesis was that patients receiving the TDB patch would have less pain in comparison to those treated with the oral COX-2 inhibitor celecoxib without increasing side effects.

Patients and methods

A total of 160 patients scheduled for primary TKA were randomly assigned to two groups: patients provided a TDB patch (10μg/h) (TDB group) and those provided oral celecoxib (CX group). The outcomes were pain scores measured using the visual analogue scale (VAS) during rest and activity, as well as morphine requirement, operated knee functional recovery and adverse events postoperatively.

Results

The total morphine given during the first 72h postoperatively was significantly lower in the TDB group than CX group. The VAS scores were significantly lower in the TDB group than CX group during rest at 2, 4, 6, 12, 24 and 48h postoperatively, and during activity at 12, 24 and 48h and 3 days postoperatively. The mean range of motion on postoperative days (PD) 1, 2 and 3 were significantly greater in the TDB group. In addition, the Lysholm score was significantly higher in the TDB group on PD 3. There were no remarkable adverse events in either group.

Discussion

Use of a TDB patch provides effective pain relief and reduces the requirement for rescue morphine without increasing side effects in comparison with oral celecoxib during the early post-operative stage following TKA.

Level of evidence

II.

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Keywords : Transdermal buprenorphine patch, Celecoxib, Total knee arthroplasty, Postoperative pain

☆	Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.