Preoperative celecoxib analgesia is more efficient and equally tolerated compared to postoperative celecoxib analgesia in knee osteoarthritis patients undergoing total knee arthroplasty: A randomized, controlled study

The aim of the present study was to evaluate the efficacy and safety of preoperative celecoxib administration in alleviating postoperative pain in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA). A total of 226 knee OA patients underwent TKA were consecutively recruited and randomized into preoperative analgesia group and postoperative analgesia group as 1:1 ratio. Preoperative analgesia group received celecoxib before and post operation; postoperative analgesia group received celecoxib post operation, all patients received TKA and intravenous patient-controlled analgesia (PCA) post operation. Pain visual analog scale (VAS), patient's global assessment (PGA), flexional angles, PCA consumption, percentage of patients receiving pethidine, pethidine consumption, and adverse events were assessed. Pain VAS scores at rest and at flexion were both lower in preoperative analgesia group compared to postoperative analgesia group at 2 hours, 6 hours, 12 hours, and 24 hours post operation. Preoperative analgesia group also exhibited decreased PGA score compared to postoperative analgesia group at 2 hours, 6 hours, 12 hours, 24 hours, and 48 hours post operation. Meanwhile, active flexional angle and passive flexional angle in preoperative analgesia group were larger than that in postoperative analgesia group at 72 hours post operation. More interestingly, preoperative analgesia group patients consumed less PCA compared to postoperative analgesia group patients at 72 hours post operation. No difference of adverse event incidences between 2 groups was observed. Preoperative administration of celecoxib exhibits better efficacy and equal safety profiles compared to postoperative administration of celecoxib in knee OA patients undergoing TKA.