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Sex-specific and Age-specific Analgesia for Early Postoperative Pain Management After Lumbar Decompressive Surgery

A Randomized Clinical Trial

Kim, Sang-Il MD*; Ha, Kee-Yong MD, PhD*; An, Howard S. MD, PhD; Rhyu, Kee-Won MD, PhD; Lee, Hyun-Woo MD§; Oh, In-Soo MD, PhD§

doi: 10.1097/BSD.0000000000000761
PRIMARY RESEARCH
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Study Design: This was a randomized clinical trial.

Objective: To compare the efficacy and safety of nonsteroidal anti-inflammatory drug and opioid for acute pain management after lumbar decompressive surgery.

Summary of Background Data: Multimodal analgesia is associated with synergistic effects while reducing opioid-related adverse effects. However, there is no consensus on the ideal multimodal analgesic regimen. We assumed that each agent in various multimodal regimens under different conditions may have different effects.

Materials and Methods: This prospective randomized clinical trial recruited adult patients who underwent single-level lumbar decompressive surgery. Patients were randomized to receive our postoperative analgesic regimen including either nonsteroidal anti-inflammatory drug (celecoxib) or opioid (extended-release oxycodone) from postoperative day 3 to 14. The Visual Analog Scale (VAS) and Oswestry Back Pain Disability Index (ODI) were used to evaluate effectiveness preoperatively and on postoperative days 2, 3, 7, and 14, and at 6 months. Drug-related adverse effects were also recorded.

Results: One hundred patients were enrolled and 93 patients (46 patients with celecoxib vs. 47 patients with oxycodone) were randomized. No differences were observed in patient demographics and preoperative VAS and ODI between the 2 groups. VAS and ODI were not different at all postoperative time points. However, subanalysis according to sex and age, revealed significant differences in efficacy: celecoxib was effective in female individuals and oxycodone was effective in male individuals on postoperative days 7 and 14; oxycodone was effective in patients aged above 65 years on postoperative days 7 and 14. Although nausea/vomiting and constipation were more common in the oxycodone group than in the celecoxib group, other adverse effects were not different.

Conclusions: In patients who underwent single-level lumbar decompressive surgery, treatment with celecoxib and oxycodone for postoperative pain management showed no significant differences in efficacy. However, subanalysis showed that each drug was effective in different ages and sex groups.

Level of Evidence: Level II.

*Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL

Department of Orthopaedic Surgery, St. Vincent Hospital, College of Medicine

§Department of Orthopaedic Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

The authors declare no conflict of interest.

Reprints: In-Soo Oh, MD, PhD, Department of Orthopaedic Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsuro, Bupyeong-gu, Incheon 21431, Korea (e-mail: insoooh@catholic.ac.kr).

Received May 7, 2018

Accepted October 1, 2018

© 2019 by Lippincott Williams & Wilkins, Inc.