[Systematic review to assess the effectiveness and safety of parecoxib].
OBJECTIVE
Conduct a meta-analysis of randomized clinical trials to assess the effectiveness and safety of parecoxib as analgesic for orthopedic surgery.


METHODS
The search strategy included Medline, Embase and Cochrane. Two independent investigators selected the trials. The meta-analyses were performed using the RevMan v.5.0 software. Calculations were based on the similarity of the trials considering the parecoxib dose (20 or 40 mg) and the type of comparator (placebo, other analgesics).


RESULTS
A total of 1253 titles were reviewed and 10 trials that assess parecoxib for hip, knee and spine surgery and bunionectomy were selected. In 6/10 trials parecoxib 40 mg did better in the overall assessment versus the placebo (OR 0.20; 95% CI, 0.13-0.31), in the frequency of rescue analgesic use (OR 0.18; 95% CI, 0.07-0.47) as well as in the use of morphine and in pain intensity at 48 hours (p < 0.001). Three trials did not show any difference between parecoxib and ketorolac, morphine, metamizole or paracetamol. Regarding safety, the frequency of adverse events with parecoxib was similar to the placebo or other analgesics.


CONCLUSIONS
Parecoxib 40 mg is an effective and safe analgesic choice during the postoperative period in orthopedic surgery.
Villasís-Keever
Miguel Angel
MA
Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Pediatria, Centro Médico Nacional Siglo XXI. Av. Cuauhtémoc Núm. 330, Col. Doctores, DF México. miguel.villasis@imss.gob.mx
Rendón-Macías
Mario Enrique
ME
Escamilla-Núñez
Alberto
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D019637:Orthopedic Procedures; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D010919:Placebos; D016032:Randomized Controlled Trials as Topic; D012449:Safety
D000700:Analgesics; D052246:Cyclooxygenase 2 Inhibitors; D007555:Isoxazoles; D010919:Placebos; C409945:parecoxib