Single dose oral etodolac for acute postoperative pain in adults Stable (no update expected for reasons given in 'What's new')

Abstract

Abstract
Background

Etodolac is a selective cyclo‐oxygenase‐2 (COX‐2) inhibitor, with evidence of efficacy in osteoarthritis and rheumatoid arthritis. Its analgesic efficacy in postoperative pain has not been clearly established. There are no systematic reviews on Etodolac's use in this condition.

Objectives

To assess the analgesic efficacy of etodolac in single oral doses for moderate and severe postoperative pain.

Search methods

We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to May 2009.

Selection criteria

Randomised, double blind, placebo‐controlled trials of single dose orally administered etodolac (any formulation) in adults with moderate to severe acute postoperative pain.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk (RR) and number needed to treat to benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected.

Main results

Nine studies (1459 participants) compared etodolac and placebo. Studies were of adequate reporting quality, and the majority of participants had pain following dental extractions. The dose of etodolac used was 25 mg to 1200 mg, with most of the information for 100 mg and 200 mg. For at least 50% pain relief over 4 to 6 hours compared with placebo the NNT for etodolac 100 mg (498 participants) was 4.8 (3.5 to 7.8) and for etodolac 200 mg (670 participants) it was 3.3 (2.7 to 4.2). Very limited information with the extended release formulation did not suggest improved benefit for this outcome.

The proportion of participants with at least 50% pain relief was 41% with 100 mg and 44% with 200 mg. Remedication was needed by about 60% with etodolac 200 mg or 400 mg over 6 to 8 hours, compared with almost 80% with placebo.

Adverse events were uncommon, and not significantly different form placebo.

Authors' conclusions

Etodolac 200 mg may be a useful analgesic in postoperative pain, with efficacy similar to paracetamol 1000 mg and celecoxib 200 mg. Higher doses may provide analgesia equivalent to more commonly used drugs, such as ibuprofen 400 mg, naproxen 500 mg and diclofenac 50 mg.

Author(s)

Shravan Kumar Tirunagari, Sheena Derry, R Andrew Moore, Henry J McQuay

Abstract

Plain language summary

 Single dose oral etodolac for acute postoperative pain in adults 

Etodolac 200 mg provides a high level of pain relief in about 40% of those with moderate or severe acute postoperative pain. This is fewer than one would expect to see of the same level of pain relief with standard doses of ibuprofen, naproxen and diclofenac. Higher doses of etodolac may be more effective There were no more adverse events than with placebo in these single dose studies.

Author(s)

Shravan Kumar Tirunagari, Sheena Derry, R Andrew Moore, Henry J McQuay

Reviewer's Conclusions

Authors' conclusions

Implications for practice

Etodolac is an effective analgesic in acute postoperative pain. At a dose of 200 mg it is comparable to paracetamol 1000 mg, and lower doses of commonly used analgesics, such as naproxen 200 mg and celecoxib 200 mg. It provides a clinically useful level of analgesia over 4 to 6 hours to about 40% of those treated with Etodolac. The higher dose of 400 mg may provide better levels of analgesia. In single dose, etodolac is well tolerated and is associated with a low rate of adverse events, similar to that with placebo.

Implications for research

Further information would be needed to confirm a dose response, and in particular to determine whether the higher dose of 400 mg can provide analgesia equivalent to other commonly used analgesics such as ibuprofen 400 mg, naproxen 500 mg, and diclofenac 50 mg. New studies should also report on time to use of rescue medication to provide information about duration of analgesia.

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