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

Abstract

Abstract Background

This is an updated version of the original Cochrane review published in Issue 2, 2000. Piroxicam is a non‐steroidal anti‐inflammatory drug (NSAID) with analgesic properties, and is used mainly for treating rheumatic disorders. Some drugs have been directly compared against each other within a trial setting to determine their relative efficacies, whereas other have not. It is possible, however, to compare analgesics indirectly by examining the effectiveness of each drug against placebo when used in similar clinical situations.

Objectives

To determine the analgesic efficacy and adverse effects of single‐dose piroxicam compared with placebo in moderate to severe postoperative pain. To compare the effects of piroxicam with other analgesics.

Search methods

Published studies were identified from systematic searching of MEDLINE, Biological Abstracts, EMBASE, CENTRAL and the Oxford Pain Relief Database in December 2007. Additional studies were identified from the reference lists of retrieved reports.

Selection criteria

The following inclusion criteria were used: full journal publication, randomised placebo controlled trial, double‐blind design, adult participants, postoperative pain of moderate to severe intensity at the baseline assessment, postoperative administration of oral or intramuscular piroxicam.

Data collection and analysis

Summed pain intensity and pain relief data were extracted and converted into dichotomous information to yield the number of participants obtaining at least 50% pain relief. This was used to calculate estimates of relative benefit and number‐needed‐to‐treat‐to‐benefit (NNT) for one participant to obtain at least 50% pain relief. Information was collected on adverse effects and estimates of relative risk and number‐needed‐to‐treat‐to‐harm (NNH) were calculated.

Main results

In this update no further studies were found. The original search identified three studies (141 participants) which compared oral piroxicam 20 mg with placebo and one (15 participants) compared oral piroxicam 40 mg with placebo. For single doses of piroxicam 20 mg and 40 mg the respective NNT for at least 50% pain relief were 2.7 (2.1 to 3.8) [95% confidence interval (CI)] and 1.9 (1.2 to 4.3) [95% CI] compared with placebo over four to six hours in moderate to severe postoperative pain. The reported incidence of adverse effects was no higher with piroxicam (20 mg or 40 mg) than with placebo. No further additional studies were found in the updated search.

Authors' conclusions

Piroxicam appears to be of similar efficacy to other NSAIDs and intramuscular morphine 10 mg when used as a single oral dose in the treatment of moderate to severe postoperative pain.

Author(s)

R Andrew Moore, Jayne Edwards, Yoon Kong K Loke, Sheena Derry, Henry J McQuay

Abstract

Plain language summary

Piroxicam as a single dose in treating acute postoperative pain

There is insufficient evidence that single doses of piroxicam provide effective analgesia in adults with acute postoperative pain. This review assessed the efficacy of oral single‐dose piroxicam in adults with moderate/severe postoperative pain using information from randomised placebo controlled trials. The results were based on few data and were not robust. The results suggested that piroxicam (20 mg or 40 mg) was more effective than placebo and comparable to other non‐steroidal anti‐inflammatory drugs and intramuscular morphine 10 mg. Adverse effects were uncommon. The most frequently reported adverse effects were dizziness, nausea and vomiting.

Author(s)

R Andrew Moore, Jayne Edwards, Yoon Kong K Loke, Sheena Derry, Henry J McQuay

Reviewer's Conclusions

Authors' conclusions

Implications for practice

The update of this review has not identified any further information to provide evidence for or against the use of 'Single dose piroxicam for acute postoperative pain'. There remains insufficient high quality information available on which to make purchasing or policy decisions. However, the NNTs suggest that single doses of piroxicam (20 mg and 40 mg) are reasonably effective for treating moderate to severe postoperative pain, and compare favourably with opioid analgesics such as dextropropoxyphene and tramadol, and other NSAIDs. Few adverse effects were reported and piroxicam appears to be fairly well tolerated in this clinical context. In multiple dosing the adverse effect profile may be more prominent. There is a definite need to be able to quantitatively assess the efficacy and adverse effects of piroxicam in prolonged dosing regimens.

Implications for research

Further work is required to reliably assess the relative efficacy and safety of piroxicam under well controlled conditions, particularly intramuscular piroxicam. Study designs should include systematic, well defined methods for collecting and reporting adverse effects.

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