Is Preoperative Administration of Celecoxib and Pregabalin Associated with Decreased Intraoperative and Postoperative Opioid Consumption in Patients Undergoing Total Hip or Knee Arthroplasty?

Abstract: The purpose of this study was to determine if a preoperative dose of celecoxib and pregabalin in patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) was associated with less opioid consumption intraoperatively and postoperatively compared to those who did not receive this regimen.

Introduction: THA and TKA have been associated with a high incidence of postoperative pain. Historically, this pain has been managed with opioids; however, these drugs have negative side effects associated with their use. Consequently, anesthesia providers have begun utilizing multimodal non-opioid analgesics. Recently, a specific combination has been utilized, which includes a nonsteroidal anti-inflammatory drug known as celecoxib (Celebrex) and an anticonvulsant known as pregabalin (Lyrica). While this combination may be a beneficial alternative for opioids, there is no consensus on the timeliness or effectiveness of a single combination dose of these drugs at alleviating perioperative pain.

Methodology: A retrospective cross-sectional study design was utilized for this study that included 200 patients who underwent THA or TKA between May 1, 2008 and May 1, 2018 at Charleston Area Medical Center. A total of 100 patients were included in group one, which consisted of patients who did not receive a preoperative dose of celecoxib and pregabalin or any other preoperative analgesics. Group two consisted of 100 patients who did receive a preoperative dose of both celecoxib and pregabalin. The primary independent variable was the preoperative administration of celecoxib and pregabalin. Secondary independent variables consisted of gender, age, body mass index (BMI), and American Society of Anesthesiologists (ASA) physical classification scores. The dependent variables consisted of intraoperative opioid consumption and total opioid consumption in the postoperative anesthesia care unit (PACU). Control variables consisted of gender, age, BMI and ASA physical classification scores. The research hypotheses were that patient who underwent THA or TKA and received preoperative doses of both celecoxib and pregabalin would have less opioid consumption in the intraoperative period and less opioid consumption in the PACU, compared to those who did not receive the same combination preoperatively.

Results: Comparison of the two groups yielded no differences between mean age, BMI or gender. The mean age and ASA classification between the two groups were statistically different, p=.0001 and p=.017. Group one consisted of 55 females and 45 males, while group two consisted of 52 females and 48 males. The study also revealed there was a statistical significance in terms of PACU opioid consumption (p=.001) between the two groups but no statistical difference in intraoperative opioid consumption (p>.05). Group one received a mean difference of approximately 1.2 morphine equivalents more than group two. There was no statistical significance between PACU opioid consumption and age, gender, BMI, or ASA classification. Analysis showed there was a statistical association between intraoperative opioid consumption and age (p=.022) and gender (p=.025). Further analysis revealed females received a mean of 3.22 morphine equivalents more than males.

Discussion: The study results supported the hypothesis that preoperative celecoxib and pregabalin would be associated with a decrease in PACU opioid consumption in patients undergoing THA or TKA. These results did not support the additional study hypothesis that this combination would also decrease intraoperative opioid consumption.

Implications and Recommendations: The results of this study supported the use of preoperative celecoxib and pregabalin at reducing PACU opioid consumption. Additional prospective, randomized studies are needed to compare the use of celecoxib and pregabalin independently versus in combination.

Conclusion: In conclusion, this study found an association between the preoperative administration of celecoxib and pregabalin in patients undergoing THA or TKA and decreased PACU opioid consumption; however, no association was found between the preoperative administration of celecoxib and pregabalin and decreased intraoperative opioid consumption in these patients.