Tehran University of Medical Sciences
Archives of Anesthesiology and Critical Care
2423-5849
11
Supp. 1
2025
05
25
Comparative Analysis of Two Celecoxib Regimens for Postoperative Pain Management Following Bi-Malleolar Fracture Surgery
627
634
Arezou
Ashari
Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Dariush
Abtahi
Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2025
02
21
2025
02
23
Background: Bimalleolar fractures, which often necessitate surgery due to instability, are linked to considerable postoperative pain. Selective cyclooxygenase-2 (COX-2) inhibitors, like celecoxib, have demonstrated potential in alleviating pain and decreasing the need for opioids. However, the optimal dosing regimen remains unclear. This study compares the efficacy of two celecoxib regimens in reducing postoperative pain after ankle fracture surgery.
Methods: A double-blind, randomized controlled trial was carried out with 240 patients undergoing bimalleolar fracture surgery under spinal anesthesia. The participants were split into three groups: a placebo group, a group receiving 400 mg of celecoxib (Group 400), and a group receiving 600 mg of celecoxib (Group 600). Pain levels were evaluated using the Visual Analog Scale (VAS) at specific time points (0, 6, 24, and 72 hours after surgery). Additionally, total morphine consumption, the time until first analgesic use, patient satisfaction, and side effects were documented.
Results: Patients in Group 600 experienced significantly lower pain scores and delayed morphine use compared to the placebo group (P < 0.05). Both celecoxib groups consumed less morphine overall, with higher patient satisfaction scores reported in Group 600. Adverse events were minimal and comparable across all groups.
Conclusion: The preemptive use of celecoxib, particularly at a 600 mg dose, significantly reduces postoperative pain and opioid use while enhancing patient satisfaction with minimal side effects. These results suggest that COX-2 inhibitors are a practical alternative to opioids for managing pain after ankle fracture surgery.
https://aacc.tums.ac.ir/index.php/aacc/article/view/1214
ngle-blind clinical trial was carried out with 40 adults diagnosed with radicular pain from lumbar disc protrusion at L4-L5 or L5-S1. They were randomly placed into two equal-sized groups. The first group (n=20) received a caudal injection containing dexamethasone (8 mg), lidocaine (5 mL, 1%), and saline (3 mL). The second group (n=20) received the same injection along with 5 mL of ozone (10 µg/cc). Fluoroscopy was used to guide all procedures. Pain and physical function were tracked using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), both before treatment and again after one, three, and six months.
Results: Improvements were seen in both groups over time. Still, the ozone group reported stronger pain relief and better functional scores at every follow-up. At one month, VAS and ODI scores were significantly lower in the ozone group (VAS: 1.85 ± 0.75 vs. 2.40 ± 0.90, p = 0.029; ODI: 22.3 ± 4.5 vs. 26.7 ± 5.1, p = 0.025). The difference held steady at three months (VAS: p = 0.022; ODI: p = 0.021) and at six months (VAS: p = 0.017; ODI: p = 0.015). No major side effects occurred, and mild ones cleared up on their own.
Conclusion: The addition of ozone therapy to fluoroscopic-guided caudal epidural steroid injections significantly enhances pain relief and functional recovery in patients with lumbosacral radiculopathy compared to steroid injections alone. This combination therapy represents a safe, minimally invasive, and effective treatment option for individuals with refractory radicular pain. Further large-scale, multicenter trials with long-term follow-up are warranted to validate these findings and optimize treatment protocols.
https://aacc.tums.ac.ir/index.php/aacc/article/view/1225