A randomized controlled study comparing rofecoxib, diclofenac sodium, and placebo in post-bunionectomy pain.

Abstract

OBJECTIVE:

The relative efficacy of rofecoxib, diclofenac sodium, and placebo were compared in the treatment of acute pain after bunionectomy surgery.

RESEARCH DESIGN AND METHODS:

This was a double-blind, randomized, two-part study of 252 patients with moderate-to-severe pain the day after first metatarsal bunionectomy. Patients were treated with a single dose of rofecoxib 50 mg (N = 85), enteric-coated diclofenac sodium 100 mg (N = 85), or placebo (N = 82) on study Day 1 (Part I), and subsequently with daily rofecoxib 50 mg or placebo (diclofenac patients switched to placebo) over study Days 2-5 (Part II). Patients rated their pain at 16 time points over the first 24 h. Primary endpoint was total pain relief over 8 h (TOPAR8). Pre-specified secondary endpoints on Day 1 included onset of analgesia, peak pain relief, and duration of response. For Part II, supplemental analgesia use with rofecoxib compared to placebo was pre-specified for analysis over Days 2-5, with the focus on Days 2-3. Adverse experiences were recorded over Days 1-5.

RESULTS:

For TOPAR8 scores, rofecoxib 50 mg was significantly more effective than placebo (9.5 vs. 3.7, p < 0.001) and diclofenac (9.5 vs. 5.0, p < 0.001). Onset of analgesia was more rapid with rofecoxib than placebo (p = 0.003) and diclofenac (p = 0.019); proportion of patients achieving onset within 4 h with rofecoxib, diclofenac, and placebo was 46%, 27%, and 23%, respectively. Peak pain relief was greater with rofecoxib (1.8) than diclofenac (1.2, p = 0.004) and placebo (1.0, p < 0.001). Diclofenac and placebo patients required supplemental analgesia sooner than rofecoxib patients (2:03 h vs. 4:02 h, p < 0.001 and 1:41 h vs. 4:02 h, p < 0.001). Rofecoxib patients used significantly less (p < 0.001) supplemental analgesia than placebo patients over Days 2-3 (1.1 tablets/day vs. 2.1 tablets/day) and Days 2-5 (0.9 tablets/day vs. 1.8 tablets/day). No significant differences in adverse experiences between treatments were seen.

CONCLUSION:

Rofecoxib 50 mg was significantly more effective than placebo on all measures of treatment of post-bunionectomy pain. Rofecoxib 50 mg was significantly more effective than diclofenac sodium 100 mg based on Day 1 endpoints of total pain relief, onset time, and duration of response. All study medications were generally well tolerated.

• Authors: Paul J Desjardins, Peter M Black, Steven Daniels, Steven R Bird, Brian J Fitzgerald, Richard A Petruschke, Andrew Tershakovec, David J Chang
• Journal: Current medical research and opinion (Curr Med Res Opin) Vol. 20 Issue 10 Pg. 1523-37 (Oct 2004) ISSN: 0300-7995 [Print] England
• PMID: 15462686 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Lactones
• Placebos
• Sulfones
• rofecoxib
• Diclofenac

Topics

• Administration, Oral
• Adult
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Diclofenac (therapeutic use)
• Double-Blind Method
• Female
• Hallux Valgus (surgery)
• Humans
• Lactones (therapeutic use)
• Male
• Middle Aged
• Orthopedic Procedures (adverse effects)
• Pain Measurement
• Pain, Postoperative (drug therapy)
• Placebos
• Sulfones (therapeutic use)