Pain after elective arthroscopy of the knee: a prospective, randomised, study comparing conventional NSAID to coxib

Although outpatient knee arthroscopy is probably by far the most frequently performed orthopaedic procedure, there are limited guidelines or consensus concerning the peroral postoperative pain management. A diversity of analgesics both in potency and action is prescribed. The purpose of the present investigation was to grade the pain and need for rescue medication during the first 4 days after the knee arthroscopy, comparing a conventional nonsteroidal anti-inflammatory drug (NSAID) with a selective cox-II-inhibitor (coxib) as postoperative pain medication. One hundred and twenty-two patients scheduled for primary elective knee arthroscopy in general anaesthesia were randomised to either a NSAID (lornoxicam) or a selective cox-II-inhibitor (rofecoxib) postoperatively. Pain ratings and the need for rescue medication were followed for four consecutive days. Side effects were also registered. The need for rescue analgesics was highest the evening after surgery, when 42% of patients required one, or more, oral additional analgesics. The use of rescue medication decreased with time and 30, 25, 16 and 11% of the patients required additional analgesics for day 1 to 4, respectively, still 50% of all patients required at some point one or more rescue analgesics. Overall pain ratings were low, and showed similar pattern with evening and day, 50% of all patients required at some point one or more rescue analgesics. We found, however, no differences in pain ratings, or need for rescue analgesics between the two groups, conventional NSAID and coxib as well as no difference in side-effect profile. In conclusion, patients do require proper pain management also after minor outpatient surgical procedures such as knee arthroscopy. The traditional NSAIDs seem to be the first choice for analgesic and anti-inflammatory effects, when needed after elective arthroscopy of the knee.