Comparison of transdermal and oral anti-inflammatory drugs on immediate post-operative pain control in total knee arthroplasty: a randomized controlled trial.

BACKGROUND

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as multimodal pain-control medications in total knee arthroplasty (TKA), while topical NSAIDs are commonly used for chronic pain conditions. There is limited evidence on whether topical NSAIDs could provide effective pain control after surgery. We compared the efficacy of topical and oral NSAIDs for immediate post-operative pain following TKA.

METHODS

This prospective, randomized, non-inferiority trial included 100 patients undergoing primary TKA. Following uniform anesthesia and multimodal pain management, from post-operative day 1 (POD 1) onward, patients were randomly assigned to receive either a transdermal Esflurbiprofen patch (Group A) or oral Celecoxib (Group B) once daily for 14 days. Pain at rest and on motion, functional outcomes, and adverse events were serially evaluated from POD 0 through 6 weeks post-operatively.

RESULTS

There were 50 patients in both Group A and B, with a mean age of 72 years and a female predominance (over 70%). There were no differences in demographic data. Both groups had significantly lower visual analog scale (VAS) scores at rest and on motion at POD 0, POD 1, POD 2, POD 3, POD 5, POD 14, and the 6th week, with no differences between groups. The timed up-and-go test (TUGT), 5-time sit-to-stand test (5TSST), and 3-min walk test (3MWT) were similarly significantly worse in both groups at POD 14 and improved in the 6th week. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was similarly improved at POD 3, POD 14, and in the 6th week, without differences. Both groups had no serious adverse events and no changes in creatinine clearance at any follow-up point.

CONCLUSION

A multimodal pain control regimen in TKA using a transdermal Esflurbiprofen patch provided immediate post-operative pain control that was non-inferior to oral Celecoxib, with comparable VAS, functional outcomes, and safety profiles.