Rationale for preoperative (versus postoperative) administration of meloxicam for acute pain management and assessment of satisfaction in patients with femoroacetabular impingement who underwent hip arthroscopy

Abstract

Objective: This study is aimed to compare the analgesic effect and safety of preoperative (versus postoperative) meloxicam administration in femoroacetabular impingement (FAI) patients who underwent hip arthroscopy (HA). Methods: Totally, 136 FAI patients who scheduled for HA were recruited, then they were randomly assigned to preoperative administration (PREA) group (orally meloxicam 7.5 mg in 12h, 24h before operation, then orally 7.5 mg/d from 12h to Day 7 after operation; N = 68) or postoperative administration (POSA) group (orally meloxicam 7.5 mg/d from 12h to Day 7 after operation; N = 68) in 1:1 ratio. Furthermore, pain visual analog scale (VAS) score, patient satisfaction score, Harris hip score (HHS) and adverse events were assessed. Besides, the accumulated pethidine consumption for rescuing analgesia was calculated. Rationale for preoperative (versus postoperative) administration of meloxicam for acute pain management and assessment of satisfaction in patients with femoroacetabular impingement who underwent hip arthroscopy Yongqing Li, MB1, Guowei Li, MM2, Kai Zhang, MM3, Menglu Jiang, MB4, Xu Dai, MM4, Zhenqing Liu, MB4, Ou Wang, MB3 1Department of Anesthesiology, Shanghai Liqun Hospital, Putuo District, Shanghai, China 2Department of Anesthesiology, Wuxi Fifth People’s Hospital Affiliated to Jiangnan University, Wuxi, China 3Department of Orthopedics, Shanghai Liqun Hospital, Putuo District, Shanghai, China 4Department of Anesthesiology, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, China Declarations Yongqing Li and Guowei Li contributed equally to this work. Running title Meloxicam in FAI patients who underwent HA. Acknowledgements This study was supported by Wuxi Science and Technology Development Medical and Health Guidance Plan (No: NZ2019038). Conflicts of Interest The authors of this work have nothing to disclose. 20 Оригінальна стаття / Original article ISSN 2414–3812 Introduction Femoroacetabular impingement (FAI) is characterized by abnormal morphology of femoral head–neck or acetabulum that leads to impingement [1, 2]. The main symptom of FAI is pain, meanwhile, FAI might also lead to mechanical symptoms (such as articular stiffness and objective hip instability), articular lesions (including hip osteoarthritis), and even disability [3]. Current treatments for FAI mainly consist of non-operative management (such as rest, physiotherapy and administration of nonsteroidal anti-inflammatory drugs (NSAIDs)) and surgical management (such as open surgery and hip arthroscopy (HA)) [4, 5]. Among these treatments, HA is becoming more popular for it is minimally invasive, which corrects hip shape abnormalities and prevents intraarticular injury [4, 6]. However, FAI patients who underwent HA still suffer from postoperative pain that rises the risk of complications and hinders hip joint recovery [6]. In regular open surgery, strong opioid analgesics have been frequently administrated to control postoperative pain; while in minimal invasive surgery (such as HA), weak opioid and NSAIDs are preferred, while their administration are related to several adverse events (such as respiratory suppression, nausea and vomiting) and potential addiction [7]. Meloxicam is a kind of selective NSAIDs, which presents similar analgesic, anti-inflammatory effects, and reduces the incidence of gastric and renal disorders compared to non-selective NSAIDs [8]. Although meloxicam has been widely administrated for treating osteoarthritis, rheumatoid arthritis and other pain syndromes caused by osteoarticular lesions, the effect of preoperative meloxicam administration on managing postoperative pain in patients with osteoarticular lesions is not discovered until recent [9, 10]. For instance, one recent study suggests that compared with postoperative meloxicam administration, preoperative meloxicam administration attenuates acute pain and reduces additional analgesia consumption in patients who underwent arthroscopic knee surgery [11]. Moreover, another interesting study reveals that preoperative meloxicam administration has better effect than postoperative meloxicam administration on controlling acute postoperative pain, while it presents similar effect on the incidence of adverse events and knee function recovery to postoperative meloxicam administration in patients who underwent arthroscopic knee surgery [12]. However, whether preoperative meloxicam administration would also present good analgesic effect and tolerance in FAI patients after HA is not clear. Therefore, we performed this randomized, controlled study and aimed to compare the analgesic effect and safety of preoperative versus postoperative meloxicam administration in FAI patients who underwent HA.