Reachout Orthopedics - Issue 2

when compared with D/E group with no significant difference between group E and group D (Fig. 3). At 48 h, total morphine re- quirement were still significantly increased in the P group compared with all groups with significant increases in both E and D groups when compared with D/E group with no significant difference between group E and group D (Fig. 4). But it was still significantly lower in the three groups at 48 h post-surgery when compared with those required at 24 h. The Pain Score With regard to pain scores at rest all time points, the duloxetine/etoricoxib (D/E) group had significantly lower pain scores when compared to placebo group P, while when it compared to etoricoxib group E, also when compared D/E with duloxetine group D (Table 2). The pain score in group E was signifi- cantly decreased at most time periods when compared to group P at 0, 2 and 4 h at rest when compared with group D. The pain score in group D was significantly decrease at 24 and 48 h compared to group P (Table 2). While on movement pain was signifi- cantly decreased in D/E at all times when compared to group P and when it compared to group E and when it compared to group D with no significant difference between other groups on movement (Table 3). Patients’ Satisfaction The percentage of patients’ satisfaction (excel- lent) shows significant differences between the four groups at 24 h (Table 4) with no signifi- cant differences between the three groups at 48 h. The most common adverse effect expect- ed by patients in the study was nausea and vomiting grades III and IV. There was a sig- nificant increase in percentage of patients in group P (43.3%) when compared with group D/E (16.6%) and who reported nausea and vomiting. All complained patients responded to i.v.ondansetron. No statistically significant differences were noted between groups with regard to adverse effects (Table 5). Discussion To our knowledge, there have been no studies evaluating the combination of selective COX-2 inhibitors (etoricoxib) and a selective 20.2(3.4) bcd 15.1(3.4) ad 14.8(4.2) ad 12.3(2.8) abc 0 5 10 15 20 25 Dose (mg) Group P Group C Group D Group D/E 62.0(37.2) bcd 105.3(28.4) ad 91.7(35.5) ad 137.0(61.3) abc 0 20 40 60 80 100 120 140 160 Time (min) Group P Group E Group D Group D/E 31.9(6.7) bcd 24.6(4.5) ad 22.6(.4.1) ad 17.9(3.2) abc 0 5 0 15 20 25 30 35 Dose (mg) Group P Group E Group D Group D/E 0 20 40 Group P Group E Group D Group D/E 31.9(6.7) bcd 24.6(4.5) ad 22.6(.4.1) ad 17.9(3.2) abc 0 5 10 15 20 25 30 35 Dose (mg) Group P Group E Group D Group D/E Fig. 2: Time to morphine administration after surgery in the four groups as Mean(SD). Placebo group (P), etoricoxib (E), duloxetine (D), duloxetine/etoricoxib (D/E). a: when compared with P group. b: when compared with E group. c: when compared with D group. d: when compared with E/D group. Fig. 3: Morphine requirements at 24 h in the four groups as mean (SD). Placebo group (P), etoricoxib (E), Duloxetine (D), duloxetine/etoricoxib (D/E). a: when compared with P group. b: when compared with E group. c: when compared with D group. d: when compared with E/D group. Fig. 4: Morphine requirements at 48 h in the four groups as mean (SD). Placebo group (P), etoricoxib (E), Duloxetine (D), Duloxetine/etoricoxib (D/E). a: when compared with P group. b: when compared with E group. c: when compared with D group. d: when compared with E/D group. serotonin and norepinephrine reuptake inhibitor (SNRI) (duloxetine) after spine surgery. Therefore, we decided in this study to use this regimen based on the results of previous clinical trials. A number of reports have demonstrated success with either the use of etoricoxib [18–20, 23] or duloxetine [8–11] with less reported success about the efficacy of their combination in humans. Sun et al ., [24] reported that pretreatment with an intraperitoneal injection of duloxetine and celecoxib produced synergistic analgesia and could attenuate pain in mice 1 h after formalin injection. 15 reachOut Orthopedics