Table 8: Systemic NSAID versus placebo: study details and qualitative outcomes

Study

n

treatment/
control

Comparison

Supplemental

analgesic

VAS scores and type of pain, where specified

Time to first analgesic request

Use of supplemental analgesic

Other important outcomes

(Boeckstyns 1992)

(LoE 1)

26/19

Piroxicam (40 mg) rectally, immediately postop, then 20 mg daily (Pir) vs. placebo (Pb)

Postop: IM buprenorphine (0.3 mg), immediately postop, then on demand 0.2–0.4 mg sublingually or IM on day 1; 10 x 0.2 mg sublingually daily, days 2–10, self-administered

NS over days 2–10 (i.e. at all time points recorded)

__

Daily consumption of buprenorphine: Pir superior at all time points (i.e. days 2–10) (p values not reported)

PONV

N/A (data from both hip and knee patients)

(Eggers 1999)

(LoE 1)

34/34/33

Oral placebo preop and IV tenoxicam (40 mg) postop, then IV tenoxicam (40 mg) on day 1, then oral tenoxicam (20 mg) days 2–8 (IVTen) vs. oral and IV placebo (Pb)

PCA-morphine for 48 h postop, then oral co-

dydramol

At rest: NS at all time points recorded (i.e. over 1^st 48 h and between days 3 and 9); on movement: NS at all time points recorded (i.e. days 3–9)

__

Total morphine consumption: NS; total co-dydramol requirement: IVTen superior (p<0.01)

Functional outcomes

At 24 h, most patients unable to raise straight leg: IVTen 2/34, Pb 0/33–NS

(Silvanto 2002)

(LoE 1)

24/24/16

30 min IV infusion of 100 mg ketoprofen in 100 ml saline, followed by 100 mg oral ketoprofen 3 times daily until day 3 (Ketpfen) vs. 30 min IV infusion of 75 mg diclofenac in 100 ml saline, followed by 50 mg oral diclofenac 3 times daily until day 3 (Diclof) vs. 30 min IV infusion of 100 ml saline, followed by placebo capsules 3 times daily until day 3 (Pb)

Postop: PCA-oxycodone, IV

Ketpfen superior to Pb on day 2 (p<0.05), but not on days 0, 1 or 3; Diclof superior to Pb on days 1–3 (p<0.05, in all cases), but NS on day 0

__

Oxycodone consumption: Ketpfen superior to Pb at 13–24 h and 61–72 h (p<0.05, in both cases), but NS at other time periods (i.e. 0–12 h, 25–36 h, 37–48 h, 49–60 h); Diclof superior to Pb at 25–36 h (p<0.05), 37–48 h (p<0.01) and 49–60 h (p<0.05), but NS at other time periods

Pain

VRS: Diclof superior to Pb on day 1 (p<0.05), but NS on days 0, 2 or 3

PONV

Nausea and/or vomiting: Diclof superior on day 3 (p<0.01), but NS on days 0–2

Complications

Blood loss: NS; irritation at infusion site on day 0: Pb superior to both Ketpfen and Diclof (p<0.01, in both cases); dizziness, drowsiness: NS

*Study*	n treatment/ control	*Comparison*	*Supplemental* *analgesic*	*VAS scores and type of pain, where specified*	*Time to first analgesic request*	*Use of supplemental analgesic*	*Other important outcomes*
(Boeckstyns 1992) (LoE 1)	26/19	Piroxicam (40 mg) rectally, immediately postop, then 20 mg daily (Pir) *vs.* placebo (Pb)	Postop: IM buprenorphine (0.3 mg), immediately postop, then on demand 0.2–0.4 mg sublingually or IM on day 1; 10 x 0.2 mg sublingually daily, days 2–10, self-administered	NS over days 2–10 (i.e. at all time points recorded)	__	Daily consumption of buprenorphine: Pir superior at all time points (i.e. days 2–10) (p values not reported)	PONV N/A (data from both hip and knee patients)
(Eggers 1999) (LoE 1)	34/34/33	Oral placebo preop and IV tenoxicam (40 mg) postop, then IV tenoxicam (40 mg) on day 1, then oral tenoxicam (20 mg) days 2–8 (IVTen) *vs.* oral and IV placebo (Pb)	PCA-morphine for 48 h postop, then oral co- dydramol	At rest: NS at all time points recorded (i.e. over 1^st 48 h and between days 3 and 9); on movement: NS at all time points recorded (i.e. days 3–9)	__	Total morphine consumption: NS; total co-dydramol requirement: IVTen superior (p<0.01)	Functional outcomes At 24 h, most patients unable to raise straight leg: IVTen 2/34, Pb 0/33–NS
(Silvanto 2002) (LoE 1)	24/24/16	30 min IV infusion of 100 mg ketoprofen in 100 ml saline, followed by 100 mg oral ketoprofen 3 times daily until day 3 (Ketpfen) *vs.* 30 min IV infusion of 75 mg diclofenac in 100 ml saline, followed by 50 mg oral diclofenac 3 times daily until day 3 (Diclof) *vs.* 30 min IV infusion of 100 ml saline, followed by placebo capsules 3 times daily until day 3 (Pb)	Postop: PCA-oxycodone, IV	Ketpfen superior to Pb on day 2 (p<0.05), but not on days 0, 1 or 3; Diclof superior to Pb on days 1–3 (p<0.05, in all cases), but NS on day 0	__	Oxycodone consumption: Ketpfen superior to Pb at 13–24 h and 61–72 h (p<0.05, in both cases), but NS at other time periods (i.e. 0–12 h, 25–36 h, 37–48 h, 49–60 h); Diclof superior to Pb at 25–36 h (p<0.05), 37–48 h (p<0.01) and 49–60 h (p<0.05), but NS at other time periods	Pain VRS: Diclof superior to Pb on day 1 (p<0.05), but NS on days 0, 2 or 3 PONV Nausea and/or vomiting: Diclof superior on day 3 (p<0.01), but NS on days 0–2 Complications Blood loss: NS; irritation at infusion site on day 0: Pb superior to both Ketpfen and Diclof (p<0.01, in both cases); dizziness, drowsiness: NS