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Study flow diagram.
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Figure 1

Study flow diagram.

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Forest plot of comparison: 1 Etoricoxib 120 mg versus placebo, outcome: 1.1 Participants with at least 50% pain relief over 6 hours
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Figure 4

Forest plot of comparison: 1 Etoricoxib 120 mg versus placebo, outcome: 1.1 Participants with at least 50% pain relief over 6 hours

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L'Abbé plot of etoricoxib 120 mg versus placebo for at least 50% pain relief. Size of circle is proportional to size of study (inset scale). Cream circles ‐ dental studies; pink circle ‐ orthopaedic study.
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Figure 5

L'Abbé plot of etoricoxib 120 mg versus placebo for at least 50% pain relief. Size of circle is proportional to size of study (inset scale). Cream circles ‐ dental studies; pink circle ‐ orthopaedic study.

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Forest plot of comparison: 1 Etoricoxib 120 mg vs placebo, outcome: 1.4 Participants using rescue medication within 24 hours
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Figure 6

Forest plot of comparison: 1 Etoricoxib 120 mg vs placebo, outcome: 1.4 Participants using rescue medication within 24 hours

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Forest plot of comparison: 2 Etoricoxib (all doses) versus placebo, outcome: 2.1 Participants with any adverse event
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Figure 7

Forest plot of comparison: 2 Etoricoxib (all doses) versus placebo, outcome: 2.1 Participants with any adverse event

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Comparison 1 Etoricoxib 120 mg vs placebo, Outcome 1 Participants with at least 50% pain relief over 6 hours.
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Analysis 1.1

Comparison 1 Etoricoxib 120 mg vs placebo, Outcome 1 Participants with at least 50% pain relief over 6 hours.

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Comparison 1 Etoricoxib 120 mg vs placebo, Outcome 2 Participants with at least 50% pain relief over 6 hours, dental.
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Analysis 1.2

Comparison 1 Etoricoxib 120 mg vs placebo, Outcome 2 Participants with at least 50% pain relief over 6 hours, dental.

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Comparison 1 Etoricoxib 120 mg vs placebo, Outcome 3 Participants using rescue medication within 6 hours.
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Analysis 1.3

Comparison 1 Etoricoxib 120 mg vs placebo, Outcome 3 Participants using rescue medication within 6 hours.

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Comparison 1 Etoricoxib 120 mg vs placebo, Outcome 4 Participants using rescue medication within 24 hours.
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Analysis 1.4

Comparison 1 Etoricoxib 120 mg vs placebo, Outcome 4 Participants using rescue medication within 24 hours.

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Comparison 1 Etoricoxib 120 mg vs placebo, Outcome 5 Participants with any adverse event.
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Analysis 1.5

Comparison 1 Etoricoxib 120 mg vs placebo, Outcome 5 Participants with any adverse event.

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Comparison 2 Etoricoxib (all doses) versus placebo, Outcome 1 Participants with any adverse event.
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Analysis 2.1

Comparison 2 Etoricoxib (all doses) versus placebo, Outcome 1 Participants with any adverse event.

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Etoricoxib compared with placebo for acute postoperative pain

Patient or population: adults with moderate or severe acute postoperative pain

Settings: community or hospital

Intervention: etoricoxib 120 mg

Comparison: placebo

Outcomes

Probable outcome with

Relative effect and NNT or NNH

(95% CI)

No of studies, events

Quality of the evidence
(GRADE)

Comments

comparator

intervention

At least 50% of maximum pain relief over 4 to 6 hours

120 in 1000

660 in 1000

RR 5.6 (4.0 to 7.8)

NNT 1.9 (1.7 to 2.1)

6 studies

789 participants

366 events

High

Adequate numbers of studies, participants and events. Consistency across studies

Participants with at least 1 adverse event

360 in 1000

330 in 1000

RR 0.93 (0.74 to 1.2)

NNH not calculated

5 studies

643 participants

219 events

Moderate

Moderate numbers of studies, participants and events. Consistency across studies. Single dose studies may not reflect clinical practice

Participants with a serious adverse event

No serious adverse events

Low

Studies underpowered to detect rare events

Deaths

No deaths

Low

Studies underpowered to detect rare events

CI: Confidence interval; NNH: number needed to treat for harm; NNT: number needed to treat for benefit; RR: Risk Ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

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Comparison 1. Etoricoxib 120 mg vs placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Participants with at least 50% pain relief over 6 hours Show forest plot

6

798

Risk Ratio (M‐H, Fixed, 95% CI)

5.60 [4.02, 7.81]

2 Participants with at least 50% pain relief over 6 hours, dental Show forest plot

5

643

Risk Ratio (M‐H, Fixed, 95% CI)

6.68 [4.55, 9.82]

3 Participants using rescue medication within 6 hours Show forest plot

2

268

Risk Ratio (M‐H, Fixed, 95% CI)

0.24 [0.17, 0.34]

4 Participants using rescue medication within 24 hours Show forest plot

4

505

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.53, 0.67]

5 Participants with any adverse event Show forest plot

5

643

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.74, 1.17]
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Comparison 1. Etoricoxib 120 mg vs placebo
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Comparison 2. Etoricoxib (all doses) versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Participants with any adverse event Show forest plot

5

1059

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.74, 1.12]
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Comparison 2. Etoricoxib (all doses) versus placebo
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