Effect of Perioperative Celecoxib on Patient Outcomes After Major Plastic Surgery Procedures

BACKGROUND: Controversy continues to surround the use of COX-2 inhibitors in the perioperative period. This randomized, double-blind, placebo-controlled study was designed to examine the hypothesis that administration of celecoxib preoperatively or postoperatively and for a total of 4 days after major plastic surgery would improve pain control and clinically-important patient outcomes. Another objective of the study was to determine if perioperative administration of celecoxib offered any advantages over postoperative administration alone. METHODS: One hundred and twenty healthy consenting patients undergoing major plastic surgery (e.g., breast augmentation, abdominoplasty procedures) utilizing a standardized general anesthetic technique were randomized to one of three treatment groups: (1) Control group (n=40) received two placebos orally before and after surgery, as well as one placebo BID for three days after surgery (2) Postoperative group (n=40) received two placebos before surgery and two celecoxib 200 mg po after surgery, followed by one celecoxib 200 mg po BID on POD #1, #2 and #3, and (3) Perioperative group (n=40) received two celecoxib 200 mg po 30-90 minutes before surgery and two placebos after surgery, followed by one celecoxib 200 mg po BID on POD #1, #2 and #3. Pain scores, the need for "rescue" analgesics, and side effects were recorded at specific time intervals in the postoperative period. Follow-up evaluations were performed at 24 h, 48 h, 72 h and 7 d after surgery to assess post-discharge pain, analgesic requirements, return of bowel function, resumption of normal daily activities, quality of recovery, and patients' satisfaction with their pain management. RESULTS: Compared to the Control group, the two celecoxib groups had similarly significant reductions in postoperative pain and need for opioid analgesics during the first three postoperative days (p<0.01). Patients recovered bowel function 1 d earlier and resumed normal activities 2 d earlier in the celecoxib groups. In addition, patient satisfaction with pain management and quality of recovery were significantly improved in the celecoxib (vs. control) groups (p<0.05). CONCLUSION: Celecoxib (400 mg po) administered on the day of surgery and for three days postoperatively is effective in improving postoperative pain management, as well as the speed and quality of recovery after major plastic surgery. However, perioperative administration offers no advantages over simply giving the drug after surgery.