NEW YORK (Reuters Health) – Celecoxib is associated with lower perioperative opioid requirements after head and neck surgery with free tissue reconstruction, researchers say.
Dr. Richard Cannon of the University of Utah School of Medicine in Salt Lake City matched 51 patients who received celecoxib postoperatively with 51 who did not. The mean age was 61.6 in the celecoxib cohort and 66.1 for controls. Half of both groups were women.
Celecoxib, 200 mg, was given twice daily through a feeding tube for at least five days starting on postoperative day one. Oral opioids – hydrocodone, oxycodone, morphine, and hydromorphone – were offered on a schedule and as needed, with doses converted into morphine milligram equivalents (MMEs). IV opioids were used for severe pain.
As reported online April 18 in JAMA Otolaryngology-Head and Neck Surgery and at the American Head & Neck Society annual meeting in National Harbor, Maryland, treatment with celecoxib was associated with decreased use of oral opioids (mean difference in daily MMES, 9.9 mg), IV opioids (mean difference, 3.9 mg), and total opioids (mean difference, 14mg).
Among patients who underwent the most common ablative procedure – composite oral resection – the effect was more significant. In this subset, the mean MMEs per day with vs without celecoxib, respectively, were 26.0 mg vs. 51.1 mg for oral drugs, 0.9 mg vs. 4.4 mg for IV administration, and 26.9 mg vs. 55.5 mg overall.
There was no significant difference in complication rates between the two groups.
“Rofecoxib, another COX-2 inhibitor, was taken off the market in 2004 owing to concerns about increased cardiovascular risk,” Dr. Cannon noted in an email to Reuters Health. “However, this concern has not been shown with celecoxib after long-term multi-institutional randomized clinical trials on numerous patients . . . demonstrated no difference in incidence of cardiovascular adverse events.”
“We saw no clinical difference in cardiovascular events in the cohort of patients that received celecoxib versus those patients that did not received celecoxib,” he added.
“Our data has limitations but represents a pilot study to evaluate potential mechanisms to decrease opioid use in patients who undergo head and neck surgery,” he said.
“Future studies should include prospective placebo-controlled trials including patient pain scores and patient-centered outcome measurements. Trials like this will be essential in providing further insight into the qualitative pain levels while minimizing potential observer bias,” he concluded.
Dr. Christopher G. Gharibo, associate professor of Anesthesiology, Perioperative Care, and Pain Medicine and Orthopedic Surgery at NYU Langone Health in New York City, agrees that “celecoxib can improve the quality of the pain relief while reducing the reliance on opioids and decreasing discharge doses.”
However, “celecoxib and other NSAIDs may be associated with exacerbation of end-organ diseases (including) cardiovascular, renal and gastrointestinal,” he told Reuters Health by email.
While NSAIDs other than celecoxib might be similarly effective in reducing opioid requirements, he said, “They’re associated with platelet inhibition and increasing the bleeding risk.”
SOURCE: http://bit.ly/2r94R5M
JAMA Otolaryngol Head Neck Surg 2018.
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