Browsing by Subject "Pain, Postoperative"
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Item Effect of Perioperative Celecoxib on Patient outcomes after Major Plastic Surgery Procedures(2008-12-23) Sun, Tiffany B.; White, Paul F.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.Item Effect of Short-Term Postoperative Celecoxib Administration on Patient Outcome After Outpatient Laparoscopic Surgery(2011-10-03T13:54:07Z) Eng, Matthew R.; White, Paul F.Purpose: Non-opioid analgesics are increasingly used as part of a multimodal regimen for pain management. This prospective, randomized, double-blinded, placebo-controlled study was designed to evaluate the effect of short-term postoperative administration of celecoxib on pain management and recovery outcomes following laparoscopic surgery. Methods: Eighty consenting ASA I–III outpatients undergoing laparoscopic surgery were randomly assigned to one of two treatment groups: Control (placebo) or Celecoxib (celecoxib, 400 mg•day-1). The initial dose (celecoxib 400 mg or placebo po) was administered in the recovery room, and celecoxib 200 mg (or a placebo) po bid was continued for three additional days after surgery. Postoperative pain scores and the need for opioid-containing analgesics were recorded at specific intervals in the recovery room. Follow-up evaluations were performed at 24 hr, 48 hr, 72 hr and seven days and one month after surgery to assess post-discharge pain, analgesic requirements, complications, quality of recovery, and resumption of normal activities, as well as patient satisfaction with their pain management. Results: Celecoxib reduced mean pain scores and the need for analgesics at 24 hr and 48 hr postoperatively. Patient satisfaction with their postoperative pain management was also higher in the Celecoxib group (94 ± 8 vs 80 ± 25, P < 0.05). Quality of recovery scores were significantly higher in the Celecoxib group on the first and second postoperative days (17 ± 1 vs 15 ± 2, and 18 ± 1 vs 16 ± 2, respectively). Finally, bowel function recovered an average of one day earlier and patients resumed activities of daily living two days earlier in the Celecoxib group (P < 0.05). Conclusion: Short-term administration of celecoxib, 400 mg•day-1 po, decreased postoperative pain and the need for opioid-containing analgesic medication, leading to an improved quality of recovery after outpatient laparoscopic surgery. (Keywords: Celecoxib; anesthesiology; amubulatory; outpatient; NSAIDs; Cyclooxygenase-2; surgery; analgesia; Celebrex)