title: The efficacy of celecoxib premedication on postoperative pain and recovery times after ambulatory surgery: a dose-ranging study.
abstract: Recently, the Food and Drug Administration increased the celecoxib dosage recommendation from 200 mg to 400 mg for acute pain management. No studies have directly compared the analgesic efficacy of different doses of celecoxib for the prevention of postoperative pain. In this prospective, double-blinded, placebo-controlled study, we compared oral celecoxib 200 mg to 400 mg when administered for premedication of outpatients undergoing minor ear-nose-throat surgery. A total of 93 healthy outpatients were assigned to 1 of 3 study groups: control (placebo; n = 30), celecoxib 200 mg (n = 30), or celecoxib 400 mg (n = 33). The study drug was given orally 30-45 min before surgery, and all patients received a standardized general anesthetic technique. During the postoperative period, pain scores (0-10), recovery times, the need for rescue analgesics, quality of recovery (0-100), patient satisfaction with pain management (0-100), and side effects were recorded. Pain was assessed at 30-min intervals using a verbal rating scale, with 0 = no pain to 10 = worst pain imaginable, in the postanesthesia care unit and day surgery unit recovery areas and at 24 h after surgery. Celecoxib 400 mg was significantly more effective than 200 mg (and placebo) in reducing postoperative pain. Both celecoxib 200 mg and 400 mg were more effective than placebo in reducing the postoperative fentanyl requirement (74 +/- 67 micro g and 56 +/- 62 micro g versus 120 +/- 86 micro g, respectively). The larger dose of celecoxib significantly reduced the percentage of patients with severe pain at discharge (6% versus 37% and 30% in the celecoxib 200 mg and control groups, respectively). The median number of doses of oral analgesic medication after discharge was also significantly reduced in the celecoxib 400 mg group (0 versus 2 and 2 in the celecoxib 200 mg and control groups, respectively). However, no differences were found among the three study groups with respect to recovery times and secondary outcome variables (e.g., patient satisfaction and quality of recovery). We conclude that oral premedication with celecoxib 400 mg was more effective than 200 mg in reducing severe postoperative pain and the need for rescue analgesic medication in the postoperative period.
  
  
  CONCLUSIONS
  Oral premedication with celecoxib 400 mg was more effective than 200 mg in reducing postoperative pain and the need for rescue analgesic medication in the early postoperative period. However, neither dose of celecoxib was more effective than a placebo in facilitating the recovery process after outpatient surgery.
authors.affiliation: *Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas; and †Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Recart
authors.forename: Tijani
authors.initials: T
authors.lastname: Issioui
authors.forename: Paul F
authors.initials: PF
authors.lastname: White
authors.forename: Kevin
authors.initials: K
authors.lastname: Klein
authors.forename: Mehernoor F
authors.initials: MF
authors.lastname: Watcha
authors.forename: Louis
authors.initials: L
authors.lastname: Stool
authors.forename: Mary
authors.initials: M
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000068579:Celecoxib; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011229:Preanesthetic Medication; D011292:Premedication; D011446:Prospective Studies; D011720:Pyrazoles; D013449:Sulfonamides / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D016861:Cyclooxygenase Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib; D005283:Fentanyl