Making progress in the management of postoperative pain: a review of the cyclooxygenase 2-specific inhibitors.
Postoperative pain is one of the most common forms of acute pain. Optimal pain management decreases the stress response to surgery, reduces complications, improves recovery time, and results in improved economic and quality-of-life outcomes. A preoperative, multimodal approach to postoperative analgesia can be achieved through a combination of therapies that continue beyond the immediate perioperative time frame. This multimodal approach provides superior analgesia with opioid-sparing effects and reduced opioid-related adverse events. Although the use of nonspecific nonsteroidal antiinflammatory drugs in a surgical setting has been limited owing to concerns of renal and gastrointestinal complications as well as platelet dysfunction, cyclooxygenase (COX)-2-specific inhibitors appear to be safe and effective alone and in combination with opioids for a variety of surgical procedures. The COX-2-specific inhibitors may have an important role in extending the use of balanced, multimodal analgesia to a broad surgical population, thus ultimately improving patient outcomes after surgery.
Stephens
Jennifer M
JM
Abt Associates Clinical Trials, Health Economic Research and Quality of Life Evaluation Services (HERQuLES), Bethesda, Maryland, USA. jennifer_stephens@abtassoc.com
Pashos
Chris L
CL
Haider
Seema
S
Wong
Josephine M
JM
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007668:Kidney / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D010595:Pharmacists; D013923:Thromboembolism / Q000139:chemically induced; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors