The effect of cyclooxygenase-2 inhibition on acute and chronic donor-site pain after spinal-fusion surgery.
OBJECTIVE
The development of chronic pain after spinal-fusion surgery represents a significant source of morbidity. One of the predictive factors for the development of chronic postsurgical pain is inadequate acute postoperative pain management. Further, the up-regulation of cyclooxygenase-2 (COX-2) after surgery may result in neuro-plastic changes that may contribute to a progression from acute to chronic pain. The goal of this prospective, randomized, double-blind study was to examine the effect of perioperative COX-2 inhibition on acute and chronic donor-site pain in patients undergoing spinal-fusion surgery.


METHODS
Eighty patients scheduled to undergo instrumented posterior spinal fusion were randomized to either receive celecoxib 400 mg 1 hour before surgery, and then 200 mg every 12 hours after surgery for the first 5 days or receive matching placebo at similar time intervals. Patients were administered morphine via patient-controlled analgesia pump for the first 24 hours, and then acetaminophen and oxycodone tablets. Patients were asked to quantify their average pain on postoperative days 1 to 5. At 1 year after surgery, patients were questioned about the presence and subjective characteristics of any residual donor-site pain.


RESULTS
Patients administered celecoxib reported lower pain scores and less opioid use during the first 5 postoperative days. Chronic donor-site pain was significantly higher (P<.01) in the placebo group (12 of 40, or 30%) compared with the celecoxib group (4 of 40, or 10%) at 1 year after surgery.


CONCLUSIONS
The administration of celecoxib for the first 5 days after spinal-fusion surgery resulted in improved analgesia and a reduction in chronic donor-site pain at 1 year after surgery.
Reuben
Scott S
SS
Department of Anesthesiology and Pain Medicine, Baystate Medical Center and the Tufts University School of Medicine, Springfield, MA 01199, USA. scott.reuben@bhs.org
Ekman
Evan F
EF
Raghunathan
Karthik
K
Steinberg
Robert B
RB
Blinder
Jordan L
JL
Adesioye
John
J
D000082:Acetaminophen / Q000627:therapeutic use; D000208:Acute Disease; D000328:Adult; D016058:Analgesia, Patient-Controlled; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016025:Bone Transplantation / Q000009:adverse effects*; D000068579:Celecoxib; D002908:Chronic Disease; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010098:Oxycodone / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D011720:Pyrazoles / Q000627:therapeutic use*; D013123:Spinal Fusion; D013449:Sulfonamides / Q000627:therapeutic use*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D016861:Cyclooxygenase Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000082:Acetaminophen; D009020:Morphine; D010098:Oxycodone; D000068579:Celecoxib