The role of COX-2 inhibitors in the perioperative setting: efficacy and safety--a systematic review.
A new class of nonsteroidal anti-inflammatory drugs (NSAIDs) selective for cyclooxygenase-2 (COX-2) offers new options for managing perioperative pain. However, new and conflicting data have emerged regarding all nonsteroidal anti-inflammatory drugs, including those selective for COX-2. The data highlight the potential for increased risks of adverse cardiovascular events associated with all NSAIDs and of potential serious skin reactions and gastrointestinal bleeding with specific agents. As of June 2005, the National Institutes of Health and Food and Drug Administration suspended all clinical trials involving NSAIDs. This article reviews 30 prospective studies on the role of COX-2 selective inhibitors in the perioperative setting. The studies examined a variety of variables, including efficacy, perioperative opioid reduction, and effects on platelet aggregation and renal function. The data reveal an overall reduction in postoperative opioid use and significant patient satisfaction with perioperative COX-2 use, no effect on platelet aggregation, and a minor negative effect on renal function. The literature suggests that perioperative use of selective COX-2 inhibitors can be well tolerated and efficacious in carefully selected patient groups. Further data are needed to fully examine the role of these drugs in the perioperative setting. Intensive research into cardiovascular issues surrounding all NSAIDs is warranted.
Virginia Commonwealth University, Richmond, USA. mhzemmel@hotmail.com
Melissa Holmes
MH
Zemmel
D000208:Acute Disease; D016718:Arachidonic Acid / Q000378:metabolism; D001792:Blood Platelets / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000139:chemically induced; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000600:supply & distribution / Q000627:therapeutic use; D003875:Drug Eruptions / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D007249:Inflammation; D007668:Kidney / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D017060:Patient Satisfaction; D018579:Patient Selection; D019990:Perioperative Care / Q000379:methods / Q000451:nursing / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D017751:Safety Management; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration
D052246:Cyclooxygenase 2 Inhibitors; D016718:Arachidonic Acid