The role of COX-2 inhibitors in the treatment of postoperative pain.
Postoperative pain requires treatment not only to provide comfort to patients but also to improve postoperative outcome. Anti-inflammatory compounds are an important component of multimodal analgesia in the postoperative period. The newer cyclooxygenase (COX)-2 inhibitors are as effective as classical nonsteroidal anti-inflammatory drugs (NSAIDs) in this setting. However, COX-2 inhibitors offer a number of advantages over NSAIDs when used to treat postoperative pain. These include a reduced incidence of gastrointestinal ulceration and no inhibitory effect on platelet function and thereby a reduced risk of blood loss. Other benefits are less impairment of bone healing and no induction of bronchospasm in patients with aspirin-sensitive asthma. Increased cardiovascular thromboembolic events by COX-2 inhibitors have been reported after coronary artery bypass graft surgery only, but in general, surgery studies the incidence of such complications was comparable to placebo. Overall, COX-2 inhibitors offer a number of advantages over classical NSAIDs in the postoperative pain setting, but require the same caution with regard to renal effects.
Schug
Stephan A
SA
School of Medicine and Pharmacology, The University of Western Australia, and Royal Perth Hospital, MRF Building at RPH, GPO Box X2213, Perth WA 6847, Australia. schug@cyllene.uwa.edu.au
D000698:Analgesia; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy*; D012307:Risk Factors
D000893:Anti-Inflammatory Agents; D052246:Cyclooxygenase 2 Inhibitors