title: The effects of oral ibuprofen and celecoxib in preventing pain, improving recovery outcomes and patient satisfaction after ambulatory surgery.
abstract: BACKGROUND
  Nonsteroidal antiinflammatory drugs have become increasingly popular as part of multimodal analgesic regimens for pain management in the ambulatory setting. We designed this randomized, double-blind, placebo-controlled study to evaluate the effect of postoperative administration of either a nonselective nonsteroidal antiinflammatory drug (ibuprofen) or the cyclooxygenase-2 selective inhibitor (celecoxib when administered as part of a multimodal analgesic regimen) on the severity of pain, the need for rescue analgesics, and clinically relevant patient outcomes after ambulatory surgery. The primary end point was the time to resumption of normal activities of daily living.
  
  
  METHODS
  One hundred eighty patients undergoing outpatient surgery were randomly assigned to 1 of 3 treatment groups: group 1 (control) received either 2 placebo capsules (matching celecoxib) or 1 placebo tablet (matching ibuprofen) in the recovery room and 1 placebo tablet at bedtime on the day of surgery, followed by 1 placebo capsule or tablet 3 times a day for 3 days after discharge; group 2 (celecoxib) received celecoxib 400 mg (2 capsules) orally in the recovery room and 1 placebo capsule and tablet at bedtime on the day of surgery, followed by celecoxib 200 mg (1 capsule) twice a day + placebo capsule every day at bedtime for 3 days after surgery; or group 3 (ibuprofen) received ibuprofen 400 mg (1 tablet) orally in the recovery room and 400 mg orally at bedtime on the day of surgery, followed by 400 mg orally 3 times a day for 3 days after surgery. Recovery times, postoperative pain scores, and the need for rescue analgesics were recorded before discharge. Follow-up evaluations were performed at 24 hours, 48 hours, 72 hours, 7 days, and 30 days after surgery to assess postdischarge pain, analgesic requirements, resumption of normal activities, opioid-related side effects, as well as quality of recovery and patient satisfaction with their postoperative pain management using a 5-point verbal rating scale.
  
  
  RESULTS
  The 3 groups did not differ with respect to their demographic characteristics. Compared with the placebo treatment, both celecoxib and ibuprofen significantly decreased the need for rescue analgesic medication after discharge (P < 0.05). The effect sizes (celecoxib and ibuprofen versus control group) were 0.73 to 1 and 0.3 to 0.8, respectively. Quality of recovery scores and patient satisfaction with their postoperative pain management were also improved in the celecoxib and ibuprofen groups compared with the control group (P < 0.05, effect size [vs control group] = 0.67). The incidence of postoperative constipation was significantly higher in the control group (28%) compared with the celecoxib (5%) and ibuprofen (7%) groups, respectively (P < 0.05). Both active treatments were well tolerated in the postdischarge period. However, the time to resumption of normal activities of daily living was similar among the 3 groups.
  
  
  CONCLUSIONS
  Both ibuprofen (1200 mg/d) and celecoxib (400 mg/d) significantly decreased the need for rescue analgesic medication in the early postdischarge period, leading to an improvement in the quality of recovery and patient satisfaction with their pain management after outpatient surgery.
authors.affiliation: Department of Anesthesia, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Paul F
authors.initials: PF
authors.lastname: White
authors.forename: Jun
authors.initials: J
authors.lastname: Tang
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Wender
authors.forename: Manxu
authors.initials: M
authors.lastname: Zhao
authors.forename: Michael
authors.initials: M
authors.lastname: Time
authors.forename: Alan
authors.initials: A
authors.lastname: Zaentz
authors.forename: Roya
authors.initials: R
authors.lastname: Yumul
authors.forename: Alexander
authors.initials: A
authors.lastname: Sloninsky
authors.forename: Robert
authors.initials: R
authors.lastname: Naruse
authors.forename: Robert
authors.initials: R
authors.lastname: Kariger
authors.forename: Tom
authors.initials: T
authors.lastname: Webb
authors.forename: David E
authors.initials: DE
authors.lastname: Fermelia
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Tsushima
mesh_terms: D000203:Activities of Daily Living; D000284:Administration, Oral; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D000068579:Celecoxib; D016009:Chi-Square Distribution; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage*; D007558:Italy; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D015990:Placebo Effect; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage*; D020127:Recovery of Function; D013449:Sulfonamides / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib; D007052:Ibuprofen