title: Perioperative celecoxib decreases opioid use in patients undergoing testicular surgery: a randomized, double-blind, placebo controlled trial.
abstract: OBJECTIVE
  We evaluated the effect of daily perioperative celecoxib on patient reported pain control and opioid use after testicular surgery.
  
  
  METHODS
  Men scheduled to undergo elective outpatient microsurgical testicular sperm extraction were prospectively randomized to receive 200 mg celecoxib or placebo twice daily, which was initiated the night before surgery and continued for 6 days thereafter. Using an 11-point visual analog scale, participants self-reported the postoperative pain level and acetaminophen/hydrocodone use for supplemental pain control. We compared differences in pain scores and opioid use between the 2 patient groups using the Student t test with p<0.05 considered significant.
  
  
  RESULTS
  At 1-year interim analysis 35 of 78 eligible participants (45%) had returned the study questionnaire, of whom 34 were included in the final analysis. Of the 34 patients the 16 who received celecoxib had significantly lower postoperative opioid use than those on placebo (6 vs 16 pills, p=0.02). We noted a statistically significant difference in postoperative day 1 and 2 patient reported pain scores (4 vs 6, p<0.05 and 3 vs 5, p=0.03) and opioid use (1 vs 5 pills, p<0.01 and 2 vs 4, p=0.02) seen between the celecoxib and placebo groups, respectively. No study complications were identified. The trial was terminated early based on the results of interim analysis.
  
  
  CONCLUSIONS
  Twice daily celecoxib use started preoperatively significantly decreased patient reported postoperative pain and opioid use, especially in the early postoperative period. A short course of celecoxib is well tolerated and may be effective as part of multimodal postoperative analgesia in patients who undergo testicular surgery for sperm retrieval.
authors.affiliation: James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College, New York, New York. Electronic address: mehtagrossberg@gmail.com.
authors.forename: Akanksha
authors.initials: A
authors.lastname: Mehta
authors.forename: Wayland
authors.initials: W
authors.lastname: Hsiao
authors.forename: Peggy
authors.initials: P
authors.lastname: King
authors.forename: Peter N
authors.initials: PN
authors.lastname: Schlegel
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000068579:Celecoxib; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage*; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage*; D053625:Sperm Retrieval / Q000009:adverse effects; D013449:Sulfonamides / Q000008:administration & dosage*
chemical_list: D000701:Analgesics, Opioid; D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib
keywords: COX; NSAID; POD; TESE; analgesics; celecoxib; cyclooxygenase; microsurgery; nonsteroidal anti-inflammatory drug; opioid; pain; postoperative day; testicular sperm extraction; testis