The effect of cyclooxygenase-2 inhibition on acute and chronic donor-site pain after spinal-fusion surgery

Reg Anesth Pain Med. 2006 Jan-Feb;31(1):6-13. doi: 10.1016/j.rapm.2005.10.014.

Abstract

Background and objectives: 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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Retracted Publication

MeSH terms

  • Acetaminophen / therapeutic use
  • Acute Disease
  • Adult
  • Analgesia, Patient-Controlled
  • Analgesics, Non-Narcotic / therapeutic use
  • Analgesics, Opioid / therapeutic use
  • Bone Transplantation / adverse effects*
  • Celecoxib
  • Chronic Disease
  • Cyclooxygenase Inhibitors / therapeutic use*
  • Double-Blind Method
  • Female
  • Humans
  • Ilium / transplantation
  • Male
  • Morphine / therapeutic use
  • Oxycodone / therapeutic use
  • Pain Measurement
  • Pain, Postoperative / prevention & control*
  • Postoperative Care
  • Preoperative Care
  • Prospective Studies
  • Pyrazoles / therapeutic use*
  • Spinal Fusion*
  • Sulfonamides / therapeutic use*
  • Transplantation, Autologous
  • Treatment Outcome

Substances

  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Cyclooxygenase Inhibitors
  • Pyrazoles
  • Sulfonamides
  • Acetaminophen
  • Morphine
  • Oxycodone
  • Celecoxib