Preoperative celecoxib in noncardiac surgery: A systematic review and meta-analysis of randomised controlled trials

Eur J Anaesthesiol. 2016 Mar;33(3):204-14. doi: 10.1097/EJA.0000000000000346.

Abstract

Background: Postoperative pain continues to be undertreated after noncardiac surgery. Preoperative analgesic administration may enhance postoperative analgesia.

Objective: To determine the effects of preoperative administration of celecoxib in noncardiac surgery on pain and postoperative outcomes.

Design: Systematic review and meta-analysis of randomised controlled trials.

Data sources: MEDLINE, EMBASE, CENTRAL, CINHAL Web of Sciences and ProQuest databases were searched from inception to 2014. Reference lists of retrieved articles and grey literature were searched for additional trials.

Eligibility criteria: Articles were included if they enrolled patients of at least 18 years of age and randomised patients to receive celecoxib within 4 h of noncardiac surgery. Studies were excluded if they were animal studies, reviews/meta-analyses, did not report pain as an outcome or used epidural analgesia.

Results: Twenty trials met the eligibility criteria. Preoperative celecoxib in 14 studies (994 patients) amenable to meta-analysis demonstrated a significant decrease in 24-h parenteral morphine-equivalent consumption (mean difference -4.13 mg, 95% confidence interval -5.58 to -2.67, I = 94%). Eleven studies (755 patients) assessed postoperative pain scores at 24 h and found a significant decrease with celecoxib use [mean difference (on a 0-10 pain scale) -1.02, 95% confidence interval -1.54 to -0.50, I = 99%]. The risks of postoperative nausea and vomiting were also decreased by 44% (P = 0.01) and 38% (P = 0.03), respectively. Preoperative celecoxib did not improve patient satisfaction or length of recovery room stay, or increase intraoperative bleeding. Subgroup analyses indicated no difference between celecoxib 200 and 400 mg or between a single preoperative dose and continued postoperative dosing.

Conclusion: Results of this study are limited by significant heterogeneity and inclusion of mainly small trials. However, there appears to be a slight to modest benefit of preoperative celecoxib on reducing postoperative morphine consumption, pain, nausea and vomiting.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Celecoxib / administration & dosage*
  • Cyclooxygenase 2 Inhibitors / administration & dosage
  • Humans
  • Pain Measurement / methods*
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / epidemiology
  • Pain, Postoperative / prevention & control*
  • Preoperative Care / methods*
  • Randomized Controlled Trials as Topic / methods*

Substances

  • Cyclooxygenase 2 Inhibitors
  • Celecoxib