Effect of short-term postoperative celecoxib administration on patient outcome after outpatient laparoscopic surgery

Abstract

Short-term administration of celecoxib, 400 mg x day(-1) po, decreased postoperative pain and the need for opioid-containing analgesic medication, leading to an improved quality of recovery after outpatient laparoscopic surgery.

La prise en charge de la douleur après une chirurgie ambulatoire: où est-ce que ça coince?

“…These authors have further suggested that elimination of opioid-based analgesia would be highly desirable in the future. These important findings have been recently confirmed by White et al 14 In our prospective study involving the administration of celecoxib on the day of surgery and the subsequent three days after outpatient laparoscopic surgery as part of a multimodal analgesic regimen, we found that these patients not only experienced less pain and reduced need for opioid-containing oral analgesics, but more importantly, patients were able to resume normal activities of daily living one-to-two days earlier.…”

“…12,13 These benefits have been confirmed in more recent studies, 14,15 and multimodal techniques are the currently recommended practice in fast-track clinical care plans. 5 It is clear that the reliance on a single non-opioid analgesic modality [e.g., local analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) and/or acetaminophen] will not suffice to control moderate-severe postoperative pain, and excessive reliance on opioid analgesics produces too many undesirable side effects.…”

“…16 For example, perioperative administration of the COX-2 inhibitors as part of a multi-modal analgesic regimen in outpatients undergoing inguinal hernia repair provided limited benefit beyond the early postoperative period. 17 However, when the COX-2 inhibitors are administered for three-to-five days after ambulatory surgery, 14,15 the benefits with respect to clinicallyrelevant patient outcomes extended well beyond the simple (and predictable) reduction in pain and the need for opioid analgesic medications.…”

“…However, until recently, there have been only a handful of well-controlled clinical studies documenting the beneficial effect of these multimodal therapeutic approaches with respect to important recovery variables [e.g., resumption of normal activities (e.g., dietary intake, bowel function), return to work]. [12][13][14][15] Recently, Reuben et al 27,28 demonstrated the value of a multimodal analgesic regimen on both short and long-term outcomes after major outpatient orthopedic procedures. Although many factors, in addition to pain, must be carefully controlled in order to minimize postoperative morbidity and facilitate the recovery process after elective surgery (e.g., postoperative nausea and vomiting, hydration status), 5 the adequacy of pain control remains a major concern for all patients undergoing elective surgical procedures, as well as the healthcare providers responsible for their care.…”

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

“…35 Historically, factors with a direct impact on discharge readiness and institutional cost were assessednausea and vomiting, severe pain, 36-39 psychological distress, 37,38,[40][41][42] and basic physiological function. [43][44][45] With the advent of patient-centred care, recovery has developed into a multidimensional construct, with recovery assessment tools addressing physical (nociceptive), [36][37][38][39] psychological (emotive, satisfaction), 37,38,[40][41][42] functional (ADLs), [36][37][38][39][40][41][42]46 and more recently, cognitive domains. The latter has become more pertinent in the advent of an aging population and increasing awareness of the interplay between the perioperative inflammatory state, anesthetic agents, and neurodegenerative processes.…”