The Efficacy of Oral Celecoxib for Acute Postoperative Pain in Face-lift Surgery

Abstract

ace-lift or rhytidectomy is a cornerstone procedure in facial rejuvenation and is rising in popularity. 1 While most patients generally report positive overall experiences, elevated pain levels and accompanying opioid consumption can potentially hinder an otherwise excellent surgical effort and outcome. 2,3 Despite the known adverse effects of nausea, vomiting, dizziness, drowsiness, sedation, pruritus, and urinary retention associated with opioid analgesics, they are an established tool in controlling postoperative pain. 4,5 Publications over the last 2 decades outside of the ambulatory cosmetic surgery realm have described the technique of preemptive analgesia for abating postoperative pain. This approach has shown fewer adverse effects, better pain control, faster recovery, and less social burden on the patient than the use of postoperative opioids. 6,7 Nonsteroidal anti-inflammatory drugs (NSAIDs), particularly cyclooxygenase 2 (COX-2) inhibitors may have inhibitory effects in prostaglandin production in both the spinal cord and peripheral nervous system. This is theorized to be responsible for their role in reducing the hyperalgesia state following surgical trauma. 8 Although celecoxib possesses analgesic effects similar to those of classic NSAIDs, it lacks the adverse effects of antiplatelet function, increased risk of gastric ulceration, bleeding, and bronchospasm in patients sensitive to aspirin. 9 Increased risk of myocardial infarction and hypertension has been associated with the COX-2 inhibitors valde-IMPORTANCE Exploring methods of potentially improving patient comfort and pain control in cosmetic facial surgery.OBJECTIVE To examine the effects of celecoxib in reducing pain and possible opioid consumption following face-lift surgery. DESIGN, SETTING, AND PARTICIPANTSWe reviewed the medical records of 100 patients: 50 consecutive patients who underwent a face-lift without receiving perioperative celecoxib and 50 patients who underwent face-lift and received immediate preoperative and standing postoperative celecoxib. MAIN OUTCOMES AND MEASURESIn addition to demographic information, the following outcome measures were recorded for each group: visual analog scale patient-reported pain, acetaminophen and/or opioid consumption rates, and related analgesic adverse effects. RESULTSThe participants in the noncelecoxib vs celecoxib groups had similar demographic characteristics: mean age, 59.6 vs 57.9 years; mean BMI, 23.3 vs 22.3; history of chronic pain or opioid use, 7 (14%) vs 6 (12%); and 94% of both groups were women. Postoperative pain scores were higher in the noncelecoxib vs celecoxib groups; mean (SD) overall pain score was 3.88 (2.20) vs 2.31 (2.36) (P < .001). The noncelecoxib group had a higher number of postoperative opioid doses than did the celecoxib group: 9.40 (4.30) vs 5.18 (4.58) (P < .05). The noncelecoxib group had a higher incidence of postoperative nausea and vomiting: 12 (24%) vs 0 in the celecoxib group. CONCLUSIONS AND RELEVANCEPreemptive treatment with oral celecoxib appears to be...

Sex differences in innate immunity and its impact on opioid pharmacology

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Perioperative Analgesia for Patients Undergoing Septoplasty and Rhinoplasty: An Evidence‐Based Review

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Association of Celecoxib Use With Decreased Opioid Requirements After Head and Neck Cancer Surgery With Free Tissue Reconstruction

“…This is in agreement with prior otolaryngology studies evaluating celecoxib. 24,25 We have also demonstrated that using COX-2 inhibitors may decrease the amount of opioids used postoperatively by patients with HNC.…”