Prospective randomized, double‐blind, placebo‐controlled study of pre‐ and postoperative administration of a COX‐2‐specific inhibitor as opioid‐sparing analgesia in major colorectal surgery

Abstract

Patients treated with a cyclo-oxygenase 2-specific inhibitor have a shorter recovery time when compared with patients on a standard postoperative PCA morphine-only regimen after colorectal resection.

Opioid-sparing effect of selective cyclooxygenase-2 inhibitors on surgical outcomes after open colorectal surgery within an enhanced recovery after surgery protocol

“…These results were consistent with a report from a prospective randomized, double-blind, placebo-controlled study examining the influence of preand post-administration of a selective COX-2 inhibitor (valdecoxib 40 mg) in major colorectal surgery within a non or partial ERAS protocol [11] . The randomized clinical trial indicated that patients treated with valdecoxib had a one-third opioid reduction, a 12-h quicker time to first bowel movement and a 2-d shorter hospital stay.…”

“…In this study, there was a non-significant trend in decreased rates of overall complication and prolonged postoperative ileus in patients receiving a selective COX-2 inhibitor. The clinical relevant of NSAID-induced opioid sparing on favorable postoperative outcomes, including less incidence of postoperative gastrointestinal dysfunction and other complications, has been shown in several studies of non-colorectal surgery [31][32][33][34][35] and colorectal surgery [11] . Apart from its opioid-sparing effects, selective COX-2 inhibitors may be associated with a reduction in postoperative complication by minimizing both inflammatory response and endocrine-metabolic response to surgery [36] .…”

“…Having little or no effect on platelet aggregation, a selective COX-2 inhibitor has currently been used as a part of multimodal analgesia for several surgical procedures including colorectal surgery -which prefers a non-opioid analgesic regimen [7][8][9] . Perioperative administration of selective COX-2 inhibitors can reduce opioid requirement [10] , facilitate gastrointestinal recovery and shorten hospital stay after colorectal surgery [11] . However, there are a limited number of studies examining these outcome benefits in the setting of an ERAS protocol [10] .…”

Postoperative ileus: strategies for reduction

“…Those studies that have shown a benefi t in using COX-2 inhibitors have not been able to demonstrate that the reduction in POI is independent of the subsequent reduction in opioid use. The main benefi t of these drugs has been their ability to lower the total dose of narcotics needed for adequate pain control (Bouras et al 2004;Sim et al 2007). Similar trials have occurred using the intravenous anti-infl ammatory drug, ketorolac.…”

Ileus Management International (IMAGINE): protocol for a multicentre, observational study of ileus after colorectal surgery

“…Current evidence describes a complex relationship between inflammatory, neurogenic and vagal mechanisms, which are exacerbated by the effects of opioid analgesia and other homeostatic imbalances [11,12]. Randomized clinical trials (RCTs) of non-steroidal antiinflammatory drugs (NSAIDs) have demonstrated significant improvements in gastrointestinal recovery, probably through their anti-inflammatory and opioidsparing properties [13,14]. Although NSAIDs appear to offer effective postoperative analgesia, concerns remain over their safety, including the risk of AKI and anastomotic leak [15][16][17].…”