Does celecoxib have pre-emptive analgesic effect after Caesarean section surgery?
Kaohsiung, Taiwan
* E-mail: tanphphd{at}yahoo.com.tw
Editor—The addition of non-steroidal anti-inflammatory drugs (NSAIDs) to a postoperative Caesarean analgesic regimen could improve postoperative pain and reduce opioid analgesic requirements.1 The potential maternal side-effects (e.g. antiplatelet and gastrointestinal) and effects on breast-feeding infants raise concerns about their use in the postoperative Caesarean delivery setting.2 Cyclo-oxygenase-2-specific inhibitors (COX-2 inhibitors) are effective postoperative analgesics, decreasing pain scores and analgesic consumption after surgery.3 COX-2 inhibitors are, thus, potentially attractive alternatives for post-Caesarean use because they have less platelet inhibition compared with NSAIDs.3 As both rofecoxib and valdecoxib were removed from the market because of potential myocardial and stroke risks, celecoxib remains the only available COX-2 inhibitor. The pre-emptive analgesic efficacy of COX-2 inhibitors after Caesarean section setting has not been evaluated.
We have conducted a randomized, double-blind, placebo-controlled study to evaluate the analgesic efficacy of administering celecoxib, either before or after operation in 60 women undergoing Caesarean delivery under spinal anaesthesia in Kaohsiung Municipal Min-Sheng Hospital and E-DA Hospital/I-Shou University, Taiwan. The patients were allocated to three groups by random numbers. Patients in the preoperative group received celecoxib 400 mg 30 min before anaesthesia and a placebo tablet after wound closure (preop celecoxib group). Patients in the postoperative group received a placebo tablet 30 min before anaesthesia and celecoxib 400 mg after wound closure (postop celecoxib group) and patients in the control group received a placebo tablet 30 min before anaesthesia and after wound closure (control group). Wound closure completion was considered as time 0. Patient' characteristics, ephedrine dose, and duration of surgery were similar for the three groups. Total morphine consumption for the 24 h after surgery was significantly reduced in both the preop [13 (6.2) mg] and the postop celecoxib groups [12 (5.4) mg] compared with the control group [27 (7.2) mg] (P<0.05). Between 3 and 24 h after surgery, the patient-controlled analgesia morphine dose was also significantly reduced in the preop and postop celecoxib groups compared with the control group (P<0.05). The time to first analgesic demand was significantly later (P<0.05) in the preop but not in the postop celecoxib groups in comparison with the control group [421 (92) min, 334 (56) vs 261 (46) min]. Between 3 and 24 h after surgery, visual analogue scale pain scores during movement at 6 and 12 h after surgery were statistically lower in both celecoxib groups. No patient had severe sedation. No patient required bladder catheterization. The incidence of moderate sedation, moderate bladder dysfunction, and nausea and vomiting was similar for all groups. In summary, administration of celecoxib before Caesarean section did not provide pre-emptive analgesia. There was a trend towards improved analgesia immediately after surgery with preoperative celecoxib administration. Perioperative celecoxib administration improved postoperative analgesia during the first 24 h, without increasing adverse effects.
NSAIDs have been shown to improve postoperative pain relief in Caesarean section.4 Studies comparing COX-2 inhibitors with NSAIDs demonstrated similar analgesic efficacies and opioid-sparing after surgery in non-obstetrical settings.5 Although we compared celecoxib with placebo and did not compare celecoxib with NSAIDs, celecoxib does not provide clinically significant pre-emptive analgesia after Caesarean section. However, it improves postoperative analgesia, reduces morphine required by patients, and does not increase adverse effects. The reduced potential risk of haemorrhage in the mother and the breast-feeding infant with COX-2 inhibitors compared with NSAIDs is, theoretically, an advantage in obstetric patients.6 In addition, COX-2 inhibitors should be safe during breast-feeding, as there is minimal drug transfer to the infant.7
This work was supported, in part, by National Science Council Grant NSC 95-2314-B-214-011.
References
1 Angle PJ, Halpern SH, Leighton BL, Szalai JP, Gnanendran K, Kronberg JE. A randomized controlled trial examining the effect of naproxen on analgesia during the second day after cesarean delivery. Anesth Analg (2002) 95:741–5.
2 American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics (1994) 93:137–50.
3 Fenton C, Keating GM, Wagstaff AJ. Valdecoxib: a review of its use in the management of osteoarthritis, rheumatoid arthritis, dysmenorrhoea and acute pain. Drugs (2004) 64:1231–61.[CrossRef][Web of Science][Medline]
4 Souter AJ, Fredman B, White PF. Controversies in the perioperative use of nonsterodial anti-inflammatory drugs. Anesth Analg (1994) 79:1178–90.
5 Romsing J, Moiniche S. A systematic review of COX-2 inhibitors compared with traditional NSAIDs, or different COX-2 inhibitors for post-operative pain. Acta Anaesthesiol Scand (2004) 48:525–46.[CrossRef][Web of Science][Medline]
6 Greer I, Johnston J, Tulloch I, Walker JJ. Effect of maternal ketorolac administration on platelet function in the newborn. Eur J Obstet Gynecol Reprod Biol (1988) 29:257–60.[CrossRef][Web of Science][Medline]
7 Hale TW, McDonald R, Boger J. Transfer of celecoxib into human milk. J Hum Lact (2004) 20:397–403.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||