Recently, the Food and Drug Administration increased the
celecoxib dosage recommendation from 200 mg to 400 mg for
acute pain management. No studies have directly compared the
analgesic efficacy of different doses of
celecoxib for the prevention of
postoperative pain. In this prospective, double-blinded, placebo-controlled study, we compared oral
celecoxib 200 mg to 400 mg when administered for
premedication of outpatients undergoing minor ear-nose-throat surgery. A total of 93 healthy outpatients were assigned to 1 of 3 study groups: control (placebo;
n = 30),
celecoxib 200 mg (
n = 30), or
celecoxib 400 mg (n = 33). The study
drug was given orally 30-45 min before surgery, and all patients received a standardized
general anesthetic technique. During the postoperative period,
pain scores (0-10), recovery times, the need for rescue
analgesics, quality of recovery (0-100), patient satisfaction with
pain management (0-100), and side effects were recorded.
Pain was assessed at 30-min intervals using a verbal rating scale, with 0 = no
pain to 10 = worst
pain imaginable, in the postanesthesia care unit and
day surgery unit recovery areas and at 24 h after surgery.
Celecoxib 400 mg was significantly more effective than 200 mg (and placebo) in reducing
postoperative pain. Both
celecoxib 200 mg and 400 mg were more effective than placebo in reducing the postoperative
fentanyl requirement (74 +/- 67 micro g and 56 +/- 62 micro g versus 120 +/- 86 micro g, respectively). The larger dose of
celecoxib significantly reduced the percentage of patients with severe
pain at discharge (6% versus 37% and 30% in the
celecoxib 200 mg and control groups, respectively). The median number of doses of oral
analgesic medication after discharge was also significantly reduced in the
celecoxib 400 mg group (0 versus 2 and 2 in the
celecoxib 200 mg and control groups, respectively). However, no differences were found among the three study groups with respect to recovery times and secondary outcome variables (e.g., patient satisfaction and quality of recovery). We conclude that oral
premedication with
celecoxib 400 mg was more effective than 200 mg in reducing severe
postoperative pain and the need for rescue
analgesic medication in the postoperative period.
IMPLICATIONS: