Preoperative celecoxib in noncardiac surgery A systematic review and meta-analysis of randomised controlled trials

BACKGROUNDPostoperative pain continues to be undertreated after noncardiac surgery. Preoperative analgesic administration may enhance postoperative analgesia.OBJECTIVETo determine the effects of preoperative administration of celecoxib in noncardiac surgery on pain and postoperative outcomes.DESIGNSystematic review and meta-analysis of randomised controlled trials.DATA SOURCESMEDLINE, EMBASE, CENTRAL, CINHAL Web of Sciences and ProQuest databases were searched from inception to 2014. Reference lists of retrieved articles and grey literature were searched for additional trials.ELIGIBILITY CRITERIAArticles were included if they enrolled patients of at least 18 years of age and randomised patients to receive celecoxib within 4h of noncardiac surgery. Studies were excluded if they were animal studies, reviews/meta-analyses, did not report pain as an outcome or used epidural analgesia.RESULTSTwenty trials met the eligibility criteria. Preoperative celecoxib in 14 studies (994 patients) amenable to meta-analysis demonstrated a significant decrease in 24-h parenteral morphine-equivalent consumption (mean difference -4.13mg, 95% confidence interval -5.58 to -2.67, I-2=94%). Eleven studies (755 patients) assessed postoperative pain scores at 24h and found a significant decrease with celecoxib use [mean difference (on a 0-10 pain scale) -1.02, 95% confidence interval -1.54 to -0.50, I-2=99%]. The risks of postoperative nausea and vomiting were also decreased by 44% (P=0.01) and 38% (P=0.03), respectively. Preoperative celecoxib did not improve patient satisfaction or length of recovery room stay, or increase intraoperative bleeding. Subgroup analyses indicated no difference between celecoxib 200 and 400mg or between a single preoperative dose and continued postoperative dosing.CONCLUSIONResults of this study are limited by significant heterogeneity and inclusion of mainly small trials. However, there appears to be a slight to modest benefit of preoperative celecoxib on reducing postoperative morphine consumption, pain, nausea and vomiting.