In my latest education on Celecoxib (Celebrex) to see if I can use it as an alternative to 
opioids, all the prior studies I looked at were breast augmentation studies. In my plastic surgery world, those are smaller surgeries, with less incisions and surface area. Bleeding is for sure a risk, but not as big of an issue as it would be for a major tummy tuck.
Then I found this paper from 2008 in the Pain Medicine Journal. This was a paper out of the Anesthesia department and Plastic Surgery Departments. “Perioperative vs. Postoperative Celecoxib on Patient Outcomes After Major Plastic Surgery Procedures.” Perfect! So what did it find?
The paper opens with “Controversy continues to surround the use of COX-2 inhibitors in the perioperative period.” They made a randomized double blind placebo controlled study that looked at two scenarios: Use before the surgery and use after surgery for 3 days. They also looked at if adding it during/around surgery gave any advantage over after surgery alone.
Study:
- Major surgery was defined as anything from breast augmentation to tummy tuck
- 3 groups: control, celebrex before and after surgery, celebrex only after surgery (placebo pills given otherwise).
- The dose was 400mg prior to surgery, and then 200mg twice a day after surgery for 3 days.
- Pain score and rescue analgesics (when you needed to take an opioid in addition) were recorded.
Findings?
- The two Celebrex groups had similar reduction in postop pain
- These were statistically significantly lower than placebo
- They recovered bowel function 1 day earlier
- Resumed normal activity 2 days earlier
- Patient satisfaction in pain management and quality of recovery were significantly improved.
They conclude 400mg before and 200mg po twice a day after surgery is effective in improving post op pain, though giving it pre surgery offered no advantages to just giving it after.
My thoughts?
Why are we not all using this?
There were other medications which came out around the same time as Celebrex- Vioxx and Bextra. These other medications were touted as the newest latest and greatest, but they were removed from the market due to concerns of cardiovascular issues and allergic reactions. There was also a possible issue when used after cardiac surgery for 10-14 days.
So what about Celebrex? It is unproven that COX2 inhibitors cause cardiac issues. There was also a discussion in one paper that COX2 inhibitors cause clot issues.
For this reason people shifted away from Celebrex to the gabapentins. Gabapentins were explored, but the current studies show it does not offer significant pain improvement.
The conclusion of this paper – a short course postoperatively for 4 days of 200 mg twice a day- seems like a good conclusion. But none of this answers why it has not become wildly popular.
Will keep researching.