Effectiveness of Selective Cyclooxygenase-2 Inhibitors for Postoperative Pain Management Using Multidimensional Pain Assessment: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Usman Kahloon, John B P Le, Sarah Tierney et al.
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In 30 seconds
This systematic review and meta-analysis included 38 randomized controlled trials involving 5,424 adults and compared perioperative systemic selective COX-2 inhibitors with placebo, opioids, or usual care. COX-2 inhibitors reduced acute pain-related interference with daily functioning (Brief Pain Inventory mean difference, -1.1; 95% CI, -1.4 to -0.8; moderate certainty), a result the authors considered likely clinically meaningful. Chronic pain incidence and quality of recovery also favored COX-2 inhibitors, but evidence for these outcomes was low certainty; chronic pain intensity was not significantly reduced.
Key findings
- Acute pain-related interference was lower with COX-2 inhibitors (Brief Pain Inventory mean difference, -1.1; 95% CI, -1.4 to -0.8; n = 7; moderate certainty).
- Chronic pain incidence was lower (odds ratio, 0.44; 95% CI, 0.21 to 0.93; n = 5; low certainty), while chronic pain intensity showed no significant difference.
- Quality of recovery improved (Quality of Recovery-9 mean difference, 0.84; 95% CI, 0.33 to 1.35; n = 7; low certainty).
- Intraoperative blood loss was lower (mean difference, -22 ml; 95% CI, -40 to -4; n = 3; low certainty); no differences were observed in the other reported adverse events.
Why it matters
Pain that disrupts daily functioning captures an important dimension of postoperative recovery beyond pain intensity alone. The review suggests perioperative selective COX-2 inhibitors can meaningfully reduce this interference, while also reporting possible benefits for chronic pain incidence and recovery quality. The differing certainty across outcomes is important when interpreting these potential benefits.
What to keep in mind
Evidence certainty varied by outcome: moderate for acute pain-related interference, low for chronic pain incidence and quality of recovery, and very low for chronic pain intensity. The review included trials with different comparators and outcome measures.