Postoperative analgesic effects of celecoxib or rofecoxib after spinal fusion surgery

Nonsteroidal antiinflammatory drugs are recommended for the multimodal mana gement of postoperative pain and may have a significant opioid-sparing effe ct after major surgery. The analgesic efficacy of the cyclooxygenase-2 nons teroidal antiinflammatory drugs, celecoxib and rofecoxib, have not been eva luated after major orthopedic surgery. This study was designed to determine whether the administration of a preoperative dose of celecoxib or rofecoxi b to patients who have undergone spinal stabilization would decrease patien t-controlled analgesia (PCA) morphine use and/or enhance analgesia. We eval uated 60 inpatients undergoing spine stabilization by one surgeon. All pati ents received PCA morphine. The patients were divided into three groups. Pr eoperatively, they were given oral celecoxib 200 mg, rofecoxib 50 mg, or pl acebo. The outcome measures included pain scores and 24-h morphine use at s ix times during the first 24 postoperative h. The total dose of morphine an d the cumulative doses for each of the six time periods were significantly more in the placebo group than in the other two groups. The morphine dose w as significantly less in five of the six time intervals in the rofecoxib gr oup compared with the celecoxib group. The pain scores were significantly l ess in the rofecoxib group than in the other two groups at two of the six i ntervals, and less than the placebo group in an additional interval. Althou gh both rofecoxib and celecoxib produce similar analgesic effects in the fi rst 4 h after surgery, rofecoxib demonstrated an extended analgesic effect that lasted throughout the 24-h study. We thus recommend that rofecoxib be used as a preoperative component of pain management that includes PCA morph ine in patients undergoing spine stabilization surgery.