Perioperative COX-2 inhibitors cut pain interference by a clinically meaningful margin

The edition in brief

Four studies for anaesthetists and perioperative teams. A meta-analysis of 38 randomised trials (5,424 adults) found perioperative selective COX-2 inhibitors reduced pain interference with daily function (Brief Pain Inventory −1.1, −1.4 to −0.8, moderate certainty), were associated with fewer patients developing chronic pain (OR 0.44, low certainty) and improved quality of recovery, without detectable increases in renal failure, GI bleeding, impaired bone healing or cardiovascular events. The UK POPPY study of 7,839 day-case patients found 33.5% had a poor pain outcome in the first week and 26.3% still had pain impairing function on day 7, more often with chronic pain, frailty, anxiety or depression, and larger operations. In 30,039 non-cardiac surgical patients, narrow intraoperative pulse pressure was associated with AKI even when MAP stayed at or above 65 mmHg (OR 1.56). In 55,670 matched lumbar spine surgery patients, intraoperative ketamine was not associated with lower opioid prescribing at 3 to 12 months. The pearl: a day-7 phone call for high-risk day cases.