Selective COX-2 inhibitors cut pain interference after surgery by about a point on a ten-point scale

The edition in brief

A meta-analysis of 38 randomised trials (5,424 adults) found that perioperative selective COX-2 inhibitors reduced pain-related interference with daily living within a month of surgery (Brief Pain Inventory mean difference -1.1, 95% CI -1.4 to -0.8, moderate certainty), with low-certainty signals for less chronic pain and better recovery, and no difference in the adverse events examined. A retrospective database study of about 55,000 lumbar spine surgery patients found no lower chronic opioid dispensing with intraoperative ketamine, and more early prescribing. A double-blind trial of 94 women found less nausea and vomiting with tegileridine than sufentanil patient-controlled analgesia after caesarean delivery (6.5% vs 23.9%). A prospective cohort of adolescents found persistent surgical-site pain at month 3 in 57.9% of those after major procedures, and opioid use in weeks 3 and 4 in 39.6%. A survey of 161 superiority trials behind perioperative guidelines found a median fragility index of 4. The pearl restates that multimodal analgesia combines non-opioid drugs and regional techniques where suitable.