Selective COX-2 inhibitors cut pain interference after surgery by a clinically meaningful margin

The edition in brief

A meta-analysis published in June pooled 38 randomised trials (5,424 adults) of perioperative selective COX-2 inhibitors. They reduced pain-related interference with daily function by 1.1 points on the Brief Pain Inventory (moderate certainty), at the threshold of clinical importance, and may lower the incidence of chronic postsurgical pain (OR 0.44, low certainty) and improve quality of recovery; no excess renal failure, bleeding, myocardial infarction or stroke was detected. A French cohort of 185,455 adults having noncardiac surgery found each 5 mmHg fall in mean end-tidal CO2 below the median was associated with 63% higher odds of in-hospital death, independent of minute ventilation and hypotension. A Japanese registry of 4,878 anaesthetics in children with recent respiratory infection, asthma exacerbation or smoke exposure found supraglottic airways were associated with fewer respiratory adverse events than tracheal intubation (aRR 0.41). A Chinese trial of 70 adults having knee arthroscopy with femoral block found opioid-free anaesthesia with dexmedetomidine and esketamine was non-inferior on quality of recovery and more than halved nausea and vomiting, but brought earlier and more rescue analgesia. The pearl is about reading a falling capnograph.