Making Progress in the Management of Postoperative Pain: A Review of the Cyclooxygenase 2–Specific Inhibitors


Abt Associates Clinical Trials, HERQuLES Group, 4800 Montgomery Lane, Suite 600, Bethesda, MD 20814; e-mail:


Postoperative pain is one of the most common forms of acute pain. Optimal pain management decreases the stress response to surgery, reduces complications, improves recovery time, and results in improved economic and quality-of-life outcomes. A preoperative, multimodal approach to postoperative analgesia can be achieved through a combination of therapies that continue beyond the immediate perioperative time frame. This multimodal approach provides superior analgesia with opioid-sparing effects and reduced opioid-related adverse events. Although the use of nonspecific nonsteroidal antiinflammatory drugs in a surgical setting has been limited owing to concerns of renal and gastrointestinal complications as well as platelet dysfunction, cyclooxygenase (COX)-2–specific inhibitors appear to be safe and effective alone and in combination with opioids for a variety of surgical procedures. The COX-2–specific inhibitors may have an important role in extending the use of balanced, multimodal analgesia to a broad surgical population, thus ultimately improving patient outcomes after surgery.