Celecoxib May Reduce Pain After Face-lift

Marcia Frellick

July 12, 2014

Perioperative use of the anti-inflammatory drug celecoxib (Celebrex, Pfizer) may help reduce pain after face-lifts and reduce the use of opioids, which come with well-established adverse effects, new research shows. Results of the study were published online July 10 in JAMA Facial Plastic Surgery.

Behrad Aynehchi, MD, from the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Lenox Hill Hospital, New York City, and colleagues reviewed the records of 50 consecutive patients who underwent a face-lift without receiving perioperative celecoxib and 50 patients who received 200 mg celecoxib the night before surgery and in the morning of surgery, on waking. That group then received a standing regimen of 200 mg celecoxib every 12 hours for 5 days.

Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) cyclooxygenase 2 (COX-2 inhibitor) indicated for conditions including rheumatoid arthritis, osteoarthritis, and acute pain. COX-2s are theorized to have inhibitory effects in prostaglandin production in both the spinal cord and nervous system, which may explain their role in reducing the hyperalgesia state after surgical trauma.

Celecoxib is different from classic NSAIDs in that it lacks the adverse effects of antiplatelet function and increased risk for gastric ulceration, bleeding, and bronchospasm in patients who are sensitive to aspirin.

Previous studies have demonstrated that COX-2 inhibitors are effective in perioperative pain control in orthopedic and major plastic surgery procedures, such as breast augmentation, so the authors of this study examined whether the drugs were effective in the ambulatory cosmetic facial surgery setting.

Typically, patients undergoing face-lift are treated for pain with opioid analgesics, but the adverse effects include nausea, vomiting, dizziness, drowsiness, itching, and urinary retention.

"Although the prior studies involved procedures in which pain and massive opioid consumption are more of a concern than in the setting of face-lift surgery, there appears to be a clear role for improving the postoperative experience in our patient population as well," the authors write.

The authors found that postoperative pain scores were higher in the group that received no celecoxib vs the group that received celecoxib: mean overall pain score was 3.88 (standard deviation, 2.20) vs 2.31 (standard deviation, 2.36; P < .001). The number of postoperative opioid doses was higher in the noncelecoxib group than in the celecoxib group, at 9.40 (standard deviation, 4.30) vs 5.18 (standard deviation, 4.58; P < .05). The incidence of postoperative nausea and vomiting was higher in the noncelecoxib group, at 12 cases (24%) vs 0 in the celecoxib group.

The participants in the noncelecoxib vs celecoxib groups were similar in age (mean age, 59.6 vs 57.9 years, respectively) and in body mass index (BMI) and history of chronic pain or opioid use. All underwent a complete, platysma muscle suspension, deep-plane face-lift by Lenox Hill senior surgeon David Rosenberg, MD, between May 2 and December 10, 2013.

Despite the encouraging data, the study has limitations. It was a small medical record review with no blinding or placebos, and there was a lack of significant variance in demographics. Larger, prospective, controlled studies would help test the results. In addition, the cost of celecoxib can be considerable and is not generally covered by insurance, so the issue may need to be discussed with the patient before the procedure.

The authors have disclosed no relevant financial relationships.

JAMA Facial Plast Surg. Published online July 10, 2014. Abstract


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