Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-26T16:14:23.958Z Has data issue: false hasContentIssue false

Is celecoxib a useful adjunct in the treatment of post-tonsillectomy pain in the adult population? A randomised, double-blind, placebo-controlled study

Published online by Cambridge University Press:  06 February 2017

T-T Ng*
Affiliation:
ENT Unit, Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Australia
D Diamantaras
Affiliation:
ENT Unit, Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Australia
J Priestley
Affiliation:
ENT Unit, Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Australia
J Redman
Affiliation:
ENT Unit, Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Australia
N De Silva
Affiliation:
ENT Unit, Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Australia
V Mahanta
Affiliation:
ENT Unit, Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Australia
*
Address for correspondence: Dr T-T Ng, Department of Surgery, Peninsula Health, PO Box 52, Hastings Road, Frankston 3199, Australia E-mail: tntdynamites@yahoo.com

Abstract

Objective:

To evaluate the efficacy and safety of celecoxib for pain management in post-tonsillectomy adult patients.

Design:

A randomised, double-blind, placebo-controlled, phase 3 clinical trial was conducted in an adult population (aged 18–55 years), with a parallel group design using an allocation ratio of 1:1.

Methods:

Eighty patients underwent elective tonsillectomy or adenotonsillectomy, operated on by one surgeon. They were discharged home with randomly assigned celecoxib or placebo, together with regular post-tonsillectomy medications (paracetamol and Endone). Pain scores were measured from post-operative days 1 to 10. All patients were assessed on post-operative days 5, 12 and 28.

Results:

There were no statistically significant differences in the daily or overall pain scores, the total intake of Endone, or the time taken to achieve freedom from pain after tonsillectomy between the study arms (n = 40 each arm). The celecoxib-treated group experienced significantly more vomiting (celecoxib vs placebo p < 0.001 (Mann–Whitney test), confidence interval = 0.57 to 0.76).

Conclusion:

Celecoxib usage was associated with significantly more vomiting and did not reduce narcotic analgesia requirement post-tonsillectomy.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented orally at the 68th Annual General and Scientific Meeting of the New Zealand Society of Otolaryngology, Head and Neck Surgery, 20–23 October 2015, Nelson, New Zealand.

References

1 Isaacson, G. Pediatric tonsillectomy: an evidence-based approach. Otolaryngol Clin North Am 2014;47:673–90CrossRefGoogle ScholarPubMed
2 Graham, GG, Graham, RI, Day, RO. Comparative analgesia, cardiovascular and renal effects of celecoxib, rofecoxib and acetaminophen (paracetamol). Curr Pharm Des 2002;8:1063–75Google Scholar
3 Buvanendram, A, Kroin, JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 2009;22:588–93Google Scholar
4 Kiefer, W, Dannhardt, G. Novel insights and therapeutical applications in the field of inhibitors of COX-2. Curr Med Chem 2004;11:3147–61Google Scholar
5 Wickerts, L, Warrén Stomberg, M, Brattwall, M, Jakobsson, J. Coxibs: is there a benefit when compared to traditional non-selective NSAIDs in postoperative pain management? Minerva Anestesiol 2011;77:1084–98Google Scholar
6 Tolska, HK, Takala, A, Pitkäniemi, J, Jero, J. Post-tonsillectomy haemorrhage more common than previously described – an institutional chart review. Acta Otolaryngol 2013;133:181–6Google Scholar
7 Kim, MK, Lee, JW, Kim, MG, Ha, SY, Lee, JS, Yeo, SG. Analysis of prognostic factors for postoperative bleeding after tonsillectomy. Eur Arch Otorhinolaryngol 2012;269:977–81Google Scholar
8 Stelter, K, Hempel, JM, Berghaus, A, Andratschke, M, Luebbers, CW, Hagedorn, H. Application methods of local anaesthetic infiltrations for postoperative pain relief in tonsillectomy: a prospective, randomised, double blind, clinical trial. Eur Arch Otorhinolaryngol 2009;266:1615–20Google Scholar
9 Calderon, PS, Peixoto, RF, Gomes, VM, de Mata Correa, AN, de Alericar, EN, Rossetti, LM et al. Concordance among different pain scales in patients with dental pain. J Orofac Pain 2012;26:126–31Google Scholar
10 Gagliese, L, Weizblit, N, Ellis, W, Chan, VW. The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients. Pain 2005;117:412–20Google Scholar
11 Ferreira-Valente, MA, Pais-Ribeiro, JL, Jensen, MP. Validity of four pain intensity rating scales. Pain 2001;152:2399–404CrossRefGoogle Scholar
12 Salonen, A, Silvola, J, Kokki, H. Does 1 or 2 g paracetamol added to ketoprofen enhance analgesia in adult tonsillectomy patients? Acta Anaesthesiol Scand 2009;53:1200–6Google Scholar
13 Lauder, G, Emmott, A. Confronting the challenges of effective pain management in children following tonsillectomy. Int J Pediatr Otorhinolaryngol 2014;78:1813–27Google Scholar
14 Issioui, T, Klein, KW, White, PF, Watcha, MF, Coloma, M, Skrivanek, GD. The efficacy of premedication with celecoxib and acetaminophen in preventing pain after otolaryngologic surgery. Anesth Analg 2002;94:1188–93Google Scholar
15 Graham, GG, Scott, KF. Mechanism of action of paracetamol. Am J Ther 2005;12:4655 Google Scholar
16 Rømsing, J, Møiniche, S. A systematic review of COX-2 inhibitors compared with traditional NSAIDs, or different COX-2 inhibitors for post-operative pain. Acta Anaesthesiol Scand 2004;48:525–46Google Scholar
17 White, PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg 2005;101:S522 Google Scholar
18 Recart, A, Issioui, T, White, PF, Klein, K, Watcha, MF, Stool, L et al. The efficacy of celecoxib premedication on postoperative pain and recovery times after ambulatory surgery: a dose-ranging study. Anesth Analg 2003;96:1631–5Google ScholarPubMed
19 Schwartz, SR. Perioperative pain management. Oral Maxillofac Surg Clin North Am 2006;18:139–50Google Scholar
20 Pickering, AE, Bridge, HS, Nolan, J, Stoddart, PA. Double-blind, placebo-controlled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children. Br J Anaesth 2002;88:72–7Google Scholar
21 Tiippana, E, Bachmann, M, Kalso, E, Pere, P. Effect of paracetamol and coxib with or without dexamethasone after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2008;52:673–80Google Scholar
22 Krishna, S, Hughes, LF, Lin, SY. Postoperative haemorrhage with nonsteroidal anti-inflammatory drugs use after tonsillectomy. Arch Otolaryngol Head Neck Surg 2003;129:1086–9Google Scholar
23 Møiniche, S, Rømsing, J, Dahl, JB, Tramèr, MR. Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg 2003;96:6877 Google Scholar
24 Iverson, RE, Lynch, DJ; ASPS Committee on Patient Safety. Practice advisory on pain management and prevention of postoperative nausea and vomiting. Plast Reconstr Surg 2006;118:1060–9Google Scholar
25 McDaid, C, Maund, E, Rice, S, Wright, K, Jenkins, B, Woolacott, N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic review. Health Technol Assess 2010;14:1153 Google Scholar
26 Mösges, R, Hellmich, M, Allekotte, S, Albrecht, K, Böhm, M. Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials. Eur Arch Otorhinolaryngol 2011;268:807–16Google Scholar
27 Sasi, S, Larrier, DR, Crouse, H. Common postoperative complications in otolaryngology presenting to the pediatric emergency department. Clin Pediatr Emerg Med 2010;11:131–6Google Scholar
28 Jeyakumar, A, Brickman, TM, Williamson, ME, Hirose, K, Krakovitz, P, Whittemore, K et al. Nonsteroidal anti-inflammatory drugs and postoperative bleeding following adenotonsillectomy in pediatric patients. Arch Otolaryngol Head Neck Surg 2008;134:24–7Google Scholar
29 Kim, DW, Koo, JW, Ahn, SH, Lee, CH, Kim, JW. Difference of delayed post-tonsillectomy bleeding between children and adults. Auris Nasus Larynx 2010;37:456–60Google Scholar
30 Nikanne, E, Kokki, H, Salo, J, Linna, TJ. Celecoxib and ketoprofen for pain management during tonsillectomy: a placebo-controlled clinical trial. Otolaryngol Head Neck Surg 2005;132:287–94Google Scholar
31 Ranjit, S, Brett, RH, Lu, PK, Aw, CY. The incidence and management of post-tonsillectomy haemorrhage: a Singaporean experience. Singapore Med J 1999;40:622–6Google Scholar
32 Evans, AS, Khan, AM, Young, D, Adamson, R. Assessment of secondary haemorrhage rates following adult tonsillectomy--a telephone survey and literature review. Clin Otolaryngol Allied Sci 2003;28:489–91Google Scholar
33 Blakley, BW. Post-tonsillectomy bleeding: how much is too much? Otolaryngol Head Neck Surg 2009;140:288–90Google Scholar
34 Sarny, S, Habermann, W, Ossimitz, G, Schmid, C, Stammberger, H. Tonsilar haemorrhage and re-admission: a questionnaire based study. Eur Arch Otorhinolaryngol 2011;268:1803–7Google Scholar
35 Blomgren, K, Qvarnberg, YH, Valtonen, HJ. A prospective study on pros and cons of electrodissection tonsillectomy. Laryngoscope 2001;111:478–82Google Scholar
36 Alhamarneh, O, Raja, H, England, RJ. Inadequate analgesic prescription increases secondary post-tonsillectomy bleed rates: a completed audit loop. J Laryngol Otol 2008;122:719–21Google Scholar
37 Mattos, JL, Robison, JG, Greenberg, J, Yellon, RF. Acetaminophen plus ibuprofen versus opioids for treatment of post-tonsillectomy pain in children. Int J Pediatr Otorhinolaryngol 2014;78:1671–6Google Scholar
38 Walker, P, Gillies, D. Post-tonsillectomy hemorrhage rates: are they technique-dependent? Otolaryngol Head Neck Surg 2007;136:S27–31Google Scholar