Preoperative use of selective COX-II inhibitors for pain management in laparoscopic Nissen fundoplication

Background: This randomized, double-blind, prospective, placebo controlled study was planned to determine the effectiveness of selective COX-11 inhibitors used preoperatively to alleviate pain after Nissen fundoplication surgery. Methods: For this study, 60 patients were allocated to four groups at random: group C (celecoxib, 200 mg by mouth), group R (rofecoxib, 50 mg by mouth), group P (placebo, pill), or group D (diclophenac sodium, 75 mg intramuscularly). Postoperative abdominal and shoulder pain experienced by the patient at rest, with motion, and with coughing were assessed. Side effects and postoperative analgesic requirement (tramadol, intra- muscular) also were recorded. Results: The median tramadol requirement in the 1st h and total tramadol requirement at the 24th h were higher in group P than in the other study groups (p < 0.01). The pain scores in the first postoperative hour were higher in group P (p < 0.05). Conclusions: The preoperative use of celecoxib, rofecoxib, or diclophenac in laparoscopic Nissen fundoplication surgery decreases pain intensity and tramadol requirement in the first postoperative hour and has a trarnadol sparing effect in the first 24 h.