The Efficacy of Oral Celecoxib Following Surgical Rhinoplasty

Overview

Reducing opioid use after surgery is a stated priority, and non-narcotic alternatives are one route. This prospective cohort study compared patients who received celecoxib, an anti-inflammatory that does not increase bleeding risk in the way older ones do, against those who did not.

Sections of note

• Prospective cohort of 51 consecutive patients who had rhinoplasty between July 2018 and May 2019 by a single facial plastic surgeon.
• A questionnaire on pain medication use and complications was given at the 1-week postoperative visit; patients were grouped by whether celecoxib was used.
• 17 of the 51 patients received celecoxib.
• Mean oxycodone-acetaminophen tablets: 4.2, CI 2.4 to 6.1, versus 14.8 in controls, CI 11.1 to 18.4, p 0.0006.
• Mean oxycodone-acetaminophen dose: 17.6 mg, CI 9.0 to 26.3, versus 73.8 mg, CI 55.5 to 92.0, p 0.0001.
• Mean total oral morphine equivalents: 26.5, CI 13.5 to 39.4, versus 110.7, CI 83.3 to 138.0, p 0.001.
• Nausea and vomiting were significantly reduced, p 0.02; overall a 76.2 percent decrease in opioid milligrams and 83.4 percent decrease in nausea and vomiting, without increased surgical complications. Level of evidence 2.

What it means for a patient

• Adding a non-opioid anti-inflammatory reduced opioid use by roughly three quarters.
• Nausea and vomiting, which are largely opioid side effects, fell correspondingly.
• No increase in surgical complications such as bleeding was reported.
• Limits: 51 patients with only 17 in the treatment group, not randomized, one surgeon, and medication use self-reported at one week.

Why this paper matters

Opioid prescribing after rhinoplasty consistently exceeds what patients need, and a drug that displaces most of it addresses that directly. The effect size here is large. The non-randomized design with a small treatment group means the size of the true effect is uncertain.

Terms

• Celecoxib: An anti-inflammatory painkiller that selectively blocks COX-2.
• Oxycodone-acetaminophen: A common combination tablet of an opioid and paracetamol.
• Oral morphine equivalent: A standard unit allowing different opioids to be compared by strength.
• Prospective cohort: A group tracked forward in time as events occur.
• Perioperative: Around the time of the operation.