Association of Celecoxib Use With Decreased Opioid Requirements After Head and Neck Cancer Surgery With Free Tissue Reconstruction

Importance: Head and neck cancer (HNC) surgery with free tissue reconstruction is associated with considerable postoperative pain. Opioids are typically used but can have adverse effects, including respiratory depression and high rates of dependence and addiction. Safe alternative analgesics that minimize opioid requirements are beneficial in HNC surgery.

Objective: To investigate the association of celecoxib use with opioid requirements in the postoperative setting after HNC surgery with free tissue reconstruction.

Design, Setting, and Participants: A retrospective, matched-cohort study of 147 patients who had undergone HNC surgery with free tissue reconstruction between June 2015 and Sept 2017 in an academic cancer hospital. Patients were separated into groups based on whether celecoxib had been used perioperatively or not. These groups were then matched by stage and site resulting in 102 included participants (51 celecoxib, 51 control).

Main Outcomes and Measures: Oral, intravenous (IV), and total morphine equivalents used in the postoperative setting per patient per day.

Results: There were 51 patients in the celecoxib cohort (19 women and 32 men) and 51 patients in the control cohort (20 women and 31 men) who met inclusion criteria after clinicopathologic data were matched. The mean age of the celecoxib and control cohorts was 61.6 years and 66.1 years, respectively. Treatment with celecoxib in the postoperative setting was associated with decreased mean use of opioids in oral (mean difference, 9.9 mg/d; 95% CI, -1.2 to 21.1), IV (mean difference, 3.9 mg/d; 95% CI, 1.0-6.8), and total (mean difference, 14 mg/d; 95% CI, 2.6-25.4) amount of morphine equivalents per day. When patients were matched to surgical procedure, the effect was more significant. Patients who underwent composite oral resection and received celecoxib had decreased opioid use in oral (mean difference, 25 mg/d; 95% CI, 12.5-25.4), IV (mean difference, 3.4 mg/d; 95% CI, 1.5-5.5), and total (mean difference, 28.4 mg/d; 95% CI, 15.7-41.5) amounts compared with those in the control group. There was no significant difference in complication rates between the 2 cohorts.

Conclusions and Relevance: Use of celecoxib after head and neck cancer surgery and reconstruction with free tissue transfer was associated with a decrease in oral, IV, and total opioid requirements without increasing surgical or flap-related complications.

Media Type:

Electronic Article

Year of Publication:

2018

Contained In:

JAMA otolaryngology-- head & neck surgery - Vol. 144, No. 11 (2018), p. 988-994

Language:

English

Contributors:

Carpenter, Patrick S
Shepherd, Hailey M
McCrary, Hilary
Torrecillas, Vanessa
Kull, Amanda
Hunt, Jason P
Monroe, Marcus M
Buchmann, Luke O
Cannon, Richard B

Links:

Volltext

Keywords:

*Reconstructive Surgical Procedures
Aged
Analgesics, Opioid
Anti-Inflammatory Agents, Non-Steroidal
Celecoxib
Female
Free Tissue Flaps
Head and Neck Neoplasms
Humans
JCX84Q7J1L
Journal Article
Male
Middle Aged
Pain, Postoperative
Pain Management
Pain Measurement
Retrospective Studies
Treatment Outcome

Notes:

Date Completed 02.10.2019

Date Revised 02.10.2019

published: Print

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1001/jamaoto.2018.0284

PMID:

29710229

PPN (Catalogue-ID):

NLM283887672