Comparative Analysis of Two Celecoxib Regimens for Postoperative Pain Management Following Bi-malleolar Fracture Surgery
Abstract
Background: Bimalleolar fractures, which often necessitate surgery due to instability, are linked to considerable postoperative pain. Selective cyclooxygenase-2 (COX-2) inhibitors, like celecoxib, have demonstrated potential in alleviating pain and decreasing the need for opioids. However, the optimal dosing regimen remains unclear. This study compares the efficacy of two celecoxib regimens in reducing postoperative pain after ankle fracture surgery.
Methods: A double-blind, randomized controlled trial was carried out with 240 patients undergoing bimalleolar fracture surgery under spinal anesthesia. The participants were split into three groups: a placebo group, a group receiving 400 mg of celecoxib (Group 400), and a group receiving 600 mg of celecoxib (Group 600). Pain levels were evaluated using the Visual Analog Scale (VAS) at specific time points (0, 6, 24, and 72 hours after surgery). Additionally, total morphine consumption, the time until first analgesic use, patient satisfaction, and side effects were documented.
Results: Patients in Group 600 experienced significantly lower pain scores and delayed morphine use compared to the placebo group (P < 0.05). Both celecoxib groups consumed less morphine overall, with higher patient satisfaction scores reported in Group 600. Adverse events were minimal and comparable across all groups.
Conclusion: The preemptive use of celecoxib, particularly at a 600 mg dose, significantly reduces postoperative pain and opioid use while enhancing patient satisfaction with minimal side effects. These results suggest that COX-2 inhibitors are a practical alternative to opioids for managing pain after ankle fracture surgery.
[2] Mirkheshti A, Raji P, Komlakh K, Salimi S, Shakeri A. The efficacy of ultrasound-guided erector spinae plane block (ESPB) versus freehand ESPB in postoperative pain management after lumbar spinal fusion surgery: a randomized, non-inferiority trial. European Spine Journal. 2024;33(3):1081–8.
[3] Koujan K, Saber AY. Bimalleolar Ankle Fractures. 2023 Feb 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
[4] Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997; 85(4):808–16.
[5] Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg. 2002; 10(2):117–29.
[6] 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(6):1631–5.
[7] Farhanchi A, Nikouseresht M, Khorshidi E, Hajian P. Comparison of Preemptive Effects of Celecoxib and Ibuprofen on Postoperative Pain in Addicted Patients Undergoing Lower Abdominal Surgery. Avicenna J Clin Med. 2017;24(3):192-8.
[8] Ma N, Yi P, Xiong Z, Ma H, Tan M, Tang X. Efficacy and safety of perioperative use of non-steroidal anti-inflammatory drugs for preemptive analgesia in lumbar spine surgery: a systematic review and meta-analysis. Perioper Med (Lond). 2023; 12(1):61.
[9] Vadivelu N, Mitra S, Schermer E, Kodumudi V, Kaye AD, Urman RD. Preventive analgesia for postoperative pain control: a broader concept. Local Reg Anesth. 2014; 7:17-22.
[10] Safari S, Rahimzadeh P, Haghighi M. Local infiltration anesthesia: does it really work? Ann Transl Med. 2015; 3(18):275.
[11] Murauski JD, Gonzalez KR. Peripheral Nerve Blocks for Postoperative Analgesia. AORN J. 2002; 75(1):134–47.
[12] Sandkühler J, Ruscheweyh R. Opioids and central sensitisation: I. Preemptive analgesia. Eur J Pain. 2005; 9(2):145–8.
[13] Kano K, Kawamura K, Miyake T. Effects of preemptive analgesia with intravenous acetaminophen on postoperative pain relief in patients undergoing third molar surgery: a prospective, single-blind, randomized controlled trial. Med Oral Patol Oral Cir Bucal. 2020; 26(1):e64.
[14] Wang C, Fu H, Wang J, Huang F, Cao X. Preemptive analgesia using selective cyclooxygenase-2 inhibitors alleviates postoperative pain in patients undergoing total knee arthroplasty: A protocol for PRISMA guided meta-analysis of randomized controlled trials. Medicine. 2021; 100(7):e24512.
[15] Doleman B, Leonardi-Bee J, Heinink TP, Boyd-Carson H, Carrick L, Mandalia R, et al. Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery. Cochrane Database Syst Rev. 2021;6(6).
[16] Zhu X. Efficacy of preemptive analgesia versus postoperative analgesia of celecoxib on postoperative pain, patients’ global assessment and hip function recovery in femoroacetabular impingement patients underwent hip arthroscopy surgery. Inflammopharmacology. 2020; 28(1):131–7.
[17] Pournajafian A reza, Sehat M, Ghodrati M reza, Rokhtabnak F, Kholdbarin A reza. Comparison of post-operative pain in patients with leg fracture surgery with celecoxib administration in different preoperative times. Anesthesiology and Pain. 2011;2(2).
[18] Mahjoubifard M, Enayati H, Noori NM, Shaikh M, Jahangiri Fard A. The Effect of Preemptive Oral Celecoxib on Pain Reduction and Opioid Consumption during Elective Herniorrhaphy. Enliven: Journal of Anesthesiology and Critical Care Medicine. 2016; 3(1).
[19] Saryazdi H, Moradi D, Hamedani A, Aghadavoudi O. Comparison the efficacy of pre-emptive oral celecoxib with acetaminophen in controlling post-operative pain and nausea after lower limb surgery under general anesthesia. Journal of Cellular & Molecular Anesthesia. 2016; 1:2.
[20] Stepan JG, London DA, Osei DA, Boyer MI, Dardas AZ, Calfee RP. Perioperative Celecoxib and Postoperative Opioid Use in Hand Surgery: A Prospective Cohort Study. J Hand Surgery. 2018; 43(4):346–53.
[21] Zhou Y, Liu X, Ding C, Xiang B, Yan L. Positive Preemptive Analgesia Effectiveness of Pregabalin Combined with Celecoxib in Total Knee Arthroplasty: A Prospective Controlled Randomized Study. Pain Res Manag. 2023; 2023(1):7088004.
[22] Saito T, Iwamoto S, Murotani K, Hashimoto A, Kurahashi S, Fukami Y, et al. Efficacy of celecoxib as preemptive analgesia for patients undergoing laparoscopic inguinal hernia repair: a randomized trial. Surg Today. 2021;51(7):1118–25.
[23] Gómez-Sánchez E, Hernández-Gómez A, Guzmán-Flores JM, Alonso-Castro AJ, Serafín-Higuera NA, Balderas-Peña LMA, et al. Celecoxib Decreases the Need for Rescue Analgesics after Total Knee Arthroplasty: A Meta-Analysis. Clin Pract. 2024; 14(2):461-472.
[24] Abtahi D. Effects of preoperative celecoxib administration on pain control after tibial fracture surgery: A randomized controlled trial. Researcher Bulletin of Medical Sciences. 2023; 28(1):e12.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| COX-2 inhibitors Randomized controlled trial Visual Analogue Scale Bimalleolar fractures | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
