scholarly journals Simultaneous assessment of short-term gastrointestinal benefits and cardiovascular risks of selective cyclooxygenase 2 inhibitors and nonselective nonsteroidal antiinflammatory drugs: An instrumental variable analysis

2006 ◽  
Vol 54 (11) ◽  
pp. 3390-3398 ◽  
Author(s):  
Sebastian Schneeweiss ◽  
Daniel H. Solomon ◽  
Philip S. Wang ◽  
Jeremy Rassen ◽  
M. Alan Brookhart
Keyword(s):  
Instrumental Variable ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Cyclooxygenase 2 ◽  
Cardiovascular Risks ◽  
Short Term ◽  
Antiinflammatory Drugs ◽  
Instrumental Variable Analysis ◽  
Cyclooxygenase 2 Inhibitors ◽  
Simultaneous Assessment ◽  
Variable Analysis

scholarly journals Association of Multimodal Pain Management Strategies with Perioperative Outcomes and Resource Utilization

2018 ◽  
Vol 128 (5) ◽  
pp. 891-902 ◽  
Author(s):  
Stavros G. Memtsoudis ◽  
Jashvant Poeran ◽  
Nicole Zubizarreta ◽  
Crispiana Cozowicz ◽  
Eva E. Mörwald ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Odds Ratio ◽  
Multimodal Analgesia ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Cyclooxygenase 2 ◽  
Perioperative Outcomes ◽  
Antiinflammatory Drugs ◽  
Opioid Prescription ◽  
Total Hip ◽  
Cyclooxygenase 2 Inhibitors

Abstract Background Multimodal analgesia is increasingly considered routine practice in joint arthroplasties, but supportive large-scale data are scarce. The authors aimed to determine how the number and type of analgesic modes is associated with reduced opioid prescription, complications, and resource utilization. Methods Total hip/knee arthroplasties (N = 512,393 and N = 1,028,069, respectively) from the Premier Perspective database (2006 to 2016) were included. Analgesic modes considered were opioids, peripheral nerve blocks, acetaminophen, steroids, gabapentin/pregabalin, nonsteroidal antiinflammatory drugs, cyclooxygenase-2 inhibitors, or ketamine. Groups were categorized into “opioids only” and 1, 2, or more than 2 additional modes. Multilevel models measured associations between multimodal analgesia and opioid prescription, cost/length of hospitalization, and opioid-related adverse effects. Odds ratios or percent change and 95% CIs are reported. Results Overall, 85.6% (N = 1,318,165) of patients received multimodal analgesia. In multivariable models, additions of analgesic modes were associated with stepwise positive effects: total hip arthroplasty patients receiving more than 2 modes (compared to “opioids only”) experienced 19% fewer respiratory (odds ratio, 0.81; 95% CI, 0.70 to 0.94; unadjusted 1.0% [N = 1,513] vs. 2.0% [N = 1,546]), 26% fewer gastrointestinal (odds ratio, 0.74; 95% CI, 0.65 to 0.84; unadjusted 1.5% [N = 2,234] vs. 2.5% [N = 1,984]) complications, up to a –18.5% decrease in opioid prescription (95% CI, –19.7% to –17.2%; 205 vs. 300 overall median oral morphine equivalents), and a –12.1% decrease (95% CI, –12.8% to –11.5%; 2 vs. 3 median days) in length of stay (all P < 0.05). Total knee arthroplasty analyses showed similar patterns. Nonsteroidal antiinflammatory drugs and cyclooxygenase-2 inhibitors seemed to be the most effective modalities used. Conclusions While the optimal multimodal regimen is still not known, the authors’ findings encourage the combined use of multiple modalities in perioperative analgesic protocols.

Inflammatory response and meningioma tumorigenesis and the effect of cyclooxygenase-2 inhibitors

2007 ◽  
Vol 23 (4) ◽  
pp. E7 ◽  
Author(s):  
Brian T. Ragel ◽  
Randy L. Jensen ◽  
William T. Couldwell
Keyword(s):  
Therapeutic Benefit ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Prostaglandin Synthesis ◽  
Cyclooxygenase 2 ◽  
Antiinflammatory Drugs ◽  
Cancer Models ◽  
Chronic Therapy ◽  
Cox 2 ◽  
Rate Limiting ◽  
Cyclooxygenase 2 Inhibitors

✓In this article the authors discuss the rationale and research supporting the hypothesis that meningioma tumorigenesis may, in part, be driven by overexpression of cyclooxygenase-2 (Cox-2) and that treatment with celecoxib, a selective Cox-2 inhibitor, may hold therapeutic promise. Because therapies for recurrent or aggressive meningiomas (atypical or malignant subtypes) such as chemotherapy and radiotherapy generally offer little therapeutic benefit, interest in targeting Cox-2 has grown. This rate-limiting enzyme of prostaglandin synthesis can be inhibited with nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen and celecoxib. Treatment with NSAIDs has been shown to curb the tumorigenic properties of prostaglandins in several cancer models via both Cox-2-dependent and -independent mechanisms. In addition, celecoxib is well tolerated in humans, making its use as a chronic therapy for meningiomas attractive.

scholarly journals Does Multimodal Analgesia with Acetaminophen, Nonsteroidal Antiinflammatory Drugs, or Selective Cyclooxygenase-2 Inhibitors and Patient-controlled Analgesia Morphine Offer Advantages over Morphine Alone?

2005 ◽  
Vol 103 (6) ◽  
pp. 1296-1304 ◽  
Author(s):  
Nadia Elia ◽  
Christopher Lysakowski ◽  
Martin R. Tramèr
Keyword(s):  
Multimodal Analgesia ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Cyclooxygenase 2 ◽  
Morphine Consumption ◽  
Number Needed To Treat ◽  
Severe Bleeding ◽  
Patient Controlled Analgesia ◽  
Antiinflammatory Drugs ◽  
Cyclooxygenase 2 Inhibitors ◽  
Number Needed To Harm

The authors analyzed data from 52 randomized placebo-controlled trials (4,893 adults) testing acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors given in conjunction with morphine after surgery. The median of the average 24-h morphine consumption in controls was 49 mg (range, 15-117 mg); it was significantly decreased with all regimens by 15-55%. There was evidence of a reduction in pain intensity at 24 h (1 cm on the 0- to 10-cm visual analog scale) only with nonsteroidal antiinflammatory drugs. Nonsteroidal antiinflammatory drugs also significantly reduced the incidence of nausea/vomiting from 28.8% to 22.0% (number needed to treat, 15) and of sedation from 15.4% to 12.7% (number needed to treat, 37) but increased the risk of severe bleeding from 0% to 1.7% (number needed to harm, 59). Selective cyclooxygenase-2 inhibitors increased the risk of renal failure in cardiac patients from 0% to 1.4% (number needed to harm, 73). A decrease in morphine consumption is not a good indicator of the usefulness of a supplemental analgesic. There is evidence that the combination of nonsteroidal antiinflammatory drugs with patient-controlled analgesia morphine offers some advantages over morphine alone.

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