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Original Investigation
From the American Head and Neck Society
November 2018

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

Author Affiliations
  • 1Otolaryngology–Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City
JAMA Otolaryngol Head Neck Surg. 2018;144(11):988-994. doi:10.1001/jamaoto.2018.0284
Key Points

Question  Does the addition of celecoxib to the standard analgesia regimen decrease the amount of opioid use in patients after head and neck cancer (HNC) surgery and reconstruction with free tissue?

Findings  In this matched-cohort study, 51 patients who received celecoxib after HNC surgery with free tissue reconstruction had significantly decreased perioperative opioid requirements compared with 51 matched patients who did not receive celecoxib. There were no differences in complication rates between the 2 groups.

Meaning  Celecoxib was associated with a decrease in opioid requirements after HNC surgery with free tissue reconstruction and should remain a consideration for perioperative analgesia in select patients.

Abstract

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.

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