Cyclooxygenase-2 inhibitors in postoperative pain management: current evidence and future directions.

NONSTEROIDAL antiinflammatory drugs (NSAIDs) have been shown to reduce pain and opioid consumption and often accelerate recovery after surgery. However, perioperative inhibition of prostaglandin synthesis by NSAIDs may cause complications, including renal injury, gastric ulceration, and bleeding. Recent molecular studies distinguishing between constitutive cyclooxygenase-1 (COX-1) and inflammation-inducible cyclooxygenase-2 (COX-2) enzymes have led to the exciting hypothesis that the therapeutic and adverse effects of NSAIDs could be uncoupled. The purpose of this article is to review the mechanistic differences between nonselective NSAIDs and selective COX-2 inhibitors (COX-2Is) and to examine currently available COX-2I clinical trials to consider the role of these drugs in postoperative pain management.