Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
John Cavenagh, MBA, PhD, PA-C
Objective: The objective of this selective EBM review is to determine where or not “Are Cox-2 inhibitors such as celecoxib and parecoxib effective in reducing post-tonsillectomy pain?”
Study Design: Review of three double blind randomized controlled trials (RTC). Data Sources: All studies were published in peer-reviewed journals found via the use of PubMed.
Outcomes Measured: Patients were divided into two groups: those who received the Cox-2 inhibitor and those who received the placebo, in order to measure postoperative pain using patient or parent reported journals or diaries, questionnaires, and various pain scales (CHEOPS, and WP24HR with VAS).
Results: Two out of three studies show a modest, but clinically significant decrease in pain post tonsillectomy with or without adenoidectomy. However, one study did not show a change in pain scores between the Cox-2 group and the placebo. Using parecoxib as the drug, Li X showed Group P had significantly lower CHEOPS scores than Group S (7 [5-8] vs. 9 [8-11] respectively. P=0.001). Murto et al showed the celecoxib group resulted in an 11% reduction in WP24HR score averaged over POD 0-2 (95% CI: 0.3-14. P=0.04) and additionally a 14% increase in WP24HR pain scores on POD 3 after the cessation of the intervention. Van Daele et al did not show a statistically significant decrease in pain between the two groups even though the scores for the intervention group were generally lower than the placebo.
Conclusions: Two out of the three randomized controlled trials studied reported statistically significant decrease in pain post tonsillectomy with or without adenoidectomy in the intervention group versus the placebo. Van Daele et al concluded that there was no statistical significant decease in pain between the two groups, however, this study used patients eighteen and older, which varied from the other studies. With this information it can be concluded that in children aged two to eighteen, Cox-2 inhibitors do show a statistically significant decrease in pain post tonsillectomy. Further studies are warranted in order to determine significance in an older patient population.
Ginsburg, Shelby, "Are Cox-2 Inhibitors Such as Celecoxib and Parecoxib Effective in Reducing Post-tonsillectomy Pain?" (2018). PCOM Physician Assistant Studies Student Scholarship. 347.