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Pharmacology of cyclooxygenase-2 inhibitors and preemptive analgesia in acute pain management

Kaye, Alan Da; Baluch, Amirb; Kaye, Aaron Ja; Ralf, Gebhardb; Lubarsky, Davidb

Current Opinion in Anesthesiology: August 2008 - Volume 21 - Issue 4 - p 439–445
doi: 10.1097/ACO.0b013e3283007e8d
Drugs in anesthesia: Edited by Alan D. Kaye

Purpose of review NSAIDs have served as analgesic, antiinflammatory, and antipyretic medicines for over a century. A novel class of NSAIDs, cyclooxygenase-2 inhibitors, was introduced in 1999. All NSAIDs and aspirin inhibit active sites of cyclooxygenase-1 and cyclooxygenase-2. Recent studies have demonstrated an important role of cyclooxygenase-2 inhibitors in the management of acute pain processes.

Recent findings There have been many reports related to an ‘imbalance theory’ suggesting that cyclooxygenase-2 inhibitors create an ‘imbalance’ between thromboxane and prostacyclin (reduction of prostacyclin), resulting in a prothrombic state; however, these drugs were designed to have improved gastrointestinal safety profiles by being more selective of the cyclooxygenase-2 pathway. Although balance and regulation of hemostasis is influenced in part by the balance of prostacyclin and thromboxane A2, many other substances are involved in thrombosis and include the coagulation cascade, fibrinogen and plasminogen pathways, numerous endogenous substances such as adenosine, nitric oxide, and serotonin.

Summary On the basis of many human studies, one may conclude that perioperative cyclooxygenase-2 inhibitors, in standard doses, decrease opioid consumption. Future investigations that include different multimodal techniques, for example combining cyclooxygenase-2 inhibitors with regional blocks, may help elucidate and clarify the true benefits of perioperative cyclooxygenase-2 inhibitors in acute pain management strategies.

aDepartment of Anesthesiology, LSU School of Medicine, New Orleans, Louisiana, USA

bDepartment of Anesthesiology, University of Miami, Miami, Florida, USA

Correspondence to Alan D. Kaye, MD, PhD, DABPM, Professor and Chairman, Department of Anesthesiology, Professor, Department of Pharmacology, Louisiana State University School of Medicine, 1542 Tulane Ave, 6th floor-Anesthesia, New Orleans, LA 70112, USA Tel: +1 504 568 2319; fax: +1 504 568 2317; e-mail:


In the August 2008 issue of Current Opinion in Anesthesiolgy an author's name was stated incorrectly, the correct author list for the article ‘Pharmacology of cyclooxygenase-2 inhibitors and preemptive analgesia in acute pain management’ [1] is Alan D. Kaye, Amir Baluch, Aaron J. Kaye, Ralf Gebhard and David Lubarsky.

The publisher apologises for this error.


1 Kaye AD, Baluch A, Kaye AJ, et al. Pharmacology of cyclooxygenase-2 inhibitors and preemptive analgesia in acute pain management. Curr Opin Anaesthesiol 2008; 21:439–445.

© 2008 Lippincott Williams & Wilkins, Inc.