COXIBS FOR POSTOPERATIVE ANALGESIA
Academy of Medical Sciences, Moscow Coxibs can be regarded as an effective way of postoperative pain treatment with proven analgesic and opioid-saving effects. When comparing the opioid-saving effect after the large surgical interventions, COX-2 inhibitors are not inferior to NSAIDs and surpass paracetamol. The combination of coxibs and opiate receptors antagonists, as well as epidural analgesia is effective in the frames of multimodal analgesia. The reasonability of coxibs and paracetamol combination is questionable. In patients at risk of gastrointestinal complications development, but with none cardiovascular risk, COX- 2 inhibitors are more safe, than the combination of NSAIDs and proton pump inhibitors. Due to no cross-reactivity with aspirin and NSAIDs, coxibs can be recommended to patients with aspirin asthma and related diseases. Specific COX-2 inhibitors prescription is able to inhibit comissure formation after laparotomy, suppressing blood vessels proliferation. It is assumed that the COX-2 inhibitors may inhibit vascular endothelial growth factor of the tumor and so inhibit angiogenesis of solitary tumors and metastases, without affecting the normal endothelium. Thus, today coxibs are not inferior in efficiency to certain opioid analgesics and have improved safety profile compared with traditional NSAIDs. These qualities allow to consider them as a group of non-opioid analgesics for postoperative analgesia.