[Selective cyclooxygenase-2 inhibitors for postoperative pain therapy. Analgesic efficacy and adverse effects]

Systemic administration of analgesics is still the most widely used method for postoperative pain therapy. In the concept of balanced or multimodal analgesia non-steroidal anti-inflammatory drugs (NSAIDs) play an important role besides opioids. Their analgesic effect is based on a diminished prostaglandin synthesis by inhibition of the cyclooxygenase (COX) enzyme in the arachidonic acid metabolism. The discovery of at least two COX isoenzymes led to the development of selective COX-2 inhibitors that were hypothesized to have an improved risk-benefit-ratio compared with conventional NSAIDs. In this context the analgesic efficacy and adverse effects of selective COX-2 inhibitors for postoperative pain therapy were evaluated by reviewing the pertinent literature.