Celecoxib (Celebrex) is an oral, non-steroidal anti-inflammatory drug (NSAID). This class of medications typically inhibits two major isozymes: COX-1 (responsible for platelet aggregation, kidney perfusion, and gastrointestinal mucosa protection) and COX-2 (produced as a result of tissue damage to mitigate the inflammatory response). By selectively inhibiting COX-2, celecoxib tries to avoid the platelet and GI-related sequelae inherent to many NSAIDs.

Over a decade ago, rofecoxib (Vioxx), another selective COX-2 inhibitor, was withdrawn from the market due to concerns about increased risks of acute myocardial infarction and strokes; however, a fair amount of literature regarding celecoxib’s safety profile (ie, the PRECISION trial) seems reassuring.

As an anesthesiologist, I routinely use celecoxib as a preemptive analgesic adjunct (especially in enhanced recovery protocols); however, just like any other medication, it’s important to weigh the pros and cons in the context of a patient’s comorbidities and alternative options.

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