Y a-t-il une place pour les inhibiteurs de la COX-2 en péri-opératoire ?

COX-2 inhibitors and non selective NSAIDs have comparable analgesic effect. Long-term administration of selective and non selective NSAIDs conveys the same risk of gastrointestinal bleeding. A previous gastroduodenal ulcer is a contraindication to COX-2 inhibitors. Chronic renal failure is also a contraindication to all categories of NSAIDs. COX-2 inhibitors have no effect on platelet aggregation and do not increase the risk of per and postoperative bleeding contrarily to non selective NSAIDs. Both selective and non selective NSAIDs increase the risk of myocardial infarction in patients at risk, even for a postoperative administration of short duration. They are also all contraindicated in asthmatic patients. No deleterious effect on bone healing has been demonstrated but there is a doubt concerning the risk of increasing the incidence of bowel anastomotic fistula. Eventually, despite their analgesic efficacy, close to one over five patients has contraindication to the perioperative administration of selective and non selective NSAIDs.