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Objective: To examine the time course and clinical relevance of changes in prostaglandin E2 (PGE2) to pain and outcome in surgical drainage, and circulating blood after functional endoscopic sinus surgery (FESS).
Methods: Thirty-seven patients scheduled to undergo FESS were randomized to receive celecoxib 400 mg(n=16) one hour before anesthesia induction and celecoxib 200 mg, q12 h for five consecutive days after surgery or nothing for patients in control group(n=21). Surgical site drainage and venous blood were collected up to 48 hours after surgery to test PGE2 level. Plasma levels of thromboxane A2 (TXA2) and prostacyclin (PGI2) were also tested for the same time course.
Results: For control patients, PGE2 level was elevated in both surgical site and circulating blood, which reached a peak concentration 6 h(177.5 ± 142.2 ng/L) and 48 h (64.5 ± 21.4 ng/L)respectively after FESS. For patients in celecoxib group, a significant reduction of surgical drainage PGE2(peak level 106.2 ± 33.4 ng/L at 6 h) and plasma PGE2 (peak level 44.7 ± 30.2 ng/L at 48 h) was observed(P<0.05). Pain scores 6 h and 48 h after surgery were positively correlated with surgical drainage PGE2 level, correlation coefficient being 0.333 (P=0.044) and 0.353(P=0.032) respectively. Celecoxib did not affect the ratio of plasma TXA2 to PGI2.
Conclusion: Upregulation of PGE2 in surgical site after surgery was crucial in inflammatory response and postoperative pain. Cycloxygenase-2 inhibitor could significantly reduce surgical drainage and plasma PGE2 concentration.
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