Cyclooxygenase-2 inhibitors and free flap complications after autologous breast reconstruction, a retrospective cohort study

Publication date: Available online 20 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Christian Bonde, Hoda Khorasani, Jens Hoejvig, Henrik Kehlet
BackgroundA key component of modern analgesics is the use of multimodal opioid sparing analgesia (MOSA). In the past, our analgesic regime after autologous breast reconstruction (ABR) included either NSAID or a selective cyclooxygenase-2 inhibitor (COX-2). COX-2 inhibitors could be superior to NSAID due to the well-known side effects from NSAID (bleeding/gastrointestinal ulcers). However, COX-2 inhibitors have been suggested to increase flap failure rates. We report our experience with using COX-2 inhibitors as part of our postoperative MOSA after ABR using free flaps.Materials and Methods132 unilateral, secondary, ABR were performed (DIEP or MS-TRAM) in the NSAID period (2007-2011) and 128 in the COX-2 inhibitor period (2006, 2012-2014). The same surgical team operated all patients. Data were collected prospectively and reviewed to compare the two periods with special focus on re-operations due to bleeding/haematomas and flap thrombosis/failure. Comparisons between the COX-2 inhibitor and NSAID were performed.ResultsMedian age, ischaemia time, blood loss and operating time were similar in the two periods. Significantly more patients were re-operated due to postoperative haematoma in the NSAID group (n= 13/132, 9.8%) compared to the COX-2 inhibitor group, (n=4/128, 3.1 %), (p=0.02). We found no difference in flap loss between the NSAID (n=2/132; 1.5%) and the COX-2 inhibitor group (n=3/128, 2.3%), (p=0.63). No patients suffered thromboembolic complications or gastrointestinal bleeding.ConclusionsMultimodal analgesia using a COX-2 inhibitor is safe in ABR with free flaps and does not increase in flap failure. COX-2 inhibitors seems superior to NSAID with reduced risk of postoperative haematomas.



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