Perioperative Inflammation and Cyclooxygenase 2 (COX-2)

• Plasma valdecoxib concentration
• CSF/plasma valdecoxib concentration ratio
• CSF and plasma cytokine concentrations
• Postoperative opioid consumption
• Pain visual analogue scale (VAS) scores

• Plasma valdecoxib concentration
• CSF/plasma valdecoxib concentration ratio
• CSF and plasma cytokine concentrations
• postoperative opioid consumption
• pain VAS scores

Surgery initiates a complex cascade of events involving the release of chemical compounds from nerve endings and damaged tissue which leads to an inflammatory and pain response. The purpose of this investigation is to measure various chemical mediators in the blood and cerebrospinal fluid, and to test the hypothesis that they will be decreased in patients treated with a COX-2 inhibitor.

Surgery initiates a complex cascade of events involving the release of nociceptive compounds from nerve endings and damaged tissue which leads to an inflammatory and hyperalgesic response. COX-2 inhibitors are often used for treating pain. This is a double-blind randomized study in surgical patients receiving a spinal drain for surgical purposes. The hypothesis is that valdecoxib will reach therapeutic concentrations in CSF, and will decrease plasma and CSF concentrations of inflammatory mediators. Subjects will receive valdecoxib 40 mg or placebo approximately 1 hr prior to surgery. Serial blood and CSF samples will be obtained. Valdecoxib and cytokine concentrations will be measured.

• Neurosurgery
• Pain

Inclusion Criteria:

• Patients undergoing surgery requiring lumbar drain placement

Exclusion Criteria:

• Contraindication to COX-2 inhibitor (renal or hepatic insufficiency)
• Known adverse reaction to nonsteroidal anti-inflammatory drugs (NSAIDs)
• Use of NSAID or COX-2 within 7 days prior to surgery