Peri-operative administration of COX inhibitors and beta- adrenergic blockers Routine pre medication before surgery generally includes anxiolytics such as benzodiazepines, drugs routinely taken by the patient, and additional drugs for specific indications. Preventive administration of beta- blockers and COX inhibitors are recommended in the literature pertaining to anesthesia and pain. Administration of beta- blockers has been shown to stabilize the cardio vascular system and decrease peri-operative ischemic events (23), while preventive administration of COX inhibitors decreases post operative pain (5). Post operative pain has significant immunological effects: it causes secretion of endogenous opiates, and is often treated with synthetic opiates such as morphine. The opiates cause a stress response, suppress immune functions and promote tumor growth and spread. Studies have shown that administration of COX inhibitors together with morphine caused a decrease in morphine requirements. Administration of COX inhibitors can help control pain by abrogation of prostaglandin mediated pain pathways while at the same time decreasing opiate requirements. An additional benefit of COX inhibitors is it's direct activity against tumor cells by enhancing apoptosis and decreasing tumor blood supply as reported in a recently published study (21). These studies indicate that peri-operative use of these drugs does not have any detrimental effects, is not associated with increased complication - and in fact may be beneficial.