Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-03T03:05:59.621Z Has data issue: false hasContentIssue false
  • English
  • Français

A randomized, placebo-controlled study of rofecoxib with paracetamol in early post-tonsillectomy pain in adults

Published online by Cambridge University Press:  15 September 2005

O. Naesh ,
L. A. Niles ,
J. G. Gilbert ,
M. M. Ammar ,
P. W. Phibbs ,
A. M. Phillips ,
A. V. Khrapov ,
A. J. Robert  and
A. McClintock
O. Naesh
Affiliation:
Timaru Hospital and Bidwill Trust Hospital, Department of Anaesthesia, Timaru, New Zealand
L. A. Niles
Affiliation:
Timaru Hospital and Bidwill Trust Hospital, Department of Anaesthesia, Timaru, New Zealand
J. G. Gilbert
Affiliation:
Timaru Hospital and Bidwill Trust Hospital, Department of Otolaryngology, Timaru, New Zealand
M. M. Ammar
Affiliation:
Timaru Hospital and Bidwill Trust Hospital, Department of Otolaryngology, Timaru, New Zealand
P. W. Phibbs
Affiliation:
Timaru Hospital and Bidwill Trust Hospital, Department of Otolaryngology, Timaru, New Zealand
A. M. Phillips
Affiliation:
Timaru Hospital and Bidwill Trust Hospital, Department of Anaesthesia, Timaru, New Zealand
A. V. Khrapov
Affiliation:
Timaru Hospital and Bidwill Trust Hospital, Department of Anaesthesia, Timaru, New Zealand
A. J. Robert
Affiliation:
Timaru Hospital and Bidwill Trust Hospital, Department of Anaesthesia, Timaru, New Zealand
A. McClintock
Affiliation:
Timaru Hospital, Pharmacy Department, Timaru, New Zealand
Get access

Extract

Summary

Background and objective: Effective and early treatment of postoperative pain and nausea have become pivotal for the early discharge of patients after tonsillectomy. Opioid-based analgesia is standard practice but the use of non-steroidal anti-inflammatory drugs is discouraged due to their platelet inhibiting properties. The cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drugs are effective analgesics and do not affect platelet function. We hypothesized that premedication with cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drug in addition to paracetamol would provide effective analgesia and decrease opioid consumption during early recovery from tonsillectomy. Methods: In a randomized, placebo-controlled study of adult tonsillectomy patients (n = 40) one group (R-group; n = 20) was premedicated with paracetamol 1.5 g and rofecoxib 50 mg and a control group (P-group; n = 20) was premedicated with paracetamol 1.5 g and placebo. Morphine was used as rescue medication. Postoperative (24 h) pain scores (0–10), morphine consumption as well as intraoperative blood loss were recorded. Results: We found no overall difference in pain scores between the groups but significantly more patients in the placebo group had pain scores >5 within the first 8 h. The rofecoxib group consumed less morphine during the first 12 h. A lower intraoperative blood loss was observed in the rofecoxib group. Conclusion: Our results suggest an early although clinically minor analgesic benefit of the addition of a cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drug to paracetamol as premedication for adult tonsillectomy.

Keywords

ANTI-INFLAMMATORY AGENTS, NONSTEROIDAL, paracetamol, rofecoxibPOSTOPERATIVE PAINTONSILLECTOMY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 10 , October 2005 , pp. 768 - 773
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

McCrory CR, Lindahl SGE. Cyclooxygenase inhibition for postoperative analgesia. Anesth Analg 2002; 169: 169–176.Google Scholar
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997; 78: 606–617.Google Scholar
Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ 2001; 322: 473–476.Google Scholar
Dahl V, Raeder JC. Non-opioid postoperative analgesia. Acta Anaesthesiol Scand 2000; 44: 1191–1203.Google Scholar
Cashman JN. The mechanism of action of NSAIDs in analgesia. Drugs 1996; 52 (Suppl 5): 13–23.Google Scholar
Kehlet H, Dahl JB. The value of ‘Multimodal’ or ‘Balanced Analgesia’ in postoperative pain treatment. Anesth Analg 1993; 77: 1048–1056.Google Scholar
Romsing J, Walther-Larsen S. Peri-operative use of nonsteroidal anti-inflammatory drugs in children: analgesic efficacy and bleeding. Anaesthesia 1997; 52: 673–683.Google Scholar
Moiniche S, Romsing J, Dahl JB, Tramèr M. Nonsteroidal anti-inflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg 2003; 96: 68–77.Google Scholar
Marret E, Flahault A, Samama C-M, Bonnet F. Effects of postoperative, non-steroidal, anti-inflammatory drugs on bleeding risk after tonsillectomy. Anesthesiology 2003; 98: 1497–1502.Google Scholar
Smith I, Wilde A. Secondary tonsillectomy haemorrhage and non-steroidal anti-inflammatory drugs. J Laryngol Otol 1999; 113: 28–30.Google Scholar
Hiller A, Silvanto M, Savolainen S et al. Propacetamol and diclofenac alone and in combination for analgesia after elective tonsillectomy. Acta Anaesthesiol Scand 2004; 48: 1185–1189.Google Scholar
Gajraj NM. Cyclooxygenase-2 inhibitors. Anesth Analg 2003; 96: 1720–1738.Google Scholar
Dawson-Saunders B, Trapp RG. Basic and Clinical Biostatistics, 2nd edn. New York: Appleton and Lange, 1994.
Kehlet H, Rung GW, Callesen T. Postoperative opioid analgesia: time for a reconsideration. J Clin Anesth 1996; 8: 441–445.Google Scholar
Goudas LC, Carr DB. Postoperative analgesia – reconsider, don't reject. J Clin Anesth 1996; 8: 439–440.Google Scholar
Molliex S, Haond P, Baylot D et al. Effect of pre- vs postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy. Acta Anaesthesiol Scand 1996; 40: 1210–1215.Google Scholar
Schoem SR, Watkins GL, Kuhn JJ et al. Control of early postoperative pain with bupivacaine in adult local tonsillectomy. Arch Otolaryngol Head Neck Surg 1993; 119: 292–293.Google Scholar
Warnock FF, Lander J. Pain progression, intensity and outcomes following tonsillectomy. Pain 1998; 75: 37–45.Google Scholar
Akural EI, Koivunen PT, Teppo H et al. Post-tonsillectomy pain: a prospective, randomized and double-blind study to compare an ultrasonically activated scalpel technique with the blunt dissection technique. Anaesthesia 2001; 56: 1045–1050.Google Scholar
Hinz B, Brune K. New insights into the physiology and pathophysiological functions of cyclo-oxygenase-2. Curr Opin Anesthesiol 2000; 13: 585–590.Google Scholar
Kalso E, Smith L, McQuay HJ, Moore A. No pain, no gain: clinical excellence and scientific rigor – lessons learned from IA morphine. Pain 2002; 98: 269–275.Google Scholar
Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 2002; 88: 199–214.Google Scholar
Church JJ. Is postoperative nausea and vomiting following tonsillectomy really a problem? Anaesthesia 2002; 57: 1029–1030.Google Scholar
Kotiniemi LH, Ryhänen PT, Valanne J et al. Postoperative symptoms at home following day-case surgery in children: a multicentre survey of 551 children. Anaesthesia 1997; 52: 963–969.Google Scholar
Schafer IA. Effects of nonsteroidal anti-inflammatory therapy on platelets. Am J Med 1999; 106: 25S–36S.Google Scholar
Gallagher JE, Blauth J, Fornadley JA. Perioperative ketorolac tromethamine and postoperative haemorrhage in cases of tonsillectomy and adenoidectomy. Laryngoscope 1995; 105: 606–609.Google Scholar
Salonen A, Kokki H, Tuovinen K. I.V. ketoprofen for analgesia after tonsillectomy: a comparison of pre- and post-operative administration. Br J Anaesth 2001; 86: 377–381.Google Scholar
Silverman DG, Halaszynski T, Sinatra R et al. Rofecoxib does not compromise platelet aggregation during anaesthesia and surgery. Can J Anesth 2003; 50: 1004–1008.Google Scholar
Blaicher AM, Landsteiner HT, Al-Falaki O et al. Acetylsalicylic acid, diclofenac and lornoxicam, but not rofecoxib, affect platelet CD 62 expression. Anesth Analg 2004; 98: 1082–1085.Google Scholar
Gilron I, Milne B, Hong M. Cyclooxygenase-2 inhibitors in postoperative pain management. Anesthesiology 2003; 99: 1198–1208.Google Scholar
Reuben SS, Bhopatkar S, Maciolek H et al. The preemptive analgesic effect of rofecoxib after ambulatory arthroscopic knee surgery. Anesth Analg 2002; 94: 55–59.Google Scholar
FitzGerald GA, Patrono C. The coxibs, selective inhibitors of cyclooxygenase-2. New Engl J Med 2001; 345: 433–442.Google Scholar
Straube S, Derry HJ, McQuay H et al. Effect of preoperative COX-II selective NSAIDs (coxibs) on postoperative outcomes: a systematic review of randomized studies. Acta Anaesthesiol Scand 2005; 49: 601–613.Google Scholar
Pickering AE, Bridge HS, Nolan J et al. Double-blind, placebo-controlled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children. Br J Anaesth 2002; 88: 72–77.Google Scholar
Watcha MF, Issioui T, Klein KW, White PF. Costs and effectiveness of rofecoxib, celecoxib, and acetaminophen for preventing pain after ambulatory otolaryngologic surgery. Anesth Analg 2003; 96: 987–994.Google Scholar
White PF. Changing Role of COX-2 Inhibitors in the perioperative period: is parecoxib really the answer? Anesth Analg 2005; 100: 1306–1308.Google Scholar