Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery.
OBJECTIVE
Non-steroidal anti-inflammatory drugs (NSAIDs) are used as analgesic in postoperative pain to reduce opioid side effects, such as drowsiness and nausea. However, NSAIDs have not been used extensively in cardiac surgical patients due to the fear of untoward effects on gastric, renal, and coagulation parameters. This study will evaluate the efficacy and safety of three NSAIDs for pain control in CABG patients.


METHODS
One hundred and twenty patients scheduled for elective CABG surgery were enrolled in randomized, double blind, controlled study. Standardized fast track cardiac anesthesia was used. One dose of drug (75 mg diclofenac, 100 mg ketoprofen, 100 mg indomethacin, or placebo) was given pr one hour before tracheal extubation and a second dose 12 hr later. Pain was treated with morphine iv and acetaminophen po. Visual analogue pain scores were recorded at baseline, 3, 6, 12 and 24 hr after the first dose of drug.


RESULTS
There were no differences among the groups in pain scores. Only patients who received diclofenac required less morphine than patients in the control group (P < 0.05). When the total amounts of pain medications were computed to morphine equivalents, only patients in the diclofenac group received less pain medications than the placebo group (P < 0.05). Proportion of patients with postoperative increase of creatinine level (20% and over) did not differ between placebo and drug groups.


CONCLUSIONS
Non-steroidal anti-inflammatory drugs may be used for analgesia management post CABG surgery in selected patients. Diclofenac appears to have the best analgesic effects by reducing the morphine and other analgesic requirement postoperatively.
Hynninen
M S
MS
Division of Cardiac Anesthesia & Intensive Care, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada.
Cheng
D C
DC
Hossain
I
I
Carroll
J
J
Aumbhagavan
S S
SS
Yue
R
R
Karski
J M
JM
D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000758:Anesthesia; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D003422:Critical Care; D004311:Double-Blind Method; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine