Intravenous ketoprofen in thyroid and parathyroid surgery.
We compared the ketoprofen-propacetamol combination relative to propacetamol alone in thyroid and parathyroid surgery in terms of postoperative analgesic efficacy, bleeding, and incidence of nausea and vomiting to determine whether ketoprofen results in any benefit in this type of surgery. Patients were distributed in two parallel groups to be managed by anesthesiologists habitually prescribing (Ketoprofen group) or not prescribing (Control group) ketoprofen in this situation. The same anesthetic technique was used for all patients. Postoperative analgesia consisted of 2 g of propacetamol every 6 h and morphine boluses if the pain score measured by the numerical rating scale pain exceeded 40 (3 mg IV every 10 min in the recovery room, then 5 mg SC every 4 h in the ward). The Ketoprofen group received 100 mg of ketoprofen IV during surgery (starting on resection of specimen) and 8 h later. In the recovery room, patients received oxygen if the SpO(2) while they were breathing room air was < 95% on admission and at 1 and 2 h. Pain scores, opioid consumption, the volume of the cervical draining fluid, and the concentration and mass of hemoglobin in this fluid collected over 24 h were recorded. The 214 patients were distributed into two groups (n = 107 in each group) that were comparable in terms of age, weight, sex, duration of surgery, type of endocrinopathy, surgeon involvement, and the intraoperative dose of sufentanil (P > 0.2). The Ketoprofen group had lower numerical rating scale (P < 0.05), received less morphine during the first 24 h after surgery (7.4 +/- 5 vs 11.7 +/- 6 mg, P < 0.05), had fewer nausea and vomiting episodes (21 vs 38, P < 0.05), and were less likely to require oxygen breathing after 1 h in the recovery room (33 vs 59 patients, P < 0.05). The two groups had the same 24-h volume of cervical draining fluid (72.5 +/- 43 vs 70 +/- 42 mL, P > 0.2) and the same concentration (5.9 +/- 3.4 vs 6.4 +/- 2.8 g per 100 mL, P > 0.1) and mass of hemoglobin (3.9 +/- 2.8 vs 4.2 +/- 2.5 g, P > 0.2) in this collected fluid. Two cervical hematomas necessitating reintervention occurred in the Control group, compared with none in the Ketoprofen group. Ketoprofen reduces the pain score after thyroid and parathyroid surgery, as well as morphine requirements and related adverse effects, without increasing the risk of cervical bleeding.


CONCLUSIONS
In a prospective open study, ketoprofen reduced the pain score after thyroid and parathyroid surgery, as well as morphine requirements and related adverse effects, without increasing the risk of cervical bleeding.
Department of Anesthesiology and Intensive Care, Saint-Louis University Hospital, Paris, France.
E R
ER
Basto
C
C
Waintrop
F D
FD
Mourey
J P
JP
Landru
B G
BG
Eurin
L P
LP
Jacob
D000082:Acetaminophen / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy; D007660:Ketoprofen / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D010280:Parathyroid Glands / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D013961:Thyroid Gland / Q000601:surgery*
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D000082:Acetaminophen; C063776:propacetamol; D009020:Morphine; D007660:Ketoprofen