Pain treatment with a COX-2 inhibitor after coronary artery bypass operation: a randomized trial.
BACKGROUND
Adequate analgesic medication is mandatory after cardiac operations. Cyclooxygenase-2 inhibitors represent a new therapeutic option, acting primarily on the response to inflammation.


METHODS
We compared a cyclooxygenase-2 inhibitor (etodolac) with two traditional drugs: a nonselective cyclooxygenase inhibitor (diclofenac) and a weak opioid (tramadol) on postoperative pain and renal function in patients undergoing coronary artery bypass operations. Sixty consecutive patients were randomized into three groups: (1) group A patients who received tramadol; (2) group B patients who received diclofenac; and (3) group C patients who received etodolac. For measurement of analgesic effect, the visual analogue scale was assessed up to postoperative day 4. Creatinine-clearance was determined before and at the end of study medication, and serum creatinine and urea were monitored daily for renal effects. Study medication was given on postoperative days 2 and 3. Side effects and additional pain medication were recorded.


RESULTS
The visual analogue scale was lower in group C (p < 0.05) from postoperative days 2 to 4 and in group B (p < 0.05) from postoperative days 3 to 4 compared with group A. Amount of additional pain medication and incidence of side effects were significantly less in group C compared with group A. We observed a short-lasting elevation of serum creatinine and urea in groups B and C compared with group A (p < 0.05).


CONCLUSIONS
At the doses analyzed, etodolac and diclofenac produced better postoperative pain relief with less side-effects than tramadol. A short-lasting impairment of renal function was found in patients treated with etodolac and diclofenac.
Immer
Franz F
FF
Department of Cardiovascular Surgery, Division of Pain Therapy, University Hospital, Berne, Switzerland.
Immer-Bansi
Alexsandra S
AS
Trachsel
Nathalie
N
Berdat
Pascal A
PA
Eigenmann
Verena
V
Curatolo
Michele
M
Carrel
Thierry P
TP
D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000097:blood; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004008:Diclofenac / Q000627:therapeutic use; D017308:Etodolac / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors*; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011451:Prostaglandin-Endoperoxide Synthases; D014147:Tramadol / Q000627:therapeutic use; D014508:Urea / Q000097:blood
D000701:Analgesics, Opioid; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D004008:Diclofenac; D017308:Etodolac; D014147:Tramadol; D014508:Urea; D003404:Creatinine; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases