Analgesic efficacy of pre-operative etoricoxib for termination of pregnancy in an ambulatory centre.
BACKGROUND
Etoricoxib is a second generation cyclooxygenase-2 inhibitor with a rapid-onset time and a long duration of action. It is ideal for providing pre-emptive analgesia for ambulatory surgeries. We hypothesised that pre-operative etoricoxib can decrease the use of fentanyl post-operatively, when compared with placebo in patients undergoing termination of pregnancy. We also compared their pain scores, time to discharge, side effects and satisfaction with analgesia post-operatively.


METHODS
After approval by the hospital research ethics committee and receipt of informed written consent, we recruited 40 American Society of Anesthesiologists Physical Status Classification I and II patients scheduled for elective first trimester termination of pregnancy. Patients were randomly allocated to receive either oral etoricoxib 120 mg (Group E, n=20) or placebo tablet (Group P, n=20) pre-operatively. A blinded observer evaluated the post-operative pain scores, need for supplementary analgesia, side effects and satisfaction scores. Sample size was calculated (power of 0.8 and alpha=0.05) to detect a 20 percent difference in fentanyl usage. Amount of fentanyl used, pain scores and satisfaction scores were analysed using non-parametric tests. The incidence of side effects was analysed using chi-squared test.


RESULTS
Etoricoxib 120 mg significantly decreased the amount of fentanyl required after termination of pregnancy compared to placebo (0 microg/patient, interquartile range [IQR] 0-25 versus 50 microg/patient, IQR 0-50, p-value is less than 0.05). Patients who received etoricoxib 120 mg also had significantly lower pain scores than the placebo group at time of discharge (8 +/- 11 versus 1 +/- 3, p-value is less than 0.05) and at six hours post operation (8 +/- 12 versus 0 +/- 0, p-value is less than 0.01). There was no difference in their side effects, and time to discharge and overall satisfaction were similar in both groups.


CONCLUSIONS
Pre-operative administration of oral etoricoxib 120 mg decreased the use of fentanyl and pain scores after minor gynaecological surgery without significant side effects.
Liu
W
W
Department of Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
Loo
C C
CC
Chiu
J W
JW
Tan
H M
HM
Ren
H Z
HZ
Lim
Y
Y
D000028:Abortion, Induced / Q000009:adverse effects; D000284:Administration, Oral; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D004311:Double-Blind Method; D000077613:Etoricoxib; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D017060:Patient Satisfaction; D010919:Placebos; D011247:Pregnancy; D011300:Preoperative Care; D011725:Pyridines / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D013450:Sulfones / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*
D000701:Analgesics, Opioid; D016861:Cyclooxygenase Inhibitors; D010919:Placebos; D011725:Pyridines; D013450:Sulfones; D005283:Fentanyl; D000077613:Etoricoxib