Etoricoxib pre-medication for post-operative pain after laparoscopic cholecystectomy.
BACKGROUND
Etoricoxib alleviates and prevents acute pain. The hypothesis of our study was that the pre-operative use of etoricoxib would reduce the post-operative need for additional pain treatment.


METHODS
In this double-blind, randomized and active placebo-controlled study, 75 patients were pre-medicated 1.5 h before elective laparoscopic cholecystectomy with 120 mg of etoricoxib (E120 group), the same dose of etoricoxib combined with 1 g of paracetamol (E + P group) or placebo (Pla group). To alleviate post-operative pain, a patient-controlled analgesia (PCA) device was programmed to deliver 50 microg of fentanyl intravenously (lockout time, 5 min). The pain intensity and nausea were assessed using a visual analogue scale (VAS). The number of patients with post-operative nausea and vomiting was recorded. Blood loss was compared between the groups. Because the operations are almost blood-less, the operation time was also recorded to compare the possible effect on bleeding time.


RESULTS
Pre-medication with etoricoxib or etoricoxib plus paracetamol had a statistically significant fentanyl-sparing effect 2-20 h post-operatively compared with placebo (P = 0.001). No significant differences were demonstrated in fentanyl-sparing effect between the E120 and E + P groups. No significant differences in pain intensity were found between the three study groups. No significant differences were observed between the groups with regard to nausea, blood loss, duration of anaesthesia or duration of surgery.


CONCLUSIONS
Etoricoxib is suitable for pre-medication before laparoscopic cholecystectomy as it reduces the need for post-operative opioids. Opioid-related side-effects, however, were not reduced in the present study, despite the observed opioid-sparing effect of etoricoxib and combined etoricoxib and paracetamol.
Puura
A
A
Department of Anaesthesiology, District Hospital of Valkeakoski, and Medical Center Mehiläinen, Tampere, Finland. arto.puura@mehilainen.fi
Puolakka
P
P
Rorarius
M
M
Salmelin
R
R
Lindgren
L
L
D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D017081:Cholecystectomy, Laparoscopic; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D023381:Endpoint Determination; D000077613:Etoricoxib; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011300:Preoperative Care; D011725:Pyridines / Q000627:therapeutic use*; D018401:Sample Size; D013450:Sulfones / Q000627:therapeutic use*
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D052246:Cyclooxygenase 2 Inhibitors; D004338:Drug Combinations; D011725:Pyridines; D013450:Sulfones; D000082:Acetaminophen; D005283:Fentanyl; D000077613:Etoricoxib