Comparison of etoricoxib vs. ketorolac in postoperative pain relief.
BACKGROUND
COX-2 inhibitors have been claimed to have equal analgesic efficacy as non-selective nonsteroidal anti-inflammatory drugs, but this has been disputed in animal experiments.


METHODS
One hundred thirty-three women scheduled for ambulatory, laparoscopic gynaecological surgery were included in this randomised, double-blind study. Group E received 120 mg etoricoxib orally as premedication. Group K received 30 mg ketorolac i.v. after induction of anaesthesia. General anaesthesia was induced and maintained with propofol and remifentanil. Fentanyl 0.5 microg/kg i.v. and local wound anaesthesia was administered at the end of surgery. Postoperatively, the patients received fentanyl 0.5 microg/kg i.v. if visual analogue scale (VAS) >or=30 mm. Before discharge, Group K received 30 mg ketorolac i.v. Twenty-four hours postoperatively, Group E received 120 mg etoricoxib.


RESULTS
The first 4 h postoperatively, Group K required 83+/-65 microg and Group E required 123+/-91 microg fentanyl [mean (SD), P=0.004]. After 30 min VAS in Group K was 31.3+/-19.7 mm and 43.8+/-16.9 mm in Group E [mean (SD), P<0.001]. Discharge readiness was significantly shorter in Group K (222+/-40 min) compared with Group E (244+/-47 min) [mean (SD), P=0.004]. There were no differences in pain scores or rescue pain medication at 24 or 48 h postoperatively. Less nausea was observed in the 4-24-h period in Group E.


CONCLUSIONS
Thirty milligram ketorolac i.v. after induction of anaesthesia resulted in significantly less immediate pain and opioid consumption during the first 4 h postoperatively compared with 120 mg etoricoxib preoperatively.
Lenz
H
H
Department of Anaesthesia, Ullevaal University Hospital, University of Oslo, Oslo, Norway. harald.lenz@medisin.uio.no
Raeder
J
J
D000328:Adult; D000077613:Etoricoxib; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000009:adverse effects / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy*; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D013450:Sulfones / Q000009:adverse effects / Q000627:therapeutic use*
D011725:Pyridines; D013450:Sulfones; D000077613:Etoricoxib; D020910:Ketorolac