Comparison of Preemptive Administration of Ibuprofen Rofecoxib and Placebo in the Attenuation of Postoperative Pain Following Gynecological Surgery

摘要

One of the chief complaints of patients undergoing surgical procedures continues to be postoperative pain, which leads to increased morbidity and mortality. Preemptive analgesia is inhibition of pain pathways prior to a painful stimulus. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be beneficial as preemptive analgesic agents, reducing postoperative pain. The aim of this study was to determine if the preoperative administration of an NSAID reduces postoperative pain and if there was a difference between a non- selective cyclooxygenase (COX) inhibitor, such as ibuprofen, and a selective COX-2 inhibitor, such as rofecoxib. This study was a randomly assigned, double- blinded, placebo-controlled, clinical trail. Patients scheduled for gynecological surgery involving a lower abdominal incision were recruited. Each participant was assigned to one of three treatment groups: ibuprofen 400 mg, rofecoxib 50 mg, or placebo, given orally 1 hour prior to surgery. Pain scores and morphine consumption were the dependent variables measured. Data was analyzed for 36 subjects. No significant differences were found between groups in regard to demographics and the incidence of nausea and vomiting. Although there was not a statistically significant difference, the rofecoxib group had slightly lower Post Anesthesia Care Unit (PACU) admit pain scores (mean 3.50, SD 0.83) as compared to ibuprofen (4.09, 2.59) and placebo (4.09, 3.18). In addition, PACU discharge pain scores were also slightly lower for the rofecoxib group (3.29, 1.98) as compared to ibuprofen (3.45, 1.81) and placebo (3.82, 1. 17). Total milligram morphine use was also slightly lower in the rofecoxib group (56.08 mg, 30.11) as compared to ibuprofen (65.90 mg, 42.53) and placebo (69.35 mg, 40.66). Due to time and enrollment constraints, fewer patients were enrolled than required by the initial power analysis. As a result, this study was converted to a pilot study.