Abstract
Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) are used as analgesic in postoperative pain to reduce opioid side effects, such as drowsiness and nausea. However, NSAIDs have not been used extensively in cardiac surgical patients due to the fear of untoward effects on gastric, renal, and coagulation parameters. This study will evaluate the efficacy and safety of three NSAIDs for pain control in CABG patients.
Methods: One hundred and twenty patients scheduled for elective CABG surgery were enrolled in randomized, double blind, controlled study. Standardized fast track cardiac anesthesia was used. One dose of drug (75 mg diclofenac, 100 mg ketoprofen, 100 mg indomethacin, or placebo) was givenpr one hour before tracheal extubation and a second dose 12 hr later. Pain was treated with morphineiv and acetaminophenpo. Visual analogue pain scores were recorded at baseline, 3, 6, 12 and 24 hr after the first dose of drug.
Results: There were no differences among the groups in pain scores. Only patients who received diclofenac required less morphine than patients in the control group (P<0.05). When the total amounts of pain medications were computed to morphine equivalents, only patients in the diclofenac group received less pain medications than the placebo group (P<0.05). Proportion of patients with postoperative increase of creatinine level (20% and over) did not differ between placebo and drug groups.
Conclusion: Non-steroidal anti-inflammatory drugs may be used for anaalgesia management post CABG surgery in selected patients. Diclofenac appears to have the best analgesic effects by reducing the morphine and other analgesic requirement postoperatively.
Résumé
Objectif: Les anti-inflammatoires non stéroïdiens (AINS) servent d’analgésique postopératoire et réduisent les effets secondaires des opioïdes, comme la somnolence et les nausées. Leur emploi en cardiochirurgie est plutôt restreint où on craint des effets gastriques et rénaux indésirables et des modifications de la coagulation. On a voulu évaluer l’efficacité et la sécurité d’emploi analgésique de trois AINS chez des patients qui subissent un pontage aortocoronarien.
Méthode: L’étude randomisée, contrôlée et à double insu a porté sur 120 patients qui devaient subir un pontage aortocoronarien. Une anesthésie cardiaque normalisée pour un séjour hospitalier écourté a été utilisée. Une dose de médicament (75 mg de diclofénac, 100 mg de kétoprofène, 100 mg d’indométhacine, ou un placebo) a été administréepr une heure avant l’extubation endotrachéale et une seconde dose 12 h plus tard. La douleur a été traitée avec de la morphineiv et de l’acétaminophènepo. Les scores de douleur ont été enregistrés à l’échelle visuelle analogique au début, puis 3, 6, 12 et 24 h après la première dose de médicament.
Résultats: Les scores de douleur n’ont pas présenté de différence intergroupe. Seuls les patients du groupe diclofénac ont demandé moins de morphine que ceux du groupe témoin (P<0,05). Lorsque les quantités totales d’analgésiques ont été calculées en équivalents de morphine, seuls les patients du groupe diclofénac avaient reçu moins d’analgésique que les témoins (P<0,05). La proportion de patients qui présentaient une augmentation postopératoire du niveau de créatinine (20 % et plus) ne différait pas du groupe placebo aux autres groupes.
Conclusion: Les anti-inflammatoires non stéroïdiens sont utiles en analgésique postopératoire chez des patients qui subissent un pontage aortocoronarien planifié. Le diclofénac semble offrir la meilleure analgésie en réduisant les besoins de morphine et d’autres analgésiques.
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Hynninen, M.S., Cheng, D.C.H., Hossain, I. et al. Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery. Can J Anesth 47, 1182–1187 (2000). https://doi.org/10.1007/BF03019866
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DOI: https://doi.org/10.1007/BF03019866