Butrón-López FG, Vázquez-Labastida AB, Ávila-Castillo A, Mendoza-Ibarra MP, Suárez-Serrano FJ, García-Zarco J

Language: Spanish
References: 27
Page: 27-31
PDF size: 76.65 Kb.

ABSTRACT

Background. Among the preemptive analgesic techniques for postsurgical pain is the use of conventional non-steroidal anti-inflammatory drugs and, recently, certain selective cyclooxygenase-2 inhibitors. This study compared the analgesic effect of ketorolac tromethamine versus parecoxib sodium or valdecoxib as a preemptive analgesic technique for the treatment of postsurgical pain. Material and methods: Sixty adult patients undergoing different types of surgery were randomly assigned to one of two groups, 30 subjects each. Patients in Group 1 received 30 mg IM ketorolac tromethamine one hour before anesthesia. Postoperatively, they received 10 mg ketorolac tromethamine PO every 6 hours for 48 hours. Patients in Group 2 received 40 mg IM parecoxib sodium (valdecoxib pro-drug) one hour before anesthesia, followed after surgery by 40 mg valdecoxib PO every 12 hours for 48 hours. For the first 48 hours of the postsurgical period, pain intensity was measured every 8 hours using a visual analogue scale (0 to 10). When the intensity of pain was ≥ 5, a rescue opioid was used. Results: Variance analysis indicated that, 8 through 32 hours after surgery, ketorolac tromethamine achieved less pain (p ‹ 0.01) compared to valdecoxib; 20% of patients in Group 2 required opioid rescue medication. Conclusions: Ketorolac tromethamine provides better analgesia, with no need for rescue opioids.

REFERENCES

1. Laurito CE. Pain: physiology and pharmacology. In: Winberg GI, ed. Basic science review of anesthesiology. New York; McGraw-Hill International Edition, 1997: 173-185.

2. Gaeta RR, Brose WG. Tratamiento del dolor. En: Morgan GE, Mikhail MS, eds. Anestesiología Clínica. México; El Manual Moderno, 1995:327-345.

3. Malmberg AB, Yaksh TL. Antinociceptive actions of spinal nonsteroidal anti-inflammatory agents on the formalin test in the rat. J Pharmacol Exp Ther 1992;263:136-146.

4. McCormak K. Non-steroidal anti-inflammatory drugs and spinal nociceptive processing. Pain 1994:39-43.

5. Brune K, Menzel-Soglowek S, Zeilhofer HU. Differential analgesic effects of aspirine-like drugs. Drugs 1992;44(Suppl 5):52-59.

6. Domer F. Characterization of the activity of ketorolac in mice. Eur J Pharmacol 1990;177:127-135.

7. Tripathi A, Welch SP. Blockade of the antinociceptive activity of centrally administered ketorolac by nor-binalorphimine. Eur J Pharmacol 1995;278:27-32.

8. Granados-Soto V, Flores MFJ, Castañeda HG, et al. Evidence of the involvement of nitric oxide in the antinociceptive effect of ketorolac. Eur J Pharmacol 1995;277:281-284.

9. Xie W, Chipman JG, Robertson DL, et al. Expression of mitogen-response gene encoding prostaglandin synthase I regulated by mRNA splicing. Proc Natl Acad Sci USA 1991;88:2692-2696.

10. Hla T, Neilson K. Human cyclooxygenase-2 cDNA. Proc Natl Acad Sci USA 1992;89:7384-7389.

11. Laneuville O, Breuer D, Dewitt D, et al. Differential inhibition of human prostaglandin endo-peroxide H synthases-1 and 2 by nonsteroidal anti-inflammatory drugs. J Pharmacol Exp Ther 1994;271:927-934.

12. Cher SM, Goa KL. Parecoxib (Parecoxib Sodium). Drugs 2001;61:1133-1141.

13. Ormrod D, Wellington K, Wagstaff A. Valdecoxib new drug profile. Drugs 2002;62:2059-2071.

14. Desjardins PJ, Grossman EH, Kuss ME, et al. The injectable cyclooxygenase-2 specific inhibitor parecoxib sodium has analgesic efficacy when administered preoperatively. Anest Analg 2002;93:721-727.

15. Yee JP, Koshiver JE, Allbone C, et al. Comparison of intramuscular ketorolac tromethamine and morphine sulfate for analgesia of pain after surgery. Pharmacotherapy 1986;6:253-261.

16. O’Hara DA, Fragen RJ, Kinzer M, et al. Ketorolac tromethamine compared with morphine sulfate for treatment of postoperative pain. Clin Pharmacol Ther 1987;41:556-561.

17. Insel PA. Analgésicos-antipiréticos, antiinflamatorios y fármacos antigotosos. En: Hardman JG, Limbird LE, eds. Goodman & Gilman Las Bases Farmacológicas de la Terapéutica. Vol. 1. México; McGraw-Hill Interamericana, 1996:682-683.

18. Estenne B, Julien M, Charieux, et al. Comparison of ketorolac, pentazocine, and placebo in treating post-operative pain. Curr Ther Res 1988;43:1173-1182.

19. Glantz SA. Primer of Biostatistics: The Program. Version 4.0. New York; McGraw-Hill Co.,1997.

20. Souter AJ, Fredman B, White P. Controversies in the perioperative use of nonsteroidal anti-inflammatory drugs. Anesth Analg 1994;79:1178-1190.

21. Tamariz-Cruz O. Control del dolor agudo postoperatorio. Lineamientos generales. En: Jáuregui FLA, Tamariz-Cruz O, Zaragoza DJC, eds. Manual de Anestesiología. México; El Manual Moderno. 2001: 663-675.

22. Camu F, Lauwers MH, Vanlersberghe C. Side effects of NSAIDs and dosing recommendations for ketorolac. Acta Anesthesiol Belg 1996;47:143-149.

23. O’Neill G, Mancini J, Kargman S, et al. Overexpression of human G/H synthase-1 and 2 by recombinant vaccinia virus: inhibition by nonsteroidal anti-inflammatory drugs and biosynthesis of 15-hydroxyeicosatetranoic acid. Mol Pharmacol 1994;37:179-186.

24. Dewitt D. COX-2 selective inhibitors the new super aspirins. Mol Pharmacol 1999;55:625-631.

25. Chandrasekharan NV, Dai H, Ross KLT, et al. COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesics/antipyretic drugs: cloning structure, and expression. Proc Natl Acad Sci USA 2002;99:13926-13931.

26. Peura D. Gastrointestinal safety and tolerability of non selective anti-inflammatory agents and cyclooxygenase-2-selective. Cleve Clin J Med 2002;69(Suppl 1):S-131-139.

27. Gajraj NM. Cyclooxygenase-2 Inhibitors. Anesth Analg 2003;96:1729-1738.