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Efficacy of oral rofecoxib versus intravenous ketoprofen as an adjuvant to PCA morphine after urologic surgery

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Abstract:

Background: 

Adjunctive use of nonsteroidal anti-inflammatory drugs has become increasingly popular in the perioperative period because of their opioid-sparing effects. This randomized, controlled, double-dummy study was designed to evaluate the cost-effectiveness of using oral rofecoxib as an alternative to intravenous ketoprofen for pain management in patients undergoing urologic surgery. Methods: 

Seventy patients were randomly assigned to receive either a placebo (Control) or rofecoxib 50 mg po (Rofecoxib) 1 h prior to surgery. After a standardized spinal anesthetic, patients in the Control group received ketoprofen 100 mg IV q 8 h for 24 h, while the Rofecoxib group received an equivolume of saline at 8-h intervals for 24 h. Both groups were allowed to self-administer morphine (1 mg IV boluses) using a PCA delivery system. The need for ‘rescue’ analgesic medication, as well as pain scores [using an 11-point verbal rating scale (VRS) (0 = none to 10-severe)], were recorded at 1, 2, 6, 12, and 24-h intervals after surgery. In addition, the incidences of side-effects were recorded at the end of the study period. Results: 

Total amount of morphine required in the initial 24-h postoperative period was nonsignificantly reduced in the Rofecoxib group (29 ± 2 vs. 37 ± 4 mg). More importantly, the percentage of patients reporting moderate-to-severe pain (VRS score ≥4) during the study period was lower in the Rofecoxib group (12 vs. 22%, P < 0.05). The daily cost of rofecoxib (USD 1.14 for 50-mg dose) was also significantly less than ketoprofen (USD 3.06 for three 100-mg doses). Conclusion: 

Premedication with oral rofecoxib (50 mg) is a cost-effective alternative to the parenteral nonselective NSAID, ketoprofen (100 mg q 8 h), when used as an adjuvant to PCA morphine for pain management after urologic surgery.

Keywords: Non-steroidal anti-inflammatory drug; cyclooxygenase-2 inhibitor; ketoprofen; patient-controlled analgesia; postoperative pain; rofecoxib

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1399-6576.2004.00496.x

Affiliations: 1: Department of Anesthesiology, Air Force Hospital of Santiago de Chile, Santiago, Chile, 2: Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, 3: Department of Urology, Air Force Hospital of Santiago de Chile, Los Condes, Santiago, Chile

Publication date: October 1, 2004

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