Efficacy of Methylprednisolone and Etoricoxib Combination to attenuate Post-operative Pain and Nausea/Vomiting in Laparoscopic Surgeries

Abstract

Background and Aims:Pain and PONV (postoperative nausea and vomiting) are common complaints in the period following surgery. A multimodal approach targeting the reduction of postoperative pain with an opioid-sparing analgesic along with an antiemetic medication would minimize opioid consumption and its associated side effects. We evaluated the efficacy of methylprednisolone 125 mg IV taken along with oral 120 mg etoricoxib on postoperative pain and PONV in patients undergoing laparoscopic surgeries Material and methods:A prospective, randomized, double-blind study was conducted on 70 patients aged between 18 and 60 years with ASA grade 1 and 2 posted for elective laparoscopic surgeries. The test group was given a combination of methylprednisolone 125mgIV (given just before induction)& etoricoxib120mg oral (given 1 hr before surgery). (Group A, n=35) while control group received normal saline IV and a placebo per oral(Group B, n=35). Duration and quality of analgesia was assessed by visual analogue scale (VAS) score at 2,4,6,8,10,12,16,20 and 24hr as primary objective. Total dose of rescue analgesic(injection Fentanyl 50 mcg) in first 24 hours, peri-operative hemodynamic change and post op nausea vomiting (PONV) were observed as secondary objective. Result:Demographic profiles were comparable. Duration of postoperative analgesia was significantly prolonged(p<0.05) in Group A(7.57±1.04hrs) as compared to Group B(3.05±0.5hrs). Group A showed a significant reduction in postoperative fentanyl consumption in the form of rescue analgesic(p<0.05). Group A also showed significant reduction in the incidence of PONV(p<0.05). Conclusion:We conclude that single-dose administration of methylprednisolone IV along with oral etoricoxib has better analgesic efficacy in comparison to placebo for patients undergoing laparoscopic surgeries.