Intravenous Ketoprofen in Postoperative Pain Treatment after Major Abdominal Surgery

Abstract

In recent years considerable attention has been paid to the treatment of postoperative pain, with regard to the favorable effect of adequate analgesia on patient outcome. Multimodal analgesia (e.g., opioids and nonsteroidal anti-inflammatory drugs [NSAIDs] or local anesthetics) is recommended for effective postoperative pain relief. There are few data on the use of NSAIDs in postoperative pain treatment after abdominal surgery. We conducted a randomized, double-blind, placebo-controlled study to assess the analgesic efficacy and safety of ketoprofen after major abdominal surgery. One and nine hours postoperatively patients received 100 mg of ketoprofen i.v. (n = 21) or placebo (n = 22) in addition to a pain-treatment protocol consisting of continuous infusion of tramadol 200 mg and metamizol 5 g over 24 hours with additional 25 mg i.v. tramadol in case of inadequate analgesia. Pain was assessed by numeric rating scale at rest and at deep breath 3, 6, 12, and 24 hours postoperatively and the total dose of tramadol used in the first 24 hours was recorded. Patients in the ketoprofen group had significantly lower pain scores both at rest and at deep breath, at 3 (p < 0.01), 6, and 12 hours (p < 0.05) postoperatively. The 24-hour use of tramadol was significantly lower in the ketoprofen group (p < 0.01), with less nausea and vomiting. There were no bleeding complications or other adverse events related to ketoprofen therapy. The study showed the value of short-term use of ketoprofen to improve the quality of analgesia after major abdominal surgery without significant adverse effects.

Pharmacological characteristics of metamizole

“…This is also true for metamizole, as it has been proven that co-administration of metamizole with morphine (López-Muñ oz et al 2008, Domtnguez-Ramtrez et al 2010, paracetamol or ketoprofen (Oberhofer et al 2005) is able to produce potentiation of antinociceptive effects. Domínguez-Ramírez et al (2010) demonstrated that co-administration of morphine and metamizole under acute treatment produced a significantly higher antinociceptive effect than that obtained with morphine alone.…”

“…Over recent years, they have gained popularity as a medication to relieve postoperative pain; used alone to stop mild to moderate pains, but even more importantly as a component of multimodal analgesia (Schug and Manopas 2007). Very good effects have been attained in treatment of acute pain using metamizole in combination with NSAIDs, including ketoprofen (Oberhofer et al 2005) or with opioid analgesics (López-Muñ oz et al 2008, Baumgartner et al 2009). The efficacy of metamizole in post-operative pain therapy has been confirmed in studies conducted on humans (Edwards et al 2001, Chaparro et al 2012) and on animals (Imagawa et al 2011).…”

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

“…Rationale: Two single-center RCTs, one including 120 postcardiac surgery ICU patients in four parallel groups (adjunctive 75 mg diclofenac, 100 mg ketoprofen, 100 mg indomethacin, or placebo) (102) and one including 43 postabdominal surgery ICU patients in two parallel groups (adjunctive 100 mg ketoprofen or placebo) (103), evaluated the role of COX-1-selective NSAIDs for postoperative ICU pain control. Pooled analysis demonstrated that NSAIDs nonsignificantly reduced pain intensity at rest at 24 hours as measured by the 0-10 VAS or NRS (MD, -0.35 cm; 95% CI, -0.91 to +0.21; low quality).…”

A randomized, controlled clinical trial of ketoprofen for sickle-cell disease vaso-occlusive crises in adults

“…[14][15][16][17][18][19][20][21] NSAIDs and opioid analgesics have a synergic effect, 22 thereby achieving better pain control and an opioid-sparing effect with fewer adverse events in those settings. Therefore, the use of NSAIDs also could be a good strategy for the treatment of VOC in patients with SCD.…”

“…We chose ketoprofen because its efficacy has been proven in many other pain settings. 14,15,17,[19][20][21][51][52][53][54] Since its marketing in 1973 in Europe, ketoprofen, which belongs to the propionic acid class of NSAIDs, has been widely used in France and Europe. It is, like most NSAIDs (eg, ketorolac), a nonselective cyclooxygenase inhibitor.…”