Rectal indomethacin reduces postoperative pain and morphine use after cardiac surgery

Abstract

Rectal indomethacin reduces postoperative pain and morphine use after cardiac surgeryPurpose: To evaluate the combination of rectal indomethacin with patient controlled intravenous morphine analgesia (PCA) on postoperative pain relief and opioid use after cardiac surgery. Methods: With institutional ethics approval, 57 consenting adults undergoing elective aortocoronary bypass surgery were randomly assigned preoperatively in a double-blind fashion to receive either placebo in = 26) or indomethacin 100 mg suppositories (n = 31 ), 2-3 hr postoperatively, and 12 hr later. Both groups utilized PCA morphine. Pain scores in the two treatment groups were assessed on a 10-cm visual analogue scale (VAS) (at rest and with cough) at 4, 6, 12, 18 and 24 hr after initial dosing, and were analyzed through a 2 x 5 repeated measures of variance. The 24 hr analgesic consumption, 12 and 24 hr chest tube blood loss, and time to tracheal extubation were also recorded, and compared for the two treatment arms through Student's t test on independent samples. Results: Postoperative morphine consumption in the first 24 hr was 38% less in the indomethacin group (22.40 _+ 12.55 mg) than the placebo group (35.99 +_ 25.84 mg), P= 0.019. Pain scores, measured with a VAS, were 26% to 66% lower in the indomethacin vs placebo group at rest (P=0.006), but not with cough, for all times assessed. There was no difference in blood loss (at 12 hr) or time to tracheal extubation for both groups.

Postoperative naproxen after coronary artery bypass surgery: a double-blind randomized controlled trial

“…Our study suggests that in patients free of preoperative renal insufficiency, short-term postoperative naproxen use is not associated with an increased incidence of renal dysfunction following CABG. This is in agreement with other studies that have also found no increased risk of postoperative renal impairment after cardiac surgery in carefully selected patients [12,13].…”

“…The present data add to that of other studies which have also illustrated the analgesic effects of NSAIDs after cardiac surgery. A significant reduction in postoperative pain was demonstrated with the use of ketorolac [9,10], diclofenac [11] and rectal indomethacin after CABG [12]. However, unlike previous trials, this is the first to date to demonstrate an improvement in both pain control and lung function following CABG using a low-cost NSAID such as naproxen.…”

“…Although several studies have reported on the use of NSAIDs after cardiac surgery [9][10][11][12][13], their effects have seldom been evaluated in randomized controlled settings, and none have examined the use of naproxen. Therefore, the aim of this study was to examine the efficacy and safety of naproxen in a prospective, double-blind, randomized, controlled trial comparing early naproxen administration with placebo as an adjunct to opioids following coronary artery bypass graft surgery (CABG).…”

NSAID-analgesia, pain control and morbidity in cardiothoracic surgery

“…[20][21][22][23] Therefore, 20 randomized trials (19 papers and one abstract) involving a total of 1,065 patients provided data for this meta-analysis. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Table I outlines the characteristics of included trials. Baseline characteristics of patients are presented in Table II.…”

Symptom control in cancer patients: the clinical pharmacology and therapeutic role of suppositories and rectal suspensions

“…A sustained-release suppository can be produced by adding sugar esters to a lipophilic (Witepsol H-15) base [111]. Postoperative indomethacin suppositories (100 mg dosed every 12 h) reduce morphine consumption postoperatively by 38% compared with a placebo control [142].…”