Etoricoxib en analgesia postoperatoria

Etoricoxib-Analgesia preventiva y postoperatoria en pacientes con laparotomía o toracotomía-diseño y protocolos


Etoricoxib--preemptive and postoperative analgesia (EPPA) in patients with laparotomy or thoracotomy--design and protocols.
Fleckenstein J, Kramer S, Offenbächer M, Schober G, Plischke H, Siebeck M, Mussack T, Hatz R, Lehmeyer L, Lang PM, Heindl B, Conzen P, Irnich D.
Department of Anaesthesiology, University of Munich, Munich, Germany.
Trials. 2010 May 27;11:66.
Abstract
BACKGROUND AND OBJECTIVE: Our objective was to report on the design and essentials of the Etoricoxib protocol- Preemptive and Postoperative Analgesia (EPPA) Trial, investigating whether preemptive analgesia with cox-2 inhibitors is more efficacious than placebo in patients who receive either laparotomy or thoracotomy. DESIGN AND METHODS: The study is a 2 x 2 factorial armed, double blinded, bicentric, randomised placebo-controlled trial comparing (a) etoricoxib and (b) placebo in a pre- and postoperative setting. The total observation period is 6 months. According to a power analysis, 120 patients scheduled for abdominal or thoracic surgery will randomly be allocated to either the preemptive or the postoperative treatment group. These two groups are each divided into two arms. Preemptive group patients receive etoricoxib prior to surgery and either etoricoxib again or placebo postoperatively. Postoperative group patients receive placebo prior to surgery and either placebo again or etoricoxib after surgery (2 x 2 factorial study design). The Main Outcome Measure is the cumulative use of morphine within the first 48 hours after surgery (measured by patient controlled analgesia PCA). Secondary outcome parameters include a broad range of tests including sensoric perception and genetic polymorphisms. DISCUSSION: The results of this study will provide information on the analgesic effectiveness of etoricoxib in preemptive analgesia and will give hints on possible preventive effects of persistent pain.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890651/pdf/1745-6215-11-66.pdf


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890651/?tool=pubmed

Efecto de dosis única de etoricoxib en el dolor postoperatorio y el sueño después de discectomía lumbar: estudio controlado, prospectivo doble ciego.
Effects of preoperative single dose Etoricoxib on postoperative pain and sleep after lumbar diskectomy: prospective randomized double blind controlled study
Shashi Srivastava, Devendra Gupta, Anjum Naz, M M Rizvi and Prabhat K Singh
Middle East J Anaesthesiology 21, June 2012
Abstract
Background: Etoricoxib, a selective Cox-2 inhibitor has been found to be effective in the management of acute pain. This study evaluates the effect of preoperative use of oral Etoricoxib on post operative pain relief and sleep in patients undergoing single level diskectomy. Methods: In this prospective, randomized, controlled study, forty four patient (ASA 1&2,age 18-60 years) scheduled to undergo single level lumber diskectomy were given either placebo (control group) or Etoricoxib 120 mg orally one hour before surgery. Post operatively fentanyl intravenous (IV) PCA pump was started. Visual analog score (VAS ) was assessed at 0, 6, 12, 18 and 24 hours at rest and movement. Primary end point was total pain relief over 24 hours. Sleep overnight, total fentanyl consumption, incidence of nausea and vomiting, intra-operative blood loss and patient satisfaction were noted. Results: Forty three patients completed the study. Reductions in VAS at rest and on movement were observed in the Etoricoxib group when compared with the Control group at all the intervals till 24 hours postoperatively, except on movement at 24 hours postoperative (P<0.05). Total fentanyl consumption (μg/kg/hr) was higher in Control group (P=0.007). More patients in Etoricoxib group had a contented facial expression (p=0.003), relaxed body language (p=0.00) and better sleep at night than control group (p=0.0004). Conclusion: Single preoperative oral dose (120 mg) of Etoricoxib, given one hour before surgery, has significantly reduced the post operative pain at rest and movement and improved sleep in patients undergoing single level diskectomy without any side effects and with good patient satisfaction.
http://www.meja.aub.edu.lb/downloads/21_5/725.pdf




La administración prehospitalaria de etoricoxib en pacientes para remplazo de cadera produce inhibición de los mediadores de la inflamación y alivio del dolor
Preoperative administration of etoricoxib in patients undergoing hip replacement causes inhibition of inflammatory mediators and pain relief.
Renner B, Walter G, Strauss J, Fromm MF, Zacher J, Brune K.
Institute of Experimental and Clinical Pharmacology and Toxicology, University of Erlangen-Nürnberg, Erlangen, Germany.renner@pharmakologie.uni-erlangen.de
Eur J Pain. 2012 Jul;16(6):838-48. doi: 10.1002/j.1532-2149.2011.00062.x.
Abstract
OBJECTIVE: Administering cyclooxygenase-2 inhibitors preoperatively appears attractive since these drugs reduce post-operative pain, but do not increase the risk of post-operative bleeds, asthmatic attacks and stress-related gastrointestinal ulcers. In a former investigation, we could show that post-operative administration of etoricoxib reduces prostaglandin production in wound fluid, but the onset of action is variable due to delayed post-operative absorption. METHODS: In this study, we investigated the preoperative administration of etoricoxib in patients undergoing hip replacement. They received 120 mg etoricoxib or placebo 2 h before surgery and 1 day after in a double-blinded, randomized, parallel group design. RESULTS: A total of 11 patients were randomized (placebo n = 5; verum n = 6). We found high and constant levels of the drug in blood, central nervous system and wound fluid already at the end of surgery (t(max) < 2 h). This was accompanied by inhibition of prostaglandin production in the wound tissue (treatment p < 0.05), suppression of interleukin 6 increase in plasma (treatment p < 0.01), and - despite existing standard pain relief procedures - higher satisfaction with analgesics (time vs. treatment p < 0.05) and less demand for opioids (treatment p < 0.01) and intrathecal bupivacaine (treatment p = 0.05) administration. CONCLUSION: Administration of etoricoxib 2 h before surgery allows for an effective drug concentration in critical tissues, a reduction of the production of pro-inflammatory mediators and for better pain relief.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437501/pdf/ejp0016-0838.pdf



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org