Canadian Journal of Anesthesia

, Volume 46, Issue 8, pp 725–730 | Cite as

Rectal indomethacin reduces postoperative pain and morphine use after cardiac surgery

  • Theodore Rapanos
  • Patricia Murphy
  • John Paul Szalai
  • Lisa Burlacoff
  • Jenny Lam-McCulloch
  • Joseph Kay
Reports of Investigation

Abstract

Purpose

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 (n = 26) or indomethadn 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 × 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 indomethadn 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 indomethacinvs 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.

Conclusion

The combination of indomethacin with morphine after cardiac surgery results in reduced postoperative pain scores and opioid use without an increase in side effects.

Résumé

Objectif

Évaluer l’action combinée d’indométhacine rectale et d’analgésie contrôlée par le patient (ACP) avec de la morphine intraveineuse sur la douleur postopératoire et l’usage d’opioïde en cardiochirurgie.

Méthode

Ayant obtenu l’approbation du comité d’éthique de l’hôpital, 57 adultes consentants qui devaient subir un pontage aortocoronarien électif ont été répartis au hasard avant l’opération afin de recevoir en double insu, soit un placebo (n = 26), soit de l’indométhacine (n = 31) en suppositoires de 100 mg, 2–3 h après l’opération et 12 h plus tard. Tous ont utilisé de la morphine pour l’ACP. Les scores de douleur ont été évalués à l’aide d’une échelle visuelle analogue (EVA) de 10 cm (au repos et lors de la toux) à 4, 6, 12, 18 et 24 h après le dosage initial et analysés selon un plan 2 × 5 de mesures répétées de la variance. La consommation d’analgésique à 24 h, la perte sanguine au drain thoracique à 12 et 24 h et le moment de l’extubation endotrachéale ont été notés et comparés d’un groupe à l’autre par le test t de Student sur des échantillons indépendants.

Résultats

La demande postopératoire de morphine des 24 premières h a été de 38% moindre avec l’indométhacine (22,40 ± 12,55 mg) qu’avec le placebo (35,99 ± 25,84 mg),P = 0,019. Les scores de douleur de l’EVA ont été de 26% à 66% plus faibles pour l’indométhacine vs le placebo, au repos (P = 0,006), non lors de la toux, et ce, pour tous les temps de mesures. La perte sanguine a été semblable dans les deux groupes (à 12 h) ainsi que le temps total d’intubation.

Conclusion

Administrée après une intervention cardiaque, la combinaison d’indométhacine et de morphine a réduit les douleurs et l’usage d’opioïdes sans augmenter les effets secondaires.

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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Theodore Rapanos
    • 1
  • Patricia Murphy
    • 1
  • John Paul Szalai
    • 2
  • Lisa Burlacoff
    • 3
  • Jenny Lam-McCulloch
    • 1
  • Joseph Kay
    • 1
  1. 1.Department of AnaesthesiaSunnybrook and Women’s College Health Sciences Centre, University of TorontoCanada
  2. 2.Department of Research Design & BiostatisticsSunnybrook and Women’s College Health Sciences Centre, University of TorontoCanada
  3. 3.Department of Cardiovascular Intensive Care UnitSunnybrook and Women’s College Health Sciences Centre, University of TorontoCanada

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