Abstract
Purpose
In previous animal studies, a prior exposure to nonsteroidal anti-inflammatory drugs (NSAID) augmented opioid drug potency. This study was designed to answer the question whether a similar effect can be attained in man. The objective was to use NSAID for preoperative pain reduction and at the same time use the NSAID exposure to reduce opioid requirements for pain inhibition in major orthopedic surgery.
Methods
In this double-blind, randomized study, 50 patients scheduled for total hip surgery were included. Patients of Group I received a placebo drug three times a day two weeks before surgery, and those allocated to Group II received ibuprofen (600 mg) three times a day. For surgical anesthesia, all patients received intrathecal bupivacaine 20 mg plus 0.1 mg morphine in a total volume of 4 mL.
Results
The preoperative or postoperative visual analogue scale pain scores or the amount of iv morphine showed no differences between the two groups in the first 24 hr after surgery. The median total blood loss in the ibuprofen group was 1161 mL vs 796 mL in the placebo group (P < 0.01).
Conclusion
Pretreatment with ibuprofen before major hip surgery does not improve the pain scores or reduce morphine requirement but significantly increases blood loss. Considering the presence of relevant adverse effects, pretreatment with a nonselective NSAID is not recommended.
Résumé
Objectif
Des études antérieures sur des animaux ont démontré qu’une exposition préalable aux anti-inflammatoires non stéroidiens (AINS) renforce l’effet des opiacés. Cette étude a été conçue pour savoir si le même effet peut être obtenu chez l’homme. L’objectif était de prescrire un traitement antalgique préopératoire aux AINS et en même temps, profitant de l’exposition aux AINS, de réduire le besoin d’opiacés pour diminuer la douleur après des opérations orthopédiques majeures.
Méthode
Cinquante patients opérés pour la mise en place d’une prothèse totale de la hanche ont été inclus dans cette étude randomisée et en double aveugle. Les patients du Groupe I prenaient un placebo trois fois par jour pendant deux semaines avant l’opération tandis que les patients du Groupe Il prenaient de l’ibuprofène (600 mg) trois fois par jour. L’anesthésie pratiquée à l’ensemble des patients consistait en l’injection intrathécale de 20 mg de bupivacaïne et 0,1 mg de morphine dans un volume total de 4 mL.
Résultats
Aucune différence n’a été constatée entre les deux groupes dans les degrés de douleur mesurée par échelle visuelle analogique aussi bien en préopératoire qu’en postopératoire ou dans la dose de morphine injectée par voie iv pendant les 24 premières heures après l’opération. La perte totale de sang dans le groupe ibuprofène s’élevait à I 161 mL et dans le groupe placebo à 796 mL.
Conclusion
Un traitement préalable à l’ibuprofène en chirurgie majeure de la hanche n’améliore pas la douleur et ne diminue pas le besoin de morphine postopératoire, mais est associé avec une perte de sang signifcativement plus élevée. Vu ces conséquences fâcheuses, il nous apparaît judicieux de s’abstenir d’un traitement préalable aux AINS non sélectifs avant ce type de chirurgie.
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Bugter, M.L.T., Dirksen, R., Jhamandas, K. et al. Prior ibuprofen exposure does not augment opioid drug potency or modify opioid requirements for pain inhibition in total hip surgery. Can J Anesth 50, 445–449 (2003). https://doi.org/10.1007/BF03021054
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DOI: https://doi.org/10.1007/BF03021054