Evaluation of the Efficacy of Methylprednisolone, Etoricoxib and a Combination of the Two Substances to Attenuate Postoperative Pain and PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Placebo-controlled Trial
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: Establishment of laparoscopic cholecystectomy as an outpatient procedure has accentuated the clinical importance of reducing early postoperative pain, as well as postoperative nausea and vomiting (PONV). We therefore planned to evaluate the role of a multimodal approach in attenuating these problems. Methods: One hundred and twenty adult patients of ASA physical status I and II and undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized, placebo-controlled study. Patients were divided into four groups of 30 each to receive methylprednisolone 125 mg intravenously or etoricoxib 120 mg orally or a combination of methylprednisolone 125 mg intravenously and etoricoxib 120 mg orally or a placebo 1 hr prior to surgery. Patients were observed for postoperative pain, fentanyl consumption, PONV, fatigue and sedation, and respiratory depression. Results were analyzed by the ANOVA, a Chi square test, the Mann Whitney U test and by Fisher’s exact test. P values of less than 0.05 were considered to be significant. Results: Postoperative pain and fentanyl consumption were significantly reduced by methylprednisolone, etoricoxib and their combination when compared with placebo (P＜0.05). The methylprednisolone + etoricoxib combination caused a significant reduction in postoperative pain and fentanyl consumption as compared to methylprednisolone or etoricoxib alone (P＜0.05); however, there was no significant difference between the methylprednisolone and etoricoxib groups (P＞0.05). The methylprednisolone and methylprednisolone + etoricoxib combination significantly reduced the incidence and severity of PONV and fatigue as well as the total number of patients requiring an antiemetic treatment compared to the placebo and etoricoxib (P＜0.05). Conclusions: A preoperative single-dose administration of a combination of methylprednisolone and etoricoxib reduces postoperative pain along with fentanyl consumption, PONV, antiemetic requirements and fatigue more effectively than methylprednisolone or etoricoxib alone or a placebo.
Abstract
Background: Establishment of laparoscopic cholecystectomy as an outpatient procedure has accentuated the clinical importance of reducing early postoperative pain, as well as postoperative nausea and vomiting (PONV). We therefore planned to evaluate the role of a multimodal approach in attenuating these problems. Methods: One hundred and twenty adult patients of ASA physical status I and II and undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized, placebo-controlled study. Patients were divided into four groups of 30 each to receive methylprednisolone 125 mg intravenously or etoricoxib 120 mg orally or a combination of methylprednisolone 125 mg intravenously and etoricoxib 120 mg orally or a placebo 1 hr prior to surgery. Patients were observed for postoperative pain, fentanyl consumption, PONV, fatigue and sedation, and respiratory depression. Results were analyzed by the ANOVA, a Chi square test, the Mann Whitney U test and by Fisher’s exact test. P values of less than 0.05 were considered to be significant. Results: Postoperative pain and fentanyl consumption were significantly reduced by methylprednisolone, etoricoxib and their combination when compared with placebo (P＜0.05). The methylprednisolone + etoricoxib combination caused a significant reduction in postoperative pain and fentanyl consumption as compared to methylprednisolone or etoricoxib alone (P＜0.05); however, there was no significant difference between the methylprednisolone and etoricoxib groups (P＞0.05). The methylprednisolone and methylprednisolone + etoricoxib combination significantly reduced the incidence and severity of PONV and fatigue as well as the total number of patients requiring an antiemetic treatment compared to the placebo and etoricoxib (P＜0.05). Conclusions: A preoperative single-dose administration of a combination of methylprednisolone and etoricoxib reduces postoperative pain along with fentanyl consumption, PONV, antiemetic requirements and fatigue more effectively than methylprednisolone or etoricoxib alone or a placebo.
참고문헌 (29)
- Woolf CJ, "Pain: moving from symptom control toward mechanism-specific pharmacologic management", Ann Intern Med, 140, pp.441~451 (2004)
- Dubois F, "Coelioscopic cholecystectomy. Preliminary report of 36 cases", Ann Surg, 211, pp.60~62 (1990)
- Lau H, "Predictive factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy", Arch Surg, 136, pp.1150~1153 (2001)
- Mjåland O, "Outpatient laparoscopic cholecystectomy", Br J Surg, 84, pp.958~961 (1997)
- Kehlet H, "Postoperative opioid analgesia: time for a reconsideration?", J Clin Anesth, 8, pp.441~445 (1996)
- Wang JJ, "Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy", Br J Anaesth, 83, pp.772~775 (1999)
- Bisgaard T, "Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy : a randomized double-blind placebocontrolled trial", Ann Surg, 238, pp.651~660 (2003)
- Romundstad L, "Methylprednisolone intravenously 1 day after surgery has sustained analgesic and opioid-sparing effects", Acta Anaesthesiol Scand, 48, pp.1223~1231 (2004)
- Romundstad L, "Methylprednisolone reduces pain, emesis, and fatigue after breast augmentation surgery: a singledose, randomized, parallel-group study with methylprednisolone 125 mg, parecoxib 40 mg, and placebo", Anesth Analg, 102, pp.418~425 (2006)
- Bisgaard T, "Analgesic treatment after laparoscopic cholecystectomy:a critical assessment of the evidence", Anesthesiology, 104, pp.835~846 (2006)
- Rodrigues AD, "Absorption, metabolism, and excretion of etoricoxib, a potent and selective cyclooxygenase-2 inhibitor, in healthy male volunteers", Drug Metab Dispos, 31, pp.224~232 (2003)
- Puura A, "Etoricoxib pre-medication for post-operative pain after laparoscopic cholecystectomy", Acta Anaesthesiol Scand, 50, pp.688~693 (2006)
- Ramsay MA, "Controlled sedation with alphaxalone-alphadolone", Br Med J, 2, pp.656~659 (1974)
- Agarwal A, "Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy", Br J Anaesth, 101, pp.700~704 (2008)
- Clarke R, "Single dose oral etoricoxib for acute postoperative pain in adults", Cochrane Database Syst Rev, (2), pp.CD004309~ (2009)
- Sapolsky RM, "How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions", Endocr Rev, 21, pp.55~89 (2000)
- Holte K, "Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications", J Am Coll Surg, 195, pp.694~712 (2002)
- Henzi I, "Dexamethasone for the prevention of postoperative nausea and vomiting : a quantitative systematic review", Anesth Analg, 90, pp.186~194 (2000)
- Coloma M, "Dexamethasone in combination with dolasetron for prophylaxis in the ambulatory setting: effect on outcome after laparoscopic cholecystectomy", Anesthesiology, 96, pp.1346~1350 (2002)
- Kardash KJ, "Single-dose dexamethasone reduces dynamic pain after total hip arthroplasty", Anesth Analg, 106, pp.1253~1257 (2008)
- Sauerland S, "Risks and benefits of preoperative high dose methylprednisolone in surgical patients : a systematic review", Drug Saf, 23, pp.449~461 (2000)
- Lillemoe KD, "Laparoscopic cholecystectomy as a"true"outpatient procedure : initial experience in 130 consecutive patients", J Gastrointest Surg, 3, pp.44~49 (1999)
- Chung F, "Factors contributing to a prolonged stay after ambulatory surgery", Anesth Analg, 89, pp.1352~1359 (1999)
- Waddle JP, "Postanesthesia care unit length of stay : quantifying and assessing dependent factors", Anesth Analg, 87, pp.628~633 (1998)
- Kehlet H, "The value of"multimodal"or"balanced analgesia"in postoperative pain treatment", Anesth Analg, 77, pp.1048~1056 (1993)
- 김신형, "Patient-controlled Epidural Analgesia with Ropivacaine and Fentanyl: Experience with 2,276 Surgical Patients", The Korean Journal of Pain, 26(1), pp.39~45 (2013), 대한통증학회
- Joshi GP, "Multimodal analgesia techniques and postoperative rehabilitation", Anesthesiol Clin North America, 23, pp.185~202 (2005)
- Andersen R, "Pain as a major cause of postoperative nausea", Can Anaesth Soc J, 23, pp.366~369 (1976)
- Manchikanti L, "Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain", Pain Physician, 12, pp.699~802 (2009)