AINS versus opioids for postoperative analgesia in hip surgery. Comparison of adverse effects

Ioana Cucereanu-Bădică1, Liviu Bădică2, A.A. Brădiş1, Ioana Grinţescu1

1) Departamentul de Anestezie şi Terapie Intensivă
2) Secţia Ortopedie şi traumatologie, Spitalul Clinic de Urgenţă Floreasca, Bucureşti

Abstract

Background and goal. NSAID and opioid analgetics have both their own spectrum of adverse events. Paracetamol has the safest profile but is not strong enough for the relief of pain after hip arthroplasty. This study attempts to assess the best analgesic regimen for those patients.
Material and methods. After Hospital Ethics Committee approval, 90 patients who had underwent hip arthroplasty under spinal anesthesia with 0.5% bupivacaine between September 2005 – November 2006 were randomized in two groups: Group T (n = 43) received tramadol and Group NSAID (n = 47) received iv diclofenac (till max. 300 mg/day) or ketorolac (till max. 90 mg/day) as supplementary analgesia for maintaining a score = 4 on Analogue Visual Scale 1-10. All patients received paracetamol i.v. 4 g/day for at least 5 days, gastric protection therapy and DVT prophylaxis with enoxaparine. We assessed the quantity of transfused blood, the incidence of vomiting, the increase in creatinine serum level and the quality of sleep during the first five postoperative days and the incidence of digestive hemorrhage during the first 42 days after surgery. Statistics used t-test, χ2 test and Mann-Whitney U-test (p < 0.05).
Results. The groups did not differ regarding the demographic data, blood loss during surgery and postoperative sedation and analgesia (VRS – none or mild for = 90% of time). The NSAID group received more blood during the first 5 postoperative days (p < 0.05), had a lower incidence of vomiting episodes (p < 0.01) and an increase in creatinine levels, though not statistically significant. The quality of sleep was better in the group T (p < 0.01). In group T no digestive hemorrhage was recorded; in group NSAID 2 patients were readmitted with digestive hemorrhage and 2 patients experienced this during hospitalization (the first 10 days after surgery).
Conclusion. We consider that it is advisable to avoid NSAID in these patients because of evidence of an increase in postoperative blood loss and the increased risk of gastrointestinal bleeding. A regimen of i.v. paracetamol and a weak opioid as tramadol provides good pain relief with just one inconvenient side effect- nausea and vomiting.
Key words: postoperative analgesia, AINS, opioids, paracetamol i.v., orthopedic surgery

AINS versus opioide pentru analgezia postoperatorie în artroplastia de şold. Comparaţie a efectelor adverse

Jurnalul Român de Anestezie Terapie intensivă 2007, Vol.14, Nr.2, 78-80