Preemptive or preventive? The best time for peri-operative analgesia using dexketoprofen in laparoscopic cholecystectomy

C. Guran, Emilia Drăgulin, G. Stelea, Alida Moise, Natalia Mincu

Secţia Anestezie şi Terapie Intensivă, Spitalul MAI „Prof. Dr. D. Gerota”, Bucureşti

Abstract

Background and objectives. The preemptive versus preventive analgesia debate using NSAIDs as part of multimodal analgesia is yet to be solved. This trial compares the intensity of postoperative pain and the rescue analgesics consumption following an anal­gesia regimen based on dexketoprofen admi­nis­tration at two different times during laparoscopic surgery.

Material and method. A prospective, randomised, double-blind study was conducted in 89 patients undergoing laparoscopic cholecystectomy under general anaesthesia. Patients in Group A (preemptive, n = 43) received dexketoprofen 50 mg in 5 ml saline i.v. 30 minutes before induction and another injection of 5 ml saline i.v. during skin suture. Subjects in Group B (preventive, n = 46) have received the same 5 ml injections in reverse order (saline before induction and dexketoprofen during suture). The induction, main­te­nance and emergence of anaesthesia were conducted in a similar fashion, as well as the preestablished post­operative analgesia regimen, consisting of minor anal­gesics (1 g i.v. parace­tamol, 50 mg i.v. tramadol, 1 g i.v. metamizol every 12 h). Pain intensity and rescue analgesic consumption (20-30 mg i.v. petidine) were recorded for the first 24 postoperative hours. To test the differences observed in the time-related evo­lution of these variables, t Student test and dispersion indices (standard deviation, dispersion quotient) were used.

Results. Patients in Group A had better post­operative analgesia, in terms of VAS pain score (mean VAS 0.7 ± 0.04 vs 1.1 ± 0.07) and pain-free hours (10.1 ± 1.2 vs 7.3 ± 1.4) as well as lower pethidine consumption (5.6 ± 1.4 vs 11.8 ± 2.1 mg). All results were statistically significant with p < 0.05. Side effects (nausea, vomiting, excessive sedation) were comparable in the two groups.

Conclusions. Preemptive administration of dexketoprofen appears to be more effective than its preventive administration for postoperative analgesia after laparoscopic cholecystectomy.

Keywords: postoperative analgesia, preemptive, preventive, dexketoprofen

J Rom Anest Terap Int 2010; 17: 23-28

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Preemptiv sau preventiv? Momentul optim pentru analgezia perioperatorie folosind dexketoprofen în colecistectomia laparoscopică