A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: Analgesic efficacy and tolerability after gynecologic surgery

We assessed the relative morphine consumption in a combined analgesic regim en (on-demand morphine plus the nonopioids propacetamol or ketorolac) after gynecologic surgery. Two hundred women randomly received two IV doses of p ropacetamol 2 g or ketorolac 30 mg ina double-blinded, double-dummy trial. Patients were monitored for 12 h, and the following efficacy variables were assessed: total dose of morphine, pain intensity, and global efficacy. Saf ety and tolerability were evaluated by the occurrence of adverse events, es pecially the presence and intensity of gastrointestinal symptoms. Hemostati c variables were measured 30 and 60 min after the first infusion; arterial blood pressure, heart and respiratory rates, sedation scores, and renal and hepatic function were also assessed. Total morphine requirements were not significantly different between the propacetamol (10.6 +/- 4.8 mg) and keto rolac (10.2 +/- 4.4 mg) groups. The evolution of pain intensity and the glo bal efficacy also showed similar patterns in the two groups: 70.2% of patie nts in the propacetamol group rated the efficacy as "good/excellent" compar ed with 68.2% in the ketorolac group. There were no clinically significant changes in vital signs or laboratory values and no observed differences bet ween the two groups, although ketorolac slightly, but not significantly, pr olonged the bleeding time. Epigastric pain was present in 9% and 15% of pat ients receiving propacetamol and ketorolac, respectively. There were two ad verse events in the propacetamol group and four in the ketorolac group. Pro pacetamol demonstrates an efficacy similar to that of ketorolac and has an excellent tolerability after gynecologic surgery. Implications: Propacetamo l and ketorolac, combined with patient-controlled analgesia morphine, show similar analgesic efficacy after gynecologic surgery. Morphine consumption and pain scores were comparable in the two studied groups. Propacetamol is as effective as ketorolac and has an excellent tolerability af ter gynecolo gic surgery.