Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery

Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) are used as analges ic in postoperative pain to reduce opioid side effects, such as drowsiness and nausea. However, NSAIDs have not been used extensively in cardiac surgi cal patients due to the fear of untoward effects on gastric, renal, and coa gulation parameters. This study will evaluate the efficacy and safety of th ree NSAIDs for pain control in CABG patients. Methods: One hundred and twenty patients scheduled for elective CABG surger y were enrolled in randomized, double blind, controlled study. Standardized fast track cardiac anesthesia was used. One dose of drug (75 mg diclofenac , 100 mg ketoprofen, 100 mg indomethacin, or placebo) was given pr one hour before tracheal extubation and a second dose 12 hr later. Pain was treated with morphine iv and acetaminophen po. Visual analogue pain scores were re corded at baseline. 3, 6, 12 and 24 hr after the first dose of drug. Results: There were no differences among the groups in pain scores. Only pa tients who received diclofenac required less morphine than patients in the control group (P < 0.05). When the total amounts of pain medications were c omputed to morphine equivalents, only patients in the diclofenac group rece ived less pain medications than the placebo group (P < 0.05). Proportion of patients with postoperative increase of creatinine level (20% and over) di d not differ between placebo and drug groups. Conclusion: Non-steroidal anti-inflammatory drugs may be used for analgesia management post CABG surgery in selected patients. Diclofenac appears to h ave the best analgesic effects by reducing the morphine and other analgesic requirement postoperatively.