H Beloeil1, P Albaladejo2, A Sion3, M Durand2, V Martinez4, S Lasocki5, E Futier6, D Verzili7, V Minville8, C Fessenmeyer9, A Belbachir10, F Aubrun11, A Renault12, E Bellissant12. 1. Univ Rennes, Inserm, INRA, Centre Hospitalier Universitaire de Rennes, Rennes, France. Electronic address: helene.beloeil@chu-rennes.fr. 2. Department of Anaesthesia and Critical Care Medicine, Grenoble-Alps University Hospital, Grenoble, France. 3. Univ Rennes, Inserm, INRA, Centre Hospitalier Universitaire de Rennes, Rennes, France. 4. Service d'anesthésie, Hôpital Raymond Poincaré, Paris, France; Inserm U987, Hôpital Ambroise Paré, Centre D'évaluation et de Traitement de la Douleur, Boulogne-Billancourt, France; Université Versailles Saint-Quentin, Saint-Quentin-en-Yvelines, France. 5. Université d'Angers, CHU Angers, Département Anesthésie-Réanimation, Angers, France. 6. Université Clermont Auvergne, CNRS, Inserm, Centre Hospitalier Universitaire Clermont-Ferrand, Département de Médecine Périopératoire, Clermont-Ferrand, France. 7. Intensive Care Unit and Transplantation, Critical Care and Anesthesia Department (DAR-B), Hôpital Saint-Éloi, CHU de Montpellier, Inserm U1046, CNRS, UMR, Montpellier, France. 8. Département d'Anesthésie et de Réanimation, Centre Hospitalier et Universitaire de Toulouse1, Toulouse Cedex, France. 9. Department of Anesthesia and Critical Care Medicine, Bicêtre University Hospital, Paris, France. 10. Department of Anesthesia and Critical Care Medicine, Cochin University Hospital, Paris, France. 11. Department of Anaesthesia and Intensive Care Medicine, Croix Rousse Hospital, Claude Bernard University Lyon 1, Lyon, France. 12. Centre Hospitalier Universitaire de Rennes, Inserm, CIC, Rennes, France.
Abstract
BACKGROUND: Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAs-paracetamol (P), nefopam (N), and ketoprofen (K)-for postoperative analgesia. METHODS:Patients from 10 hospitals were randomised to one of eight groups: control (C) received saline as placebo, P, N, K, PN, PK, NK, and PNK. Treatments were given intravenously four times a day during the first 48 h after surgery, and morphine patient-controlled analgesia was used as rescue analgesia. The outcome measures were morphine consumption, pain scores, and morphine-related side-effects evaluated 24 and 48 h after surgery. RESULTS:Two hundred and thirty-seven patients undergoing a major surgical procedure were included between July 2013 and November 2016. Despite a failure to reach a calculated sample size, 24 h morphine consumption [median (inter-quartile range)] was significantly reduced in the PNK group [5 (1-11) mg] compared with either the C group [27 (11-42) mg; P<0.05] or the N group [21 (12-29) mg; P<0.05]. Results were similar 48 h after surgery. Patients experienced less pain in the PNK group compared with the C, N, and P groups. No difference was observed in the incidence of morphine-related side-effects. CONCLUSIONS: Combining three NOAs with morphine allows a significant morphine sparing for 48 h after surgery associated with superior analgesia the first 24 h when compared with morphine alone. CLINICAL TRIAL REGISTRATION: EudraCT: 2012-004219-30; NCT01882530.
RCT Entities:
BACKGROUND: Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAs-paracetamol (P), nefopam (N), and ketoprofen (K)-for postoperative analgesia. METHODS:Patients from 10 hospitals were randomised to one of eight groups: control (C) received saline as placebo, P, N, K, PN, PK, NK, and PNK. Treatments were given intravenously four times a day during the first 48 h after surgery, and morphinepatient-controlled analgesia was used as rescue analgesia. The outcome measures were morphine consumption, pain scores, and morphine-related side-effects evaluated 24 and 48 h after surgery. RESULTS: Two hundred and thirty-seven patients undergoing a major surgical procedure were included between July 2013 and November 2016. Despite a failure to reach a calculated sample size, 24 h morphine consumption [median (inter-quartile range)] was significantly reduced in the PNK group [5 (1-11) mg] compared with either the C group [27 (11-42) mg; P<0.05] or the N group [21 (12-29) mg; P<0.05]. Results were similar 48 h after surgery. Patients experienced less pain in the PNK group compared with the C, N, and P groups. No difference was observed in the incidence of morphine-related side-effects. CONCLUSIONS: Combining three NOAs with morphine allows a significant morphine sparing for 48 h after surgery associated with superior analgesia the first 24 h when compared with morphine alone. CLINICAL TRIAL REGISTRATION: EudraCT: 2012-004219-30; NCT01882530.
Authors: Erik Stenberg; Luiz Fernando Dos Reis Falcão; Mary O'Kane; Ronald Liem; Dimitri J Pournaras; Paulina Salminen; Richard D Urman; Anupama Wadhwa; Ulf O Gustafsson; Anders Thorell Journal: World J Surg Date: 2022-01-04 Impact factor: 3.352
Authors: Min Jung Kim; Ji Yeon Kim; Yun Hee Lim; Sung Jun Hong; Jae Hun Jeong; Hey Ran Choi; Sun Kyung Park; Jung Eun Kim; Min Ki Lee; Jae Hun Kim Journal: Korean J Pain Date: 2022-10-01