ANESTHESIA & ANALGESIA - IARS

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ANESTH ANALG ABSTRACTS 2004; 98; S-1–S-282 S-3 A DOUBLE MASKED PROSPECTIVE COMPARISON OF ROFECOXIB VERSUS KETOTOLAC FOR ACUTE POSTOPERATIVE PAIN AUTHORS: J. Kim, A. Bekker, O. Sherman, G. Cuff, A. Lebovits, M. Wajda; AFFILIATION: New York University Medical Center, New York, NY. INTRODUCTION. Ketorolac is a commonly used agent to reduce postoperative pain and inflammation in patients who undergo ambulatory orthopedic surgery. However, there is often reluctance to use this drug as a perioperative analgesic because of the potential for gastrointestinal injury and platelet deactivation. Rofecoxib is a selective COX-2 inhibitor with fewer side effects than non-selective NSAIDs (i.e. ketorolac). The aim of this study is to examine whether rofecoxib provides pain relief comparable to ketorolac in patients undergoing arthroscopic knee surgery. METHODS. With IRB approval, 30 consented ASA I-III patients scheduled for knee arthroscopy were randomly assigned to receive either ketorolac IV 30 mg at the end of the case or rofecoxib 50 mg PO prior to surgery. In addition, patients in the ketorolac group received placebo pill PO preoperatively while patients in the rofecoxib group received a saline injection at the end of the procedure. Fentanyl (1.4 mcg/kg), midazolam (0.07 mg/kg), and propofol (70 mcg/kg/min) were used for intraoperative sedation. Additionally, the surgeon infiltrated the knee with bupivacaine at the end of the procedure. The outcome measures were pain scores (verbal analog scale (VbAS)) and Percocet R use (oxycodone/acetaminophen 5/325 mg) assessed in the postoperative care unit, 6 hours and 24 hours after discharge. Additional endpoints included patient satisfaction and occurrence of side effects. Data were analyzed using independent samples t-tests for continuous variables or chi-squares test for categorical variables. P < .05 was considered significant. RESULTS. The two groups were comparable with regard to age, intraoperative medication use, and duration of surgery. There was no difference either in pain scores or Percocet R use in the PACU or 24 S-4 EVALUATION OF THE EFFICACY OF ROFECOXIB IN THE PERIOPERATIVE MANAGEMENT OF PAIN FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY AUTHORS: S. I. Serban, S. Reuben, W. Joshi, W. Prescott, H. Maciolek; AFFILIATION: Baystate Medical Center, Springfield, MA. INTRODUCTION: Recently the COX-2 inhibitor rofecoxib has become available for the management of postoperative pain. The perioperative administration of rofecoxib has demonstrated a significant opioid sparing effect following orthopedic (1,2), abdominal (3), and ENT (4) surgeries. Rofecoxib has also resulted in improved postoperative pulmonary function when administered prior to abdominal surgery(3). The preoperative administration of rofecoxib may be safer than standard NSAIDs since it has no effect on platelet aggregation. METHODS: After IRB approval, 31 patients undergoing elective laparoscopic cholecystectomy were included in this randomized, double-blinded study. Patients received either placebo (n=15) or rofecoxib 50 mg (n=16) one hour prior to surgery. Baseline pulmonary function tests (FEV-1 and FVC) were obtained. Postoperatively, patients received PCA morphine. Pain scores and morphine use were recorded. In addition, side effects including nausea, vomiting, itching and shoulder pain were recorded. RESULTS: There were no differences in patients demographics, length of surgery, intraoperative fentanyl use and preoperative FEV-1 and FVC between the two groups. There were no statistical differences between the groups regarding VAS pain scores in the PACU and 3 hours postoperatively. There was a significant difference (p
S-5 S-6 ABSTRACTS ANESTH ANALG 2004; 98; S-1–S-282 S-5 THE SEDATION WITH PROPOFOL THIOPENTAL MIXTURE VERSUS MIDAZOLAM DURING LOCAL <strong>ANESTHESIA</strong> AUTHORS: P. P. Nicolcescu, I. P. Georgescu, A. I. Georgescu, I. M. Sosea, V. N. Calina, F. O. Purcaru; AFFILIATION: University Hospital no1 Craiova, Craiova, Romania. INTRODUCTION: We compared the clinical efficacy and recovery characteristic during plastic surgery under for sedation with Propofol Thiopental mixture versus midazolam during plastic surgery under local anesthesia. METHODS: After approval by the ethics committee and obtained written informed consent we studied 80 patients (47 male) ASA physical status I-II aged 18- 50 years who were undergoing plastic surgery procedures with local anesthesia. The patients were randomized assigned in two equal groups A and B. No patients were premedicated. The patient’s level of sedation was assessed by a blinded observer using the Observer’s Assessment of Alertness/Sedation Scale. Five minutes before the surgeons begin infiltrating the operative field with Ropivacaine. The patients including in group A received 2.5 ml bolus iv followed by 15 ml/h Propofol Thiopental mixture (1g Thiopental diluted with 20 ml Propofol 10%) and the patients including in group B received 0.05mg/kg midazolam followed by continuos infusion with 1.5microg/kg/min. Vital signs and sedation scores were subsequently recorded at 5 min intervals until the end of procedure. Cognitive and psychomotor function was evaluated with an original questioner based on TEA test and Bender test. For statistical analysis we used Wilcoxon test and student t test p 5), more fatigued (5.4±3.1 vs. 3.2 ±3.0; 57% vs. 19.6 % having a value of >5), with less energy (6.9 ±2.5 vs. 4.3 ±2.8; 49% vs. 12% having a value
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