Analgesic Efficacy and Opioid Saving Strategy of Etoricoxib (An Oral Cyclooxygenase 2 Selective Inhibitor) In Postoperative Pain Relief after Gynecological Laparotomy

Background & Objective: Non-opioid analgesics are often used to supplement opioids for the management of postoperative pain. This study examined the opioid-sparing effectiveness, analgesic efficacy and tolerability of preoperative administration of the oral cyclooxygenase 2 selective inhibitor, etoricoxib, in gynecological laparotomies. Method: 60 patients ASA physical status 1&11 were randomly assigned into 2 equal groups (A&B), 30 patients each. All patients received Midazolam 10-15 mg orally on call to OR, only group A received tablet Etoricoxib 120 mg 1 hour before surgery. In the OR, all patients started crystalloid infusion, standard monitoring. Induction of anaesthesia was achieved with Fentanyl 2 ىg/kg, propofol 2 mg/kg and rocuronium 0.6 mg/kg. Anaethesia was maintained with Sevoflurane 1-2% in nitrous oxide achieved maintenance and oxygen (ratio 2:1) with mechanical ventilation to maintain end expiratory CO2 between 35-40 mmHg. After tracheal extubation, patients were transferred to the PACU where postoperative analgesia was provided by PCA morphine. SpO2, HR, MAP, VAS, Sedation score, total amount of morphine and Ondansteron consumption in the first 24 hours after surgery were recorded and analyzed. Results: There were no significant difference between the two treatment groups as regards the demographic data and the base line haemodynamic parameters. In the postoperative period, SpO2 in group A was significantly higher than in group B, and there was no significant difference between the two treatment groups as regard HR and MAP. VAS and Sedation score were significantly higher in group B than in group A. Total morphine consumption was 36.3% less in group A in comparison to group B, with a significantly less Ondansteron consumption in group A in comparison to group B. Conclusion: Administration of etoricoxib with PCA morphine resulted in significantly improved postoperative analgesic management as defined by reduction in opioid requirements, lower pain scores and less opioid side effects.