Preoperative oral administration of dextromethorphan and/or etoricoxib for pain management after laparoscopic surgery

Abstract

Objectives: To compare the efficacy of pain relief after laparoscopic surgery between the patients taking preoperative oral dextromethorphan (DM), etoricoxib, and their combination. Design: Randomized double-blind controlled trial. Setting: King Chulalongkorn Memorial Hospital which is a 1500 – bed tertiary care center. Research Methodology: Sixty six patients, aged between 18-65 years with ASA physical status I-II undergoing elective laparoscopic surgery under general anesthesia (GA), were randomly allocated into three groups. Group D received DM 60 mg orally, group E received etoricoxib 120 mg and group DE received the combination of DM 60 mg and etoricoxib 120 mg orally. All patients were given the same GA protocol and received IV morphine patient-controlled analgesia (PCA) will identical setting for 24 hours. Efficacy outcomes including the amount of morphine used during 2, 6, 12, and 24 hours and numerical pain rating scale (NRS) at rest and on coughing at 0, 2, 6, and 24 hours after surgery were recorded and analyzed. In addition adverse events were also measured and analyzed. Results: Mean total morphine used during 24 hours after surgery (14.6, 13.3, and 10.9 mg in D, E, and DE group respectively), mean total morphine used per body weight during 24 hours (0.26, 0.21 and 0.18 mg/kg in D, E, and DE group respectively), NRS at rest and on coughing in three groups were not statistically different. The overall incidence of shoulder pain was 40.9% There was no statistically significant difference in side effects among the groups except dizziness (40.9%, 9,1% and 27.3% in D, E, and DE group respectively) (p=0.032). Conclusion: DM 60 mg, etoricoxib 120 mg, and their combination as an oral medication before laparoscopic surgery did not alter the 24-hour postoperative morphine consumption significantly. NRS at rest, NRS on coughing and other adverse events were not statistically different except dizziness which was less in etoricoxib group.