Etoricoxib with Flavoxate for reducing Morphine requirement after transurethral prostatectomy : a factorial randomized controlled trial

Abstract

Objective: To compare the efficacy of etoricoxib, flavoxate or both with a placebo for reducing morphine requirement during the first 24 hours after transurethral prostatectomy (TURP). Design: A factorial randomized double-blinded controlled trial. Setting: Faculty of Medicine Siriraj Hospital, Mahidol University. Methods: Ninety-six patients were included in this study. They were randomly allocated into 4 groups. Group 1 received placebo, Group 2 received etoricoxib, Group 3 received flavoxate, and Group 4 received both etoricoxib and flavoxate. During the first 24 hours postoperative period, all patients received intravenous morphine by means of patient controlled analgesia (PCA). The total amount of morphine requirement, pain assessment by numeric rating scale (NRS), and adverse effects were recorded for 24 hours. Results: The mean 24-hour morphine usages were 16.1 ± 9.3, 6.0 ± 7.4, 7.46 ± 5.7 and 6.9 ± 6.5 mg in group 1, 2, 3, and 4 respectively which there was statistically significant different only between group 1 and the others (p <0.001). By using factorial design, patients who received etoricoxib or flavoxate required less morphine in 24 hours than those who didn't receive the treatment. But only patients in the etoricoxib group showed a statistically significant difference. There was no statistically significance in pain intensity among the 4 treatment groups at any time that the NRS was records. Conclusion: A single dose of etoricoxib or flavoxate administered preoperatively is as effective as the combination of both drugs in postoperative morphine usage after TURP.