Evid Based Nurs 14:24-25 doi:10.1136/ebn1119
  • Pain management
  • Systematic review of randomised controlled trials

Only a small reduction in morphine use with adding NSAIDs, paracetamol or COX-2 inhibitors to patient controlled morphine in the 24 h after major surgery

  1. Hance Clarke
  1. Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Hance Clarke
    Toronto General Hospital, Eaton N. 3EB – 317, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; hance.clarke{at}

Commentary on:

Objectives and overview

The objective of this study was to determine which class of non-opioid analgesics – paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2) inhibitors – was the most effective at reducing intravenous. Morphine consumption and opioid related adverse events following major surgery.

The authors conducted a systematic review which combined a review by Elia and colleagues1 with the results of 20 new studies. All studies were randomised controlled trials (RCTs) that reported postoperative 24 h cumulative morphine consumption. The other outcomes of interest were morphine-related adverse events and postoperative bleeding. With the aid of a biostatistician, the authors report a series of mixed treatment comparisons.

Results and major conclusions

The major finding of this article was that compared to placebo (45.26 mg) NSAIDs or COX-2 inhibitors reduced by 10.9 mg, and paracetamol reduced by 6.3 mg, 24 h postoperative …

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