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
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Correspondence to Hance Clarke
Toronto General Hospital, Eaton N. 3EB – 317, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada;
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 morphine use. Multiple analyses and tables were presented which postulated that non-opioid adjuncts were marginally beneficial in reducing adverse events and bleeding outcomes. The authors conclude that taking the evidence as a whole (ie, the small …