[Randomized, double-blind study with ketoprofen in gynecologic patients. Preemptive analgesia study following the Brevik-Stubhaug design]

Abstract

Study objective: The clinical effect of ketoprofen is based not only on the inhibition of prostaglandin synthesis. Ketoprofen also acts through kynurenic acid as a central antagonist on the NMDA receptor. Due to this central analgesic mechanism of ketoprofen, we expected an analgesic preemptive effect. This study was carried out following the Breivik/Stubhaug preemptive effect study design.

Methods: In 81 patients scheduled for gynaecological surgery a randomized double-blind study was performed. Three groups were studied: Group I received preoperative ketoprofen 100 mg i.v., 12 mg/h during surgery and for 48 hours afterwards. Group II received 100 mg ketoprofen as a bolus injection before the end of surgery, thereafter 12 mg/h ketoprofen continuously for 48 hours. Group III received a placebo during surgery and for 48 hours after surgery. The effects were measured postoperatively using a visual analog scale (VAS; at rest and on exertion) and the total analgesic consumption (PCA piritramide) within the first 48 hours after surgery. Furthermore, the time to first analgesic request was recorded. The vital signs and side effects were documented.

Results: The time to first analgesic request in group I was significantly longer than in groups II and III. In addition, the cumulative postoperative analgesic consumption during the first 24 hours after surgery was significantly lower in group I than in group III. Furthermore, the combination of an opioid with a non-opioid led to a lower pain score (VAS) at rest and on exertion.

Conclusions: We showed a preemptive effect with ketoprofen, which was expressed significantly both in terms of the time to first analgesic request and by the lower analgesic consumption in the first 24 hours after surgery.