A Comparison of Rectal Indomethacin with Placebo for Pain Relief following Spinal Surgery

Abstract

Rectal indomethacin was compared with placebo in a randomised, double-blind study of 100 patients undergoing spinal surgery, in which postoperative pain scores, pethidine, diazepam and metoclopramide consumption, bleeding time, blood loss and oral fluid and food tolerance were measured. Side-effects of indomethacin and pethidine were compared in the two groups. In the indomethacin group, pain scores were significantly less for all measurements made during the first three postoperative days, pethidine and diazepam consumption were significantly less on all three days, bleeding time was significantly increased, although still within the clinically normal range, intraoperative and postoperative blood losses were not significantly affected, coagulation was not significantly impaired as assessed clinically, patients tolerated oral feeding significantly earlier, there was no significant increase in the incidence of gastro-intestinal side-effects except for diarrhoea, and there was no significant reduction in the incidence of side-effects associated with the use of pethidine.

Effect of Preoperative Rectal Indomethacin on Postoperative Pain Reduction After Open Cholecystectomy

“…Also, because administration of the drugs was continued after the surgery, the preventive effect on postoperative pain was not a reliable finding. [13][14][15][16][17][18] In addition, the rectal route has been underused in adults in the perianesthesia setting; yet it is an excellent option for the patients, because so many are unable to take oral medications. Also, although the reduced availability of parenteral nonopioids should be considered, parenteral nonopioids are more expensive and have a higher rate of complication, and many surgeons refuse to use them.…”

Beyond Opioid Patient-Controlled Analgesia

“…46 Whereas indomethacin suppositories were associated with less dyspepsia and an earlier tolerance of solid food, they increased the incidence of diarrhea. 50 Importantly, none of the trials reported increased bleeding.…”

“…A variety of compounds were used. One trial did not specify the type of analgesic, 38 2 used piritramide, 31,37 1 used pethidine, 50 and the remainder used morphine for rescue analgesia or converted the opioids used to morphine equivalents. 29,32Y35,41,42,44Y48,51 Of the 13 trials that analyzed cumulative morphine consumption at 24 hrs, only 6 reported reduced morphine consumption in patients receiving NSAIDs.…”

“…32Y34,42,44,53 Rescue analgesic consumption at 48 hrs was reported in 8 studies. 30,35,37,38,41,44,45,50 Of the 5 trials that reported cumulative morphine consumption, 30,35,41,44,45 4 found that use of NSAIDs was associated with decreased morphine consumption. 30,41,44,45 The NSAIDs used were parecoxib, ketorolac, and a combination of ketoprofen and paracetamol.…”

“…In the remaining trials, either the rescue analgesic used was not specified, 38 or analgesics other than morphine were used. 37,50 Adverse Effects…”