2004 - International Anesthesia Research Society

195 Pages·2004·4.23 MB·English

ANESTHESIA
&
ANALGESIA
Journal of the International Anesthesia Research Society, the Society of Cardiovascular Anesthesiologists,
the Society for Pediatric Anesthesia, the Society for Ambulatory Anesthesia,
the International Society for Anaesthetic Pharmacology, and the Society for Technology in Anesthesia
Abstracts of Posters
Presented at the
International Anesthesia Research Society
78th Clinical and Scientific Congress
Tampa, FL
March 27-31, 2004
This Supplement will Appear On-Line Only
ISSN 0003-2999 Volume 98, Number 2S, February 2004 Supplement to Anesthesia & Analgesia
®
ANESTHESIA & ANALGESIA
Journal of the International Anesthesia Research Society®, the Society of Cardiovascular Anesthesiologists, the
Society for Pediatric Anesthesia, the Society for Ambulatory Anesthesia,
the International Society for Anaesthetic Pharmacology, and the Society for Technology in Anesthesia
Abstracts of Posters
Presented at the
International Anesthesia Research Society
78th Clinical and Scientific Congress
Tampa, FL
March 27-31, 2004
Abstracts (by category):
Ambulatory Anesthesia S-1 – S-14
Circulation - Basic Science S-15 – S-29
Circulation - Clinical S-30 – S-42
Critical Care and Trauma S-43 – S-55
Economics; Education and Patient Safety S-56 – S-83
Equipment/Monitoring S-84 – S-126
Liver S-127 – S-134
Neuroanesthesia S-135 – S-144
Obstetric Anesthesia S-145 – S-154
Pain - Basic Science S-155 – S-167
Pain - Clinical, Acute S-168 – S-192
Pain - Clinical, Chronic S-193 – S-202
Pediatric Anesthesia S-203 – S-223
Pharmacology - Basic Science S-224 – S-243
Pharmacology - Clinical S-244 – S-270
Regional S-271 – S-282
Author Index: S-283 – S-292
Subject Index: S-293 – S-302
Authors submitting abstracts have certified that if human research is reported, approval by an institutional human research committee
has been obtained, or if animal research is reported, the usual standards and guidelines for animal care have been followed. Material pub-
lished in this supplement has not undergone review by the Editorial Board of Anesthesia and Analgesia. Any of the abstracts in this sup-
plement may have been transmitted by the author to IARS in various forms of electronic medium. IARS has used its best efforts to receive
and format electronic submissions for publication in this supplement but has not reviewed each abstract for the purpose of textual error
correction and is not liable in any way for any formatting, textual or grammatical error or inaccuracy.
©2004 by the International Anesthesia Research Society
IARS 78th Clinical and Scientific Congress
Abstract Presenter Presentation Schedule
Ambulatory Anesthesia Critical Care and Trauma
(S-1) Hamza, M.A., Monday 8:00 (S-43) Wahlander, S., Monday 8:00
(S-2) Kranke, P., Monday 8:00 (S-44) Urban, M.K., Monday 8:00
(S-3) Bekker, A., Monday 8:00 (S-45) Huang, Z., Monday 8:00
(S-4) Serban, S.I., Monday 8:00 (S-46) Westphal, M., Monday 8:00
(S-5) Nicolcescu, P.P., Monday 8:00 (S-47) Agarwal, A., Monday 8:00
(S-6) Larijani, G.E., Monday 8:00 (S-48) Johnson, K., Monday 8:00
(S-7) Larijani, G.E., Monday 8:00 (S-49) Driessen, B., Monday 8:00
(S-8) Kamel, H.H., Monday 8:00 (S-50) MacKenzie, C., Monday 8:00
(S-9) Tang, J., Monday 8:00 (S-51) Shang, Y., Monday 8:00
(S-10) Iohom, G., Monday 8:00 (S-52) Rollins, M.D., Monday 8:00
(S-11) Kaminoh, Y., Monday 8:00 (S-53) Sabharwal, V., Monday 8:00
(S-12) Hamza, M.A., Monday 8:00 (S-54) Spies, C., Monday 8:00
(S-13) Macario, A., Monday 8:00 (S-55) Cronin, A.J., Sunday 3:00
(S-14) Kredel, M., Monday 8:00 (Research Awards Panel)
Circulation - Basic Science Economics, Education and Patient Safety
(S-15) Naik, B., Monday 8:00 (S-56) Lewis, A., Sunday 8:00
(S-16) Willert, J., Monday 8:00 (S-57) Vohra, P.D., Sunday 8:00
(S-17) Kaye, A.D., Monday 8:00 (S-58) Weinger, M.B., Sunday 8:00
(S-18) Gupta, D.K., Monday 8:00 (S-59) Yarmush, J.M., Sunday 8:00
(S-19) Loepke, A.W., Monday 8:00 (S-60) Barach, P., Sunday 8:00
(S-20) Rashid, M., Monday 8:00 (S-61) Irita, K., Sunday 8:00
(S-21) Kold, A.E., Monday 8:00 (S-62) Overdyk, F.J., Sunday 8:00
(S-22) Kehl, F., Monday 8:00 (S-63) Hanna, M.N., Sunday 8:00
(S-23) Mueller, R.A., Monday 8:00 (S-64) Sidi, A., Sunday 8:00
(S-24) Tse, J., Monday 8:00 (S-65) Overdyk, F.J., Sunday 8:00
(S-25) Howie, M.B., Monday 8:00 (S-66) Carter, T.E., Sunday 8:00
(S-26) Damron, D.S., Monday 8:00 (S-67) O'Hara, J.F., Sunday 8:00
(S-27) Damron, D.S., Monday 8:00 (S-68) Kratz, R.D., Sunday 8:00
(S-28) Damron, D.S., Monday 8:00 (S-69) Kratz, R.D., Sunday 8:00
(S-29) Deem, S., Sunday 3:00 (S-70) Girard, T., Tuesday 8:00
(Research Awards Panel) (S-71) Gaba, V.K., Tuesday 8:00
(S-72) Monk, T.G., Tuesday 8:00
(S-73) Szenohradszky, J., Tuesday 8:00
Circulation - Clinical (S-74) Nicolcescu, P.P., Tuesday 8:00
(S-75) Benarjee, A., Tuesday 8:00
(S-30) Nonogaki, M., Sunday 8:00
(S-76) Jahan, A., Tuesday 8:00
(S-31) Wirtz, S.P., Sunday 8:00
(S-77) Strum, D.P., Tuesday 8:00
(S-32) Isetta, C.J., Sunday 8:00
(S-78) Strum, D.P., Tuesday 8:00
(S-33) Shore-Lesserson, L., Sunday 8:00
(S-79) Joshi, G.P., Tuesday 8:00
(S-34) Murphy, G.S., Sunday 8:00
(S-80) Frasco, P.E., Tuesday 8:00
(S-35) Donahue, B.S., Sunday 8:00
(S-81) Kranke, P., Tuesday 8:00
(S-36) Fu, E.S., Sunday 8:00
(S-82) Kranke, P., Tuesday 8:00
(S-37) Wirtz, S.P., Sunday 8:00
(S-83) Apfel, C.C., Tuesday 8:00
(S-38) Skubas, N., Sunday 8:00
(S-39) Danilov, S.M., Sunday 8:00
(S-40) Wang, S., Sunday 8:00
(S-41) Ito, S., Sunday 8:00
(S-42) Subramaniam, B., Sunday 8:00
IARS 78th Clinical and Scientific Congress
Abstract Presenter Presentation Schedule
(S-133) Yorozu, T., Tuesday 8:00
Equipment & Monitoring (S-134) Miecznikowski, R., Tuesday 8:00
(S-84) Gagnon, C.S., Sunday 8:00
(S-85) Diemunsch, P.A., Sunday 8:00
(S-86) Yamakage, M., Sunday 8:00 Neuroanesthesia
(S-87) Lichtenthal, P.R., Sunday 8:00
(S-135) Patel, P., Sunday 8:00
(S-88) Glick, D.B., Sunday 8:00 (S-136) Alkire, M.T., Sunday 8:00
(S-89) Otero, P.E., Sunday 8:00
(S-137) Hare, G.M., Sunday 8:00
(S-90) Otero, P.E., Sunday 8:00 (S-138) Wendling, W.W., Sunday 8:00
(S-91) Janelle, G.M., Monday 8:00
(S-139) Sturaitis, M.K., Sunday 8:00
(S-92) Redford, D.T., Monday 8:00 (S-140) Smith, M., Tuesday 8:00
(S-93) Redford, D.T., Monday 8:00
(S-141) Hoffman, W.E., Tuesday 8:00
(S-94) Redford, D.T., Monday 8:00 (S-142) Liu, E.H., Tuesday 8:00
(S-95) Fleisher, L.A., Monday 8:00
(S-143) Kamel, I.R., Tuesday 8:00
(S-96) Dworschak, M., Monday 8:00 (S-144) Toleikis, J.R., Tuesday 8:00
(S-97) Oshiro, M., Monday 8:00
(S-98) Tong, J.L., Monday 8:00
(S-99) Lallo, A., Monday 8:00
Obstetric Anesthesia
(S-100) Patel, A., Monday 8:00
(S-145) Euliano, T.Y., Monday 8:00
(S-101) Song, D., Monday 8:00
(S-146) Stack, K.E., Monday 8:00
(S-102) Lieberman, N., Monday 8:00
(S-147) Ramanathan, S., Monday 8:00
(S-103) Kling, J.C., Monday 8:00
(S-148) Goodman, E.J., Monday 8:00
(S-104) Hino, H., Monday 8:00
(S-149) Ginsberg, S., Monday 8:00
(S-105) O'Connor, C.J., Monday 8:00
(S-150) Lim, Y., Monday 8:00
(S-106) Yajima, S., Monday 8:00
(S-151) Sah, N., Monday 8:00
(S-107) Lu, Z., Monday 8:00
(S-152) Flood, P., Monday 8:00
(S-108) Soto, R.G., Monday 8:00
(S-153) Cohen, S., Monday 8:00
(S-109) Schweiger, J.W., Monday 8:00
(S-154) Ranasinghe, J., Monday 8:00
(S-110) Hamza, M.A., Monday 8:00
(S-111) Rosenbaum, A., Monday 8:00
(S-112) Rosenbaum, A., Monday 8:00
Pain - Basic Science
(S-113) Rosenbaum, A., Monday 8:00
(S-114) Xuebing, X., Tuesday 8:00 (S-155) Flood, P., Sunday 8:00
(S-115) Kakinohana, M., Tuesday 8:00 (S-156) Kroin, J.S., Sunday 8:00
(S-116) Belda, J., Tuesday 8:00 (S-157) Kroin, J.S., Sunday 8:00
(S-117) Fan, Q., Tuesday 8:00 (S-158) Kroin, J.S., Sunday 8:00
(S-118) Zhang, Y., Tuesday 8:00 (S-159) Kroin, J.S., Sunday 8:00
(S-119) Liu, E.H., Tuesday 8:00 (S-160) Buvanendran, A., Sunday 8:00
(S-120) Singh, H., Tuesday 8:00 (S-161) Finkel, J.C., Sunday 8:00
(S-121) Terasako, K., Tuesday 8:00 (S-162) Lu, Y., Sunday 8:00
(S-122) Soto, R.G., Tuesday 8:00 (S-163) Nishiyama, T., Sunday 8:00
(S-123) Schraag, S., Tuesday 8:00 (S-164) Nishiyama, T., Sunday 8:00
(S-124) Tang, J., Tuesday 8:00 (S-165) Kraft, B., Sunday 8:00
(S-125) Tang, J., Tuesday 8:00 (S-166) Schumacher, M.A., Sunday 3:00
(S-126) Chan, M.T., Tuesday 8:00 (Research Awards Panel)
(S-167) Schaefer, M., Sunday 3:00
(Research Awards Panel)
Liver
(S-127) Aggarwal, S., Tuesday 8:00
Pain - Clinical, Acute
(S-128) Strum, E.M., Tuesday 8:00
(S-129) Auler, L., Tuesday 8:00 (S-168) Ellis, J.E., Monday 8:00
(S-130) Aggarwal, S., Tuesday 8:00 (S-169) Sickmann, K., Monday 8:00
(S-131) Neelakanta, G., Tuesday 8:00 (S-170) Hall, R.H., Monday 8:00
(S-132) Wang, Y.L., Tuesday 8:00 (S-171) Subramaniam, K., Monday 8:00
IARS 78th Clinical and Scientific Congress
Abstract Presenter Presentation Schedule
(S-172) Larijani, G.E., Monday 8:00 (S-220) Bryan, Y.F., Tuesday 8:00
(S-173) Kumagai, K., Monday 8:00 (S-221) Messieha, Z.S., Tuesday 8:00
(S-174) Maroof, M., Monday 8:00 (S-222) Sun, L.S., Tuesday 8:00
(S-175) Latasch, L., Monday 8:00 (S-223) Leyvi, G., Tuesday 8:00
(S-176) Latasch, L., Monday 8:00
(S-177) Shah, S.M., Monday 8:00
(S-178) Buvanendran, A., Monday 8:00 Pharmacology-Basic Science
(S-179) Raps, F., Monday 8:00
(S-224) Novalija, E., Sunday 8:00
(S-180) Liu, W., Tuesday 8:00
(S-225) Kitamura, A., Sunday 8:00
(S-181) Buvanendran, A., Tuesday 8:00
(S-226) Archer, D.P., Sunday 8:00
(S-182) Visser, T., Tuesday 8:00
(S-227) Herroeder, S., Sunday 8:00
(S-183) Maslovsky, O.P., Tuesday 8:00
(S-228) Umeda, E., Sunday 8:00
(S-184) Aoki, T., Tuesday 8:00
(S-229) Archer, D.P., Sunday 8:00
(S-185) Chandralekha, C., Tuesday 8:00
(S-230) Whittington, R.A., Sunday 8:00
(S-186) Fan, Q., Tuesday 8:00
(S-231) Gingrich, K.J., Monday 8:00
(S-187) Sutherland, M., Tuesday 8:00
(S-232) Takei, T., Monday 8:00
(S-188) Sutherland, M.A., Tuesday 8:00
(S-233) Murphy, P.M., Monday 8:00
(S-189) Ono, K., Tuesday 8:00
(S-234) Kaminoh, Y., Monday 8:00
(S-190) Schraag, S., Tuesday 8:00
(S-235) Buvanendran, A., Monday 8:00
(S-191) Dabir, S., Tuesday 8:00
(S-236) Kroin, J.S., Monday 8:00
(S-192) Yamaguchi, K., Tuesday 8:00
(S-237) Kroin, J.S., Monday 8:00
(S-238) Li, D., Tuesday 8:00
(S-239) Eleveld, D.J., Tuesday 8:00
Pain - Clinical, Chronic
(S-240) Lee, Y., Tuesday 8:00
(S-193) Cope, D.K., Monday 8:00 (S-241) Lee, C., Tuesday 8:00
(S-194) Huang, J.J., Monday 8:00 (S-242) Bhatt, S.B., Tuesday 8:00
(S-195) Lirk, P., Monday 8:00 (S-243) Sunaga, H., Tuesday 8:00
(S-196) Sloan, P.A., Monday 8:00
(S-197) Sloan, P.A., Monday 8:00
(S-198) Moric, M., Tuesday 8:00 Pharmacology-Clinical
(S-199) Buvanendran, A., Tuesday 8:00
(S-244) Michaud, G., Sunday 8:00
(S-200) Goldberg, M.E., Tuesday 8:00
(S-245) Trager, G., Sunday 8:00
(S-201) Yuan, C., Tuesday 8:00
(S-246) Michaud, G., Sunday 8:00
(S-202) Spacek, A., Tuesday 8:00
(S-247) Spacek, A., Sunday 8:00
(S-248) Takagi, S., Sunday 8:00
(S-249) Ruigt, G.S., Sunday 8:00
Pediatric Anesthesia
(S-250) Apfelbaum, J.L., Sunday 8:00
(S-203) Sun, L.S., Sunday 8:00 (S-251) Steinberg, D., Monday 8:00
(S-204) Sei, Y., Sunday 8:00 (S-252) Steinberg, D., Monday 8:00
(S-205) Whyte, S.D., Sunday 8:00 (S-253) Steinberg, D., Monday 8:00
(S-206) Choi, W., Sunday 8:00 (S-254) Steinberg, D., Monday 8:00
(S-207) Faberowski, L.W., Sunday 8:00 (S-255) Steinberg, D., Monday 8:00
(S-208) Nicolcescu, P.P., Sunday 8:00 (S-256) Lim, Y., Monday 8:00
(S-209) Weldon, B.C., Tuesday 8:00 (S-257) Horowitz, P.E., Tuesday 8:00
(S-210) Frandrup, C.J., Tuesday 8:00 (S-258) Song, D., Tuesday 8:00
(S-211) Sreevastava, D.K., Tuesday 8:00 (S-259) Song, D., Tuesday 8:00
(S-212) Sparks, J.W., Tuesday 8:00 (S-260) Mathews, D.M., Tuesday 8:00
(S-213) Radpay, B., Tuesday 8:00 (S-261) Engelhardt, T., Tuesday 8:00
(S-214) Glick, D.B., Tuesday 8:00 (S-262) Nicolcescu, P.P., Tuesday 8:00
(S-215) Walz, J.M., Tuesday 8:00 (S-263) Moller, D.H., Tuesday 8:00
(S-216) Verghese, S.T., Tuesday 8:00 (S-264) Moller, D.H., Tuesday 8:00
(S-217) Shinohara, Y., Tuesday 8:00 (S-265) Yamakage, M., Tuesday 8:00
(S-218) Bryan, Y.F., Tuesday 8:00 (S-266) Takasaki, Y., Tuesday 8:00
(S-219) Bryan, Y.F., Tuesday 8:00 (S-267) Zhang, Y., Tuesday 8:00
IARS 78th Clinical and Scientific Congress
Abstract Presenter Presentation Schedule
(S-268) Takada, M., Tuesday 8:00
(S-269) Song, D., Tuesday 8:00
(S-270) Kern, S.E., Sunday 3:00
(Research Awards Panel)
Regional
(S-271) McAllister, J.J., Sunday 8:00
(S-272) Greengrass, R.A., Sunday 8:00
(S-273) Takahashi, S., Sunday 8:00
(S-274) Williams, B.A., Sunday 8:00
(S-275) De Ruyter, M.L., Sunday 8:00
(S-276) Ishikawa, A., Tuesday 8:00
(S-277) Ma, M., Tuesday 8:00
(S-278) Groudine, S.B., Tuesday 8:00
(S-279) Kan, R.K., Tuesday 8:00
(S-280) Yoos, J.R., Tuesday 8:00
(S-281) Nicolcescu, P.P., Tuesday 8:00
(S-282)Schricker, T.P., Sunday 3:00
(Research Awards Panel)

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Ambulatory Anesthesia
S-1 ABSTRACTS ANESTH ANALG
S-2 2004; 98; S-1–S-282
S-1
COMPARATIVE EVALUATION OF CELECOXIB, RESULTS: Demographic data, intraoperative anesthetic dosages and
ROFECOXIB AND VALDECOXIB IN PREVENTING PAIN duration of anesthesia and surgery did not differ among the four study
AFTER AMBULATORY SURGERY groups. The postoperative pain scores, amount of pain rescue
medication, incidence of nausea, time to discharge home, and patient
AUTHORS: M. A. Hamza, K. Klein, P. F. White, L. Cox, O. Jaffer, satisfaction with their pain management are summarized in the
A. Recart; following table (* P<0.05):
AFFILIATION: UT Southwestern Medical Center at Dallas,
Cele- Rofe- Valde-
Dallas, TX. Placebo
coxib coxib coxib
(n=33)
INTRODUCTION: Non-opioid analgesics are commonly (n=34) (n=33) (n=33)
administered as part of a multimodal regimen for preventing pain after Max. pain score until discharge (0-
ambulatory surgery. The COX-2 specific inhibitors allegedly produce 7 (5-8) 4 (2-6) * 4 (2-5) * 4.5 (3-5) *
10)
comparable analgesia with less risk of platelet dysfunction, gastric
Postoperative fentanyl (g) 138±99 89±91 * 80±73 * 78±84 *
mucosa and renal tubular damage than the classical non-selective
NSAIDs (1). This randomized, double-blinded, placebo-controlled Nausea until discharge (n,%) 13, 40 8, 25 9, 28 9, 28
study compared the three available COX-2 inhibitors, celecoxib, Aldrete score of 10 (min) 60±22 48±14* 47±17* 48±16*
rofecoxib, and valdecoxib, to placebo with respect to their analgesic Home readiness (min) 166±57 138±39 142±54 143±53
efficacy when administered prior to surgery. Patient satisfaction at discharge (0-
METHODS: One hundred thirty three consenting outpatients 100) 83±17 94±8 * 97±5 * 93±9 *
undergoing otolaryngologic surgery were randomly assigned to receive Max. pain score at home (0-10) 5 (3-6) 3 (1-4) * 3 (0-4) * 3 (1-4) *
oral Vitamin C 500 mg (placebo), celecoxib 400 mg, rofecoxib 50 mg
Nausea at home (n, %) 9, 27 4, 12 3, 9 5, 15
or valdecoxib 40mg 15-45 min before the induction of anesthesia. The
Patient satisfaction at 24 h (0-100) 84±16 93±11 * 97±6 * 94±10 *
intraoperative medications were standardized in all four groups. A
second dose of the same medications were given with the dosage of DISCUSSION: Perioperative administration of oral celecoxib,
Vitamin C 250 mg, celecoxib 200 mg, rofecoxib 25 mg or valdecoxib rofecoxib, and valdecoxib were equally effective in reducing the
20 mg, on the morning of first postoperative day. Verbal rating pain postoperative pain and contributed to a significantly improved quality
scores (0=no pain to 10=worst pain), time from end of surgery to patient of recovery in outpatients undergoing otolaryngologic surgery.
achieving Aldrete score of 10 and discharge home criteria (home REFERENCES: (1) Anesth Analg. 2003;96:987-94
readiness), and incidences of nausea were assessed at regular time
intervals until patient discharge home. In addition, postoperative pain
medication and patient satisfaction with pain management (on a verbal
rating scale with 1 = highly dissatisfied to 100 = completely satisfied)
were assessed at the time of discharge home. A follow-up telephone call
was performed 24 h after surgery to assess postdischarge pain and
nausea, as well as the patient satisfaction with pain management. Data
were analyzed using ANOVA or Chi-square test, with p<0.05
considered statistically significant (mean±SD or median and IQR).
S-2
PATIENT SATISFACTION WITH ANALGESIA AND 1.21 – 2.16) or [8.3] (RR: 0.85; 955-CI: 0.75 – 0.97) and 50 (RR: 1.03;
SAFETY OF INJECTED PARECOXIB FOR POSTOPERATIVE 95%-CI: 0.89 – 1.18) for the comparisons versus placebo, morphine or
PAIN: A QUANTITATIVE SYSTEMATIC REVIEW ketorolac, respectively. Overall adverse effects for parecoxib 20mg and
40mg were not different from placebo, morphine or ketorolac.
AUTHORS: P. Kranke1, A. M. Morin2, N. Roewer1, L. H. Compared to placebo patients receiving parecoxib had significantly less
Eberhart2; headache (RR: 0.68; 95%-CI: 0.48 – 0.97) and fever (RR: 0.31; 95%-
AFFILIATION: 1University of Wuerzburg, Wuerzburg, CI: 0.21 – 0.46). The incidence of fever was similarly reduced
Germany, 2University of Marburg, Marburg, Germany. compared to morphine (RR: 0.27; 95%-CI: 0.12 – 0.62) and ketorolac
(RR: 0.15; 95%-CI: 0.07 – 0.33).
INTRODUCTION: In addition to opioid analgesics, nonsteroidal anti- DISCUSSION: Injected parecoxib significantly increased patient
inflammatory drugs have been established as useful adjuncts in the satisfaction with the analgesic regimen compared to placebo. There is a
management of postoperative pain. Parecoxib is the only parenterally tendency of parecoxib 40mg being more effective than 20mg without an
administered cyclo-oxygenase 2 selective inhibitor available so far. The increased incidence of side effects. Ketorolac and parecoxib are equally
aim of this systematic review was to evaluate efficacy and harm of effective. Considering the fact that the intraoperative use of parecoxib
parecoxib by means of patient satisfaction with the applied analgesic might be safer compared to ketorolac, parecoxib has the potential to
regimen and the observed incidence of adverse effects. become the non-opioid analgesic of choice for the perioperative period
METHODS: We performed a systematic search (MEDLINE, if oral medication is contraindicated.
EMBASE, CENTRAL, Science Citation Index, up to June 2003) for
full reports of randomized comparisons of parecoxib compared to any
other analgesic intervention for the therapy of postoperative pain.
Dichotomous data on patient satisfaction with their analgesic regimen
were extracted by means of the fraction of patients who rated their
medication as “good” or “excellent” compared to "fair" or "poor". Data
on any reported adverse effects were extracted. Relative risk (RR) and
number-needed-to-treat (NNT) were calculated with 95% confidence
intervals (CI) using a random-effects model.
RESULTS: Data from 9 trials were analyzed. In those trials including
1738 subjects, 1013 patients were randomized to receive parecoxib, 218
patients were allocated to an active control (morphine 4 mg, n=84;
ketorolac 30-60 mg, n=134) and 507 patients received a placebo. When
administered prophylactically the pooled NNT to obtain the desired
outcome (“good“ / ”excellent” rating) with parecoxib 20mg and 40mg
compared to placebo was 4.5 (RR: 1.42; 95%CI: 0.91-2.24) and 4.0
(RR: 1.40; 95%-CI: 1.10 – 1.79). In the treatment trials the NNT [harm]
to obtain the outcome of interest with parecoxib 20mg and 40mg was
2.1 (RR: 3.44; 95%CI: 1.49 – 7.96) and 1.7 (RR: 4.65; 95%-CI: 2.04 –
10.61), 5.3 (RR: 1.43; 95%CI: 1.01-2.02) and 3.7 (RR: 1.62; 95%-CI:
ANESTH ANALG ABSTRACTS S-3
2004; 98; S-1–S-282 S-4
S-3
A DOUBLE MASKED PROSPECTIVE COMPARISON OF hours after discharge. More patients in the ketorolac group required
ROFECOXIB VERSUS KETOTOLAC FOR ACUTE Percocet within 6 hours after discharge, but the difference was not
POSTOPERATIVE PAIN statistically significant. There were also no differences in the number of
patients experiencing any side effects or in patient satisfaction.
AUTHORS: J. Kim, A. Bekker, O. Sherman, G. Cuff, A. Lebovits, DISCUSSION. Preoperative rofecoxib is as effective as ketorolac for
M. Wajda; the treatment of pain after knee arthroscopy. Although our sample size
AFFILIATION: New York University Medical Center, New York, was too small to show differences in adverse effects, we believe that
rofecoxib may be preferred perioperative NSAID because it has
NY.
minimal effects on platelet function or gastrointestinal bleeding.
INTRODUCTION. Ketorolac is a commonly used agent to reduce
postoperative pain and inflammation in patients who undergo Outcome Measurements
ambulatory orthopedic surgery. However, there is often reluctance to Ketorolac Rofecoxib
use this drug as a perioperative analgesic because of the potential for Age 45.3 44.5
gastrointestinal injury and platelet deactivation. Rofecoxib is a selective VbAS prior to discharge .7 .7
COX-2 inhibitor with fewer side effects than non-selective NSAIDs VbAS (6 hrs after surgery) 1.7 1.0
(i.e. ketorolac). The aim of this study is to examine whether rofecoxib VbAS (24 hrs after surgery) 2.8 1.8
provides pain relief comparable to ketorolac in patients undergoing Percocet R in the PACU (n, %) 3/15, 20% 2/15, 13%
arthroscopic knee surgery.
Percocet R, 6 hrs after discharge (n, %) 5/14, 36% 1/13, 8%
METHODS. With IRB approval, 30 consented ASA I-III patients
scheduled for knee arthroscopy were randomly assigned to receive Percocet R 24 hrs after discharge (n, %) 7/14, 50% 5/13, 39%
either ketorolac IV 30 mg at the end of the case or rofecoxib 50 mg PO Side effects (i.e. nausea, vomiting, dizziness) 3/14, 21% 3/13, 23%
prior to surgery. In addition, patients in the ketorolac group received Patient satisfaction: Excellent/Very Good(n, %) 9/14, 64% 11/13, 85%
placebo pill PO preoperatively while patients in the rofecoxib group
received a saline injection at the end of the procedure. Fentanyl (1.4
mcg/kg), midazolam (0.07 mg/kg), and propofol (70 mcg/kg/min) were
used for intraoperative sedation. Additionally, the surgeon infiltrated
the knee with bupivacaine at the end of the procedure. The outcome
measures were pain scores (verbal analog scale (VbAS)) and PercocetR
use (oxycodone/acetaminophen 5/325 mg) assessed in the postoperative
care unit, 6 hours and 24 hours after discharge. Additional endpoints
included patient satisfaction and occurrence of side effects. Data were
analyzed using independent samples t-tests for continuous variables or
chi-squares test for categorical variables. P < .05 was considered
significant.
RESULTS. The two groups were comparable with regard to age,
intraoperative medication use, and duration of surgery. There was no
difference either in pain scores or PercocetR use in the PACU or 24
S-4
EVALUATION OF THE EFFICACY OF ROFECOXIB IN THE CONCLUSIONS: Preoperative administration of rofecoxib 50 mg
PERIOPERATIVE MANAGEMENT OF PAIN FOLLOWING reduced pain scores at 8 hours; there was no improvement in pulmonary
LAPAROSCOPIC CHOLECYSTECTOMY function at 3 or 8 hours postoperatively.
REFERENCES:
AUTHORS: S. I. Serban, S. Reuben, W. Joshi, W. Prescott, H. Anesth Analg 2000;91 : 1221-5
Maciolek; Anesth Analg 2002;94:55-9
AFFILIATION: Baystate Medical Center, Springfield, MA. Anesthesiology 2002;95:A-961
Anesth Analg 2003;96:987-94
INTRODUCTION: Recently the COX-2 inhibitor rofecoxib has Summary: Study patients received placebo or rofecoxib prior to
become available for the management of postoperative pain. The laparoscopic cholecystectomy. Preoperatively, PFT's were recorded and
perioperative administration of rofecoxib has demonstrated a significant postoperatively, total morphine use. The study showed a difference in
opioid sparing effect following orthopedic (1,2), abdominal (3), and Morphine use at 8 hours but no difference in PFT's between groups.
ENT (4) surgeries. Rofecoxib has also resulted in improved
postoperative pulmonary function when administered prior to
abdominal surgery(3). The preoperative administration of rofecoxib
may be safer than standard NSAIDs since it has no effect on platelet
aggregation.
METHODS: After IRB approval, 31 patients undergoing elective
laparoscopic cholecystectomy were included in this randomized,
double-blinded study. Patients received either placebo (n=15) or
rofecoxib 50 mg (n=16) one hour prior to surgery. Baseline pulmonary
function tests (FEV-1 and FVC) were obtained. Postoperatively,
patients received PCA morphine. Pain scores and morphine use were
recorded. In addition, side effects including nausea, vomiting, itching
and shoulder pain were recorded.
RESULTS: There were no differences in patients demographics, length
of surgery, intraoperative fentanyl use and preoperative FEV-1 and FVC
between the two groups. There were no statistical differences between
the groups regarding VAS pain scores in the PACU and 3 hours
postoperatively. There was a significant difference (p<0.05) between
the rofecoxib group VAS score (1.8 +/- 1.5) and Control group (3.1 +/-
1.8) at 8 hours post-surgery. There were no significant differences in the
pulmonary function tests between the two groups. Total morphine
required for the first 8 hours post-surgery was not different in the
rofecoxib group (5.4 +/- 6.6) than in the Control group (6.6 +/- 2.4).