Reduce Nonsteroidal Antiinflammatory Drugs Doses for Analgesia After Sternotomy
Status:
Unknown status
Trial end date:
2015-09-01
Target enrollment:
Participant gender:
Summary
Currently, the management of pain after cardiac surgery is based on the concept of multimodal
analgesia: Combined use of non-opioid analgesics associated with morphine intravenous
analgesia by a system controlled by the patient (patient-controlled analgesia-PCA).
The combination of paracetamol and morphine PCA is very effective on pain at rest, but is
limited on pain mobilization and causes the problem of side effects associated with opioid
(overdose, sedation, respiratory depression, gastrointestinal intolerance, urinary retention
...) which are contributing factors to increase the length of stay in Intensive Care Unit, an
additional cost of care and an increase postoperative morbidity and mortality.
Methods that have proved their effectiveness on pain and mobilization used in postoperative
cardiac surgery are: anti-inflammatory drugs (NSAIDs) and / or loco-regional analgesia
techniques. NSAIDs enhance analgesia produced by PCA Morphine and allow a reduction in
morphine consumption, improved postoperative pain, decreased sedation and decreased
postoperative morbidity and mortality.
Adverse effects of NSAIDs are commensurate with their time and exposure dose. Consequently,
NSAIDs, in the absence of against-indications, should always be prescribed and used at the
lowest effective dose and for the shortest possible time.
Some studies have suggested that lower doses of NSAIDs didn't appear to affect their
effectiveness. At present, the investigators have no studies that address the hypothesis from
which minimum dose of ketoprofen analgesic effect is obtained.
The investigators hypothesis is that lower dose ketoprofen may have efficacy on pain in the
postoperative mobilization of cardiac surgery. The investigators want to find, in their
study, this "optimal" ketoprofen dose which would be the minimum dose for clinical efficacy
demonstrated dose.
This optimal dose could reduce the number of adverse effects of NSAIDs, but their study will
probably not have enough power to prove it. NSAID use at these low doses, in postoperative
cardiac surgery, could be extended to patient populations most at risk or for a duration
longer than 48 hours.