The effect of dexketoprofen pre-emptively administered on the consumption of tramadol and the incidence of nausea and vomiting after laparoscopic cholecystectomy

The aim of our study has been to assess the comparative use of the two NSAIDs, dexketoprofen and ketoprofen, for postoperative analgesia after laparoscopic cholecystectomy mainly following: the quality of the analgesia, the incidence of potential adverse effects (for example, postoperative nausea and vomiting) and the rescue analgesics consumption (tramadol). This prospective, randomized, double-blind study included 90 patients undergoing laparoscopic cholecystectomy under general anaesthesia. Patients were randomly assigned into 2 groups: group D (n = 45) - patients that have received dexketoprofen 50 mg in dilution with10 ml saline solution iv., 30 minutes before the induction and group K (n = 45) - patients that have received ketoprofen 100 mg in dilution with 10 ml saline solution iv., 30 minutes before the induction (preemptive analgesia). Surgical interventions were conducted under general anaesthesia, with identical protocol for the two groups of study. Post-surgery analgesic regime consisting in 4 g of paracetamol administered for example in the first 24 hours, was started immediately after surgery. Boluses of tramadol of 100 mg (until 400 mg /daily) have been used as rescue analgesia. The main objectives of our study have been: post-surgery analgesia (VAS at mobilization, 0-100 mm) at 0, 2, 6, 12 and 24 hours after the surgery,the consumption of tramadol, incidence of PONV and the length of hospitalization period (LOS). Secondary objectives of the study have been: the incidence of gastrointestinal symptoms and the incidence of postsurgery blood losses. In the two study groups there have not been any differences concerning demographic data, post-surgery gastro-intestinal symptoms, postsurgery loss of blood and the hospitalization period. VAS was significantly lower in group D vs. K, at 0 and 6 hours after the surgery (p <0,05). The incidence of PONV was lower in the group of patients who received preemptive analgesia with dexketoprofen (p <0,05). The number of tramadol boluses administered and the number of patients requiring backup analgesia was lower in group D comparatively to group K. Preemptive administration of dexketoprofen seems to be more effective than the administration of ketoprofen for post-surgery multimodal analgesia after laparoscopic cholecystectomy. The preemptive administration of dexketoprofen also deereases tramadol consumption and the incidence of postoperative nausea and vomiting.