Comparison of etoricoxib vs. ketorolac in postoperative pain relief

Background: COX-2 inhibitors have been claimed to have equal analgesic efficacy as non-selective nonsteroidal anti-inflammatory drugs, but this has been disputed in animal experiments. Methods: One hundred thirty-three women scheduled for ambulatory, laparoscopic gynaecological surgery were included in this randomised, double-blind study. Group E received 120 mg etoricoxib orally as premedication. Group K received 30 mg ketorolac i.v. after induction of anaesthesia. General anaesthesia was induced and maintained with propofol and remifentanil. Fentanyl 0.5 mu g/kg i.v. and local wound anaesthesia was administered at the end of surgery. Postoperatively, the patients received fentanyl 0.5 mu g/kg i.v. if visual analogue scale (VAS) >= 30 mm. Before discharge, Group K received 30 mg ketorolac i.v. Twenty-four hours postoperatively, Group E received 120 mg etoricoxib. Results: The first 4 h postoperatively, Group K required 83 +/- 65 mu g and Group E required 123 +/- 91 mu g fentanyl [mean (SD), P=0.004]. After 30 min VAS in Group K was 31.3 +/- 19.7 mm and 43.8 +/- 16.9 mm in Group E [mean (SD), P < 0.001]. Discharge readiness was significantly shorter in Group K (222 +/- 40 min) compared with Group E (244 +/- 47 min) [mean (SD), P=0.004]. There were no differences in pain scores or rescue pain medication at 24 or 48 h postoperatively. Less nausea was observed in the 4-24-h period in Group E. Conclusions: Thirty milligram ketorolac i.v. after induction of anaesthesia resulted in significantly less immediate pain and opioid consumption during the first 4 h postoperatively compared with 120 mg etoricoxib preoperatively.