Efficacy of three IV non-opioid-analgesics on opioid consumption for postoperative pain relief after total thyroidectomy: a randomised, double-blind trial

Objectives: In a randomized, double-blind trial, the synergistic action of intravenous parecoxib, metamizol or paracetamol on postoperative piritramide consumption was compared in patients recovering from total thyroidectomy during the first 24h while evaluating pain intensity and patient satisfaction. Methods: 120 patients were randomly allocated to four patient groups treated with normal saline and/or one of non-opioid analgesics (parecoxib 40mg twice daily, metamizol 1g three times daily, paracetamol 1g three times daily) in addition to piritramide using the PCA pump. Beginning in the recovery room (PACU), patients were asked every 2h for 6 hours and afterwards once every 6h to quantify their pain experience and patient satisfaction while piritramide consumption was recorded. Results: Upon arrival in the PACU piritramide consumption was high and decreased thereafter significantly in all groups (P 0.05). There were no significant differences between groups in incremental and cumulative piritramide consumption during the investigation. Also, VAS scores were high upon arrival in the PACU and dropped in all groups continuously after surgery: At 2h and 4h after surgery they were significantly lower in parecoxib group compared with NaCl (P 0.01). For overall patient satisfaction, no significant differences were observed. Pain relief scores at 24h were significantly higher in parecoxib group as compared to metamizol and paracetamol (P 0.01). Mild PONV was observed frequently in all groups and was treated with metoclopramide. Conclusion: There is no clear-cut difference between the non-opioid drugs used, even though parecoxib seems to be superior in regard to VAS scores and piritramide consumption. However, the clinical significance is debatable