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Anesthesiologists of Greater Orlando; Orlando, FL; jeffrey_j_huang{at}hotmail.com
To the Editor:
Karamanlioglu et al. (1) found that preoperative administration of oral rofecoxib reduced tramadol consumption for treatment of postoperative pain after hysterectomy. In a similar study, Huang et al. (2) did not find a rofecoxib-induced reduction in pain score or morphine consumptions in patients after radical prostatectomy. Different surgical incision between the Karamanlioglu et al. (1) and Huang et al. (2) studies may account for the differing results. Midline infraumbilical incision was used when radical prostatectomywas performed in the Huang et al. (2) study. Transverse incision was used in the Karamanlioglu et al. (1) study. A meta-analysis indicated that the transverse incision results in significantly less postoperative pain (3). However, in surgical practice the midline incision is still mainly used (4). Surgeons’ main interests are as follows: time to open and close the abdomen and frequency of burst abdomen, the quick and optimal exposure of the operative field, wound infection, postoperative pulmonary complications, and incision hernias (4).
The efficacy of the nonsteroidal antiinflammatory drugs (NSAIDs) also depends on type of surgical procedure and patient population. Fredman et al. (5) studied a homogenous male population undergoing transvesical prostatectomy and found no difference in postoperative pain score or morphine consumption between patients receiving ketorolac and saline. In contrast, Parker et al. (6) studied a homogenous female population undergoing lower abdominal surgery and found that ketorolac provided significant analgesic benefit and decreased morphine consumption.
The efficacy of the NSAIDs depends on multiple factors such as surgical incision, type of surgical procedure, and patient population.
References
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