BJA Advance Access published online on February 20, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh107
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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1 Institute of Anaesthesiology, University Hospital of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
* To whom correspondence should be addressed. E-mail: thomas.hegi{at}usz.ch.
Background. Non-selective cyclooxygenase (COX) inhibitors or non-steroidal anti- inflammatory drugs (NSAIDs) are frequently omitted for perioperative pain relief because of potential side-effects. COX-2-selective inhibitors may have a more favourable side-effect profile. This study tested the hypothesis that the COX-2-selective inhibitor rofecoxib has less influence on platelet function than the NSAID diclofenac in gynaecological surgery. In addition, analgesic efficacy and side-effects of the two drugs were compared. Methods. In this single-centre, prospective, double-blind, active controlled study, women undergoing vaginal hysterectomy (n=25) or breast surgery (n=25) under general anaesthesia received preoperatively 50 mg of rofecoxib p.o. followed 8 and 16 h later by two doses of placebo or three doses of diclofenac 50 mg p.o. at the same time points. We assessed arachidonic acid-stimulated platelet aggregation before and 4 h after the first dose of study medication, estimated intraoperative blood loss, and haemoglobin loss until the first morning after surgery. Analgesic efficacy, use of rescue analgesics, and side-effects were also recorded. Results. In the rofecoxib group, stimulated platelet aggregation was disturbed less (P=0.02), and estimated intraoperative blood loss (P=0.01) and the decrease in haemoglobin were lower (P=0.01). At similar pain ratings, the use of anti-emetic drugs was less in the rofecoxib group (P=0.03). Conclusion. Besides having a smaller effect on platelet aggregation, one oral dose of rofecoxib 50 mg given before surgery provided postoperative analgesia similar to that given by three doses of diclofenac 50 mg and was associated with less use of anti-emetics and less surgical blood loss in gynaecological surgery compared with diclofenac.
Clinical Investigation
Effect of rofecoxib on platelet aggregation and blood loss in gynaecological and breast surgery compared with diclofenac
2 Division of Hematology, Department of Internal Medicine, University Hospital of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
3 Department of Biostatistics, ISPM, University of Zurich, Sumatrastrasse 30, CH-8006 Zürich, Switzerland
4 Institute of Anaesthesiology, Intensive Care Unit, Kantonsspital Zug, Artherstrasse 27, CH-6300 Zug, Switzerland
5 Department of Gynaecology, University Hospital of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
6 Institute of Anaesthesiology, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
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