Painkiller combo cut post-surgery morphine need

Women undergoing hysterectomy who are given two types of painkiller around the time of the surgery experience less postoperative pain, and this means they need less morphine, Canadian researchers report.

Dr. Ian Gilron of Queens University, Kingston, and colleagues note that doses of opioids that produce complete relief of pain at rest have relatively little effect on pain evoked by movement.

To determine if combination treatment with gabapentin (Neurontin) and rofecoxib (Vioxx) - two analgesic agents with different modes of action - improves postop pain relief, the researchers studied 110 women scheduled for abdominal hysterectomy.

The women were randomly assigned to be given gabapentin, rofecoxib, a combination of both agents, or an inactive placebo beginning 1 hour before surgery and continuing for 72 hours.

In addition, after surgery the patients were given a patient-controlled analgesia device that delivered morphine when they needed it.

The combination of gabapentin and rofecoxib was significantly superior to placebo and was more effective than either agent alone in reducing pain at rest and during cough, the team reports in the medical journal Pain.

Women given placebo used more than twice as much morphine as those given the two-drug combo.

Also, sleep and breathing were improved in the combination group compared with the placebo group.

"The outcome of this study suggests that a combination of gabapentin and rofecoxib results in lower morphine needs, improved lung performance, and more consistent pain relief than seen with either drug alone," Gilron told AMN Health.

Even though Vioxx has been withdrawn worldwide, "this trial supports the rationale for using new analgesic combinations for postoperative pain management," Gilron added.

SOURCE: Pain, January 2005.