SAFER PAIN RELIEVERS REDUCE NEED FOR NARCOTICS
NEW ORLEANS -- An injectable form of acetaminophen (the active ingriedient in Tylenol(r)) and a member of a new class of drugs called COX-2 inhibitors hold promise as safe and effective tools for controlling surgical pain, according to the results of two multicenter clinical trials presented at the annual meeting of the American Society of Anesthesiologists.
Both substances significantly reduce morphine consumption in patients recovering from major surgery, researchers from Yale University reported.
"Lowering morphine consumption reduces postsurgical complications and helps patients recover quicker," anesthesiologist Raymond Sinatra, M.D., Ph.D., said. "That translates into shorter hospital stays, healthier patients and reduced health care costs."
Although morphine does an outstanding job of relieving pain, it can cause a number of side effects, including nausea, vomiting, constipation, drowsiness and slowed breathing. As a result, the search for techniques and alternative medications that might reduce or eliminate the need for morphine altogether remains a key area of anesthesiology research.
A new soluble form of acetaminophen delivered by catheter (small tube) into a vein offers a safe and effective method of decreasing the need for morphine in surgical patients, according to one of the studies.
The medication, which is expected to receive U.S. Food and Drug Administration approval soon, lowered morphine consumption by more than 30 percent in patients studied following major hip or knee surgery, Dr. Sinatra said. Patients were able to give themselves morphine by using a patient-controlled analgesia (PCA) pump.
The injectable form of acetaminophen enhances the drug's analgesic power by reaching the central nervous system sooner and in a higher concentration than in standard tablet form. Dr. Sinatra said. It provides an excellent method of managing pain in orthopedic patients, he noted, because proper healing following many types of orthopedic surgeries relies on an inflammatory process that builds new bone. Injectable acetaminophen does not interfere with this healing process because acetaminophen is not an anti-inflammatory drug.
The second Yale study revealed the safety and effectiveness of a COX-2 inhibitor, rofecoxib, as a surgical pain reliever. The study zeroed in on the drug's ability to reduce pain improve the patients ability to cough after abdominal surgery as well as its role in lowering morphine consumption.
COX-2 inhibitors act by selectively turning off one of the cylooxygenase (COX) enzymes responsible for the production of prostaglandins, substances that cause pain by irritating surrounding nerves.
Researchers have discovered that there are two types of COX enzymes: COX-1, which helps to maintain normal body functions, and COX-2, which is released with inflammation.
Conventional nonsteroidal anti-inflammatory drugs, or NSAIDs, (aspirin, ibuprofen) block both COX-1 and COX-2, which is why they relieve pain. NSAIDS, however, can have negative side effects such as upset stomach, increased bleeding and kidney damage. Rofecoxib blocks only COX-2, the enzyme responsible for inflammation and pain.
When it comes to pain relief, what really counts is the patient's ability to breathe and move comfortably, Dr. Sinatra noted. "Patients who experience pain will avoid coughing and walking and heal more slowly than those who can function in relative comfort."
Surgical incisions in the abdominal region typically produce a 30- to 40-percent reduction in normal breathing patterns, even in patients who receive morphine after surgery, Dr. Sinatra said. In this study, patients who received a single 50 mg dose of rofecoxib syrup before surgery experienced only a 15-percent decline in lung function after surgery, compared to 35 to 40 percent for the placebo group.
In addition, the rofecoxib group consumed 44 percent less morphine than the control group during the first 24 hours after surgery.
"While we won't eliminate the need for morphine in the near future, administration of safe non-narcotic analgesics can minimize its use while at the same time improving pain relief," Dr. Sinatra said.
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During the meeting a press room will be set up in the Morial Convention Center, room 283-284. The press room will be open from 8 a.m. to 5 p.m. Saturday, October 13, through Wednesday, October 17. The media can call the press room during the dates of the annual meeting at (504) 670-6512. Before the meeting, ASA staff members can be contacted by e-mail, [email protected] or by calling (847) 825-5586. Phil Weintraub, [email protected].
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