The role of Non Steroid Anti Inflammatory Drugs (NSAIDs) as preventive analgesia

in relation with pain intensity and prostaglandin levels on post gynecology

laparotomy surgery patients

Jeffri Budianto, Muh. Ramli Ahmad, Ilham Jaya P, Syafruddin Gaus

Department of Anesthesiology, Intensive Care and Pain Management
Faculty of Medicine Hasanuddin University, Makassar

ABSTRACT

Background: Combining NSAIDs as preventive analgesia may enhance epidural analgesia

(EA) on post gynecology laparotomy. Prostaglandin (PGE2), a inflammatory mediator,
produced in response to pain, which affect pain threshold and predispose patient to chronic
pain. NSAIDs (parecoxib and ketorolac) suppress prostaglandine-E2 (PGE2) levels.
Objective: To study NSAIDs effect as preventive analgesia on PGE 2 level and pain intensity
on post gynecology laparotomy patients using EA.
Methods: Sixty patients with ASA PS I and II undergo gynecology surgery with EA were
divided into 3 groups: group K received 0.5mg/kgBW ketorolac, group P 40 mg parecoxib
and group N 0.9% NaCl 2 ml intravenously. Drug was given 30 minutes before incision, 8
and 16 hours after incision. Pain intensity and PGE 2 level were obtained. Data was collected
in numeric, mean (SD), then analyzed by using One-way ANOVA, Fischer’s Exact test,
Mann-Whitney U-test to a 5% confidence interval.
Result: NRS was 1 on all groups at beginning of incision. Eight and 16 hours after incision,
NRS of 1 retained in NSAIDs, while NRS increased to 2 in 15% of N groups 8 hours after
incision. PGE2 level (pg/ml) is highest on N group (439.7±35.1, 481.7±60.1, 565.1±58.7) and
significantly difference (p<0.05) compared to P group (230.7±19.5, 221.4±16.4, 201.1±18.1)
and K group (338.3±22.7, 360.8±20.2, 339.6±24.0).
Conclusion : Combined EA with NSAIDs as preventive analgesia in gynecology laparotomy
patients reduce pain and PGE2 level during and after surgery. Parecoxib more effective
compared to ketorolac in reducing PGE2 level, otherwise both have same effectivity in
reducing pain intensity.
Keywords: analgesia epidural, ketorolac, gynecology laparotomy, parecoxib, PGE2.