It is questionable whether the stress response to surgery is necessary. The objective of this study was to evaluate the effectiveness of postoperative analgesia on energy metabolism and compare cyclooxygenase-2 selective inhibitor with tramadol in postoperative pain management after major abdominal surgery.
A total of 112 patients undergoing major abdominal surgery were randomly assigned to one of the 4 treatment groups before surgery. Then, patients were scheduled to receive different analgesic drugs after surgery: group parecoxib/control received intravenous parecoxib (40 mg bid) for 3 days; group parecoxib/celecoxib received intravenous parecoxib (40 mg bid) for 3 days and continued oral celecoxib (0.2 mg bid) for 4 days; group tramadol/control received intravenous tramadol (0.1 g tid) for 3 days; and group tramadol/tramadol received intravenous tramadol (0.1 g tid) for 3 days and continued oral tramadol (0.1 g tid) for 4 days.
Group tramadol/tramadol showed much lower rest energy expenditure 1 week after surgery (P<0.05). The measured rest energy expenditure was significantly lower in patients treated with analgesic drugs administered from day 4 to 7 after surgery relative to control group (P<0.01). From the fourth day after surgery, groups parecoxib/celecoxib and tramadol/tramadol showed significantly lower pain intensity ratings compared with groups parecoxib/control and tramadol/control during leg raising (P<0.05).
These results confirm that sufficient postoperative analgesia may be efficient to reduce some of the stress responses to operative trauma. In addition, intravenous parecoxib (40 mg bid) followed by oral celecoxib (0.2 g bid) is as effective as intravenous tramadol (0.1 g tid) with continued oral tramadol (0.1 g tid) after major abdominal surgery.