ABSTRACT:
Objective: Study Design: Prospective, single blind, randomized single centre study The analgesic efficacy and safety of etoricoxib and diclofenac was compared in combination with tramadol and paracetamol at lower doses. Primary outcome measures were Visual Analogue Scale (VAS) and need for rescue analgesics and secondarily, average daily pain relief and patients’ subjective rating of study medication were measured. Background: Posterior spinal surgery is a common major orthopedic operation for certain spine disorders, however POP from the wound is unavoidable, which may increase morbidity and incidence of complications and prolong postoperative rehabilitation. It is difficult to achieve effective pain control using a single treatment. Most analgesics cannot be prescribed at unlimited doses due to the ceiling of efficacy and/or safety and tolerability concerns. Rational combinations of analgesic with different mechanisms of action can improve efficacy and/or tolerability and safety compared with full analgesic dose individually. Material and methods: 203 patients of spine surgery were divided in to 2 groups: group E (n=103, received etoricoxib 30 mg twice daily orally) and group D (n=100, received diclofenac 12.5 mg i.m. twice daily on the day of surgery and 25 mg thrice daily orally from the next day of surgery). Both groups received tramadol / paracetamol combination. Rescue medication as required were given. POP (post operative pain) was evaluated by VAS every 24 hr for 10 days. Results: The POP of both study groups, as measured by VAS showed a significant reduction of pain at rest as well as on movement (p=0.0001) progressively in 10 days. There was no significant difference between the groups, except on day 2 when group D showed higher efficacy in reducing pain at movement. Significant differences were not found in need for rescue analgesic, daily pain relief, patient’s preference and adverse outcomes in the groups. Conclusion: Etoricoxib and diclofenac in combination with tramadol and paracetamol at lower doses are effective in reducing spinal POP especially after the first 48 hours.