Efficacy of oral paracetamol and ketoprofen for pain management after major orthopedic surgery.

The hypothesis of this study was that oral paracetamol or ketoprofen can reduce opioid consumption and the adverse effects of opioids after major orthopedic surgery. Sixty patients who had elective total hip replacement surgery took part in this double-blind, randomized, placebo-controlled study. The total doses were paracetamol 4 g and ketoprofen 300 mg. After the surgery, analgesia was provided with a patient-controlled analgesia device: 0.05-mg bolus doses of fentanyl i.v. for 5 min, followed by a lockout interval of 5 min, with a maximum of 0.3 mg in any 1-h period. Pain (measured by visual analog scale), respiratory rate, peripheral arteriolar oxygen saturation, heart rate, blood pressure and side effects were recorded every 4 h for a period of 20 h. The mean pain scores were similar among the groups. Patients in the ketoprofen group consumed a mean of 22% less fentanyl (P < 0.05) in a 20-h period than the placebo group, and 28% less than the patients in the paracetamol group (P < 0.05). Oral ketoprofen (300 mg) decreased fentanyl consumption by 22% in the 20-h period immediately following major orthopedic surgery; fentanyl consumption was unaffected by paracetamol (4 g). The frequency of adverse effects was not reduced by using adjunctive nonopioid analgesics.