A randomized, placebo-controlled study of rofecoxib with paracetamol in early post-tonsillectomy pain in adults

Background and objective: Effective and early treatment of postoperative pain and nausea have become pivotal for the early discharge of patients after tonsillectomy. Oploid-based analgesia is standard practice but the use of nonsteroidal anti-inflammatory drugs is discouraged due, to their platelet inhibiting properties. The cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drugs are effective analgesics and do not affect platelet function. We hypothesized that premedication with cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drug in addition to paracetamol would provide effective analgesia and decrease oploid consumption during early recovery from tonsillectomy. Methods: In a randomized, placebo-controlled study of adult tonsillectomy patients (n = 40) one group (R-group; n = 20) was premedicated with paracetamol 1.5 g and rofecoxib 50 mg and a control group (P-group; n = 20) was premedicated with paracetamol 1.5 g and placebo. Morphine was used as rescue medicdtion. Postoperative (24 h) pain scores (0-10), morphine consumption as well as intraoperative blood loss were recorded. Results: We found no overall difference in pain scores between the groups but significantly more patients in the placebo group had pain scores > 5 within the first 8 h. The rofecoxib group consumed less morphine during the first 12 h. A lower intraoperative blood loss was observed in the rofecoxib group. Conclusion: Our results suggest an early although clinically minor analgesic benefit of the addition of a cyclo-oxygenase-2 selective nonsteroidal anti-inflammatory drug to paracetamol as premedication for adult tonsillectomy.