Oral celecoxib and tramadol after 24 hours in patients undergoing major operation in kuantan: a randomized comparattve study

Introduction: Tramadol is a weak opioid analgesic, acting mainly on μ-opioid receptor and has been proven to be effective and safe analgesic used for use in post-operative patients. Whereas celecoxib is a highly selective COX-2 inhibitor belonging to the non-steroidal anti-inflammatory drugs (NSAIDs) group which reduces inflammation and pain while minimizing gastrointestinal adverse reactions. This selectivity feature makes celecoxib an attractive alternative to opioids for the control of postoperative pain. Aim: The purpose of this study was to evaluate the effectiveness of oral celecoxib in comparison with oral tramadol in term of analgesic properties and the need for additional tablet acetaminophen as rescue pain reliever. Methods: A randomized, single-blinded study was conducted on 160 selected ASA I and II patients who were divided into two groups by a closed-envelope technique to receive either oral tramadol or celecoxib. Following major gynaecology, orthopaedic and general surgery, all patients were given standard patient-controlled analgesia (PCA) regimen with intravenous morphine. Patients received either oral tramadol 100 mg 8 hourly or oral celecoxib 200mg 12 hourly as a pain reliever 24 hours post operation, after they can resume oral intake. Tablets acetaminophens 500mg were ready as a rescue pain reliever. Patients were monitored for pain score according to Modified Pain Score ( 0 : No pain, l : slight pain, 2 : Tolerable pain, 3 : Bad pain, 4 : Worst pain) and side effects. They were again evaluated at 32, 40 and 48 hours post operation. Results: The mean pain score at 24, 32, 40 and 48 hours post operation were 0.84 ± 0.49, 0.60 ± 0.52, 0.29 ± 0.46, 0.11 ± 0.32 in the celecoxib group. In the tramadol group the mean pain score at 24,32,40 and 48 hours post operation were 0.88 ± 0.49, 0.70 ± 0.49, 0.36 ± 0.51 and 0.15 ± 0.36. There were no significant differences in the mean pain score between the two groups at each duration of assessment (p>0.05). None of the patients developed side effects or requested for tablet acetaminophen. Conclusion: This study indicates that oral celecoxib 200 mg 12 hourly is adequate and suitable to be used as an alternative to oral tramadol 100 mg 8 hourly in controlling pain 24 hours following major operation without the need for additional tablet acetarninophen