New Pain Relievers Reduce Morphine Use

Multicenter trials have shown that an injectable form of acetaminophen and COX-2 inhibitors may be safe and effective for controlling surgical pain. These findings were presented at the annual meeting of the American Society of Anesthesiologists (ASA) by researchers from Yale University (New Haven, CT, USA).

The two substances were found to significantly reduce morphine consumption in patients recovering from major surgery. Although morphine is an excellent pain reliever, it can cause a number of side effects, including nausea, vomiting, drowsiness, and slowed breathing. One trial showed that the new soluble form of acetaminophen, delivered by catheter into a vein, lowered morphine consumption by more than 30% in patients who had major hip or knee surgery. The injectable form enhances the drug's analgesic power by reaching the central nervous system sooner and in a higher concentration form than in tablet form.

Another trial demonstrated the safety and effectiveness of a COX-2 inhibitor (rofecoxib) as a surgical pain reliever. COX-2 inhibitors act by selectively turning off one of the cylooxygase (COX) enzymes responsible for the production of prostaglandins, which cause pain by irritating surrounding nerves. In the study, patients who received a single 50 mg dose of rofecoxib syrup before surgery experienced only a 15% decline in lung function after surgery, compared to 35-40% for the placebo group. Also, the rofecoxib group consumed 44% less morphine than the control group during the first 24 hours after surgery.

"While we won't eliminate the need for morphine in the near future, administration of safe non-narcotic analgesics can minimize its use while at the same time improving pain relief,” said Dr. Raymond Sinatra, anesthesiologist at Yale.




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