PMID- 25485880
OWN - NLM
STAT- MEDLINE
DCOM- 20160515
LR  - 20181202
IS  - 1365-2346 (Electronic)
IS  - 0265-0215 (Linking)
VI  - 32
IP  - 4
DP  - 2015 Apr
TI  - The effect of triple vs. double nonopioid therapy on postoperative pain and 
      functional outcome after abdominal hysterectomy: a randomised double-blind 
      control trial.
PG  - 269-76
LID - 10.1097/EJA.0000000000000190 [doi]
AB  - BACKGROUND: Movement-evoked pain is more severe than pain at rest and is likely 
      to interfere more with functional recovery after surgery. OBJECTIVE: To compare 
      triple vs. double nonopioid perioperative analgesic regimens in women undergoing 
      abdominal hysterectomy. DESIGN: A randomised, parallel design, double-blind 
      controlled trial. SETTING: A single-centre trial. Study period from November 2009 
      to July 2013. PATIENTS: Adults (>18 years) of American Society of 
      Anesthesiologists' status 1 to 2 scheduled for abdominal hysterectomy. 
      INTERVENTIONS: Patients were randomised to one of four study treatment groups: 
      acetaminophen, meloxicam and gabapentin (AMG); acetaminophen and meloxicam; 
      acetaminophen and gabapentin; and meloxicam and gabapentin. In addition to 
      intravenous patient-controlled opioid analgesia, study treatments were 
      administered for 48 h, starting 1 h preoperatively. MAIN OUTCOME MEASURES: The 
      primary outcome was cough-evoked pain. Secondary outcomes included pain at rest, 
      during sitting and peak expiration, opioid consumption, side effects, peak 
      expiratory flow rate, timed up and go test (TUG), and modified Brief Pain 
      Inventory (mBPI). RESULTS: Interim analysis indicated a minimal chance of 
      demonstrating superiority of the triple regimen group over all three double 
      regimen groups if the trial were to be recruited to planned sample size. Thus, 
      the trial was prematurely terminated for futility. All four analgesic regimens 
      were well tolerated. Exploratory analyses revealed consistent significant 
      negative correlations between pain and TUG and between pain and interference with 
      activity, walking and sleep. CONCLUSION: This trial failed to demonstrate 
      substantial benefits with the addition of a third nonopioid analgesic to three 
      different double-drug regimens. Further research is needed that will more 
      definitively support expanding multimodal analgesic practices. Our results 
      demonstrate consistent correlations between evoked pain and functional outcomes 
      further emphasising the need for improved analgesic regimens that will accelerate 
      postsurgical functional recovery. TRIAL REGISTRATION: International Standard 
      Randomised Controlled Trial Number Register 12723675.
FAU - Gilron, Ian
AU  - Gilron I
AD  - From the Department of Anesthesiology & Perioperative Medicine (IG, DD-S, SD, RR, 
      EO), Department of Biomedical & Molecular Sciences (IG), Centre for Neuroscience 
      Studies (IG), Department of Mathematics & Statistics (DT), and Department of 
      Obstetrics & Gynaecology, Queen's University, Kingston, Ontario, Canada (MM).
FAU - Tu, Dongsheng
AU  - Tu D
FAU - Dumerton-Shore, Deborah
AU  - Dumerton-Shore D
FAU - Duggan, Scott
AU  - Duggan S
FAU - Rooney, Rachel
AU  - Rooney R
FAU - McGrath, Michael
AU  - McGrath M
FAU - Orr, Elizabeth
AU  - Orr E
LA  - eng
SI  - ISRCTN/ISRCTN12723675
GR  - MSH-55041/Canadian Institutes of Health Research/Canada
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur J Anaesthesiol
JT  - European journal of anaesthesiology
JID - 8411711
RN  - 0 (Amines)
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Cyclohexanecarboxylic Acids)
RN  - 0 (Thiazines)
RN  - 0 (Thiazoles)
RN  - 362O9ITL9D (Acetaminophen)
RN  - 56-12-2 (gamma-Aminobutyric Acid)
RN  - 6CW7F3G59X (Gabapentin)
RN  - 76I7G6D29C (Morphine)
RN  - VG2QF83CGL (Meloxicam)
SB  - IM
MH  - Acetaminophen/therapeutic use
MH  - Adult
MH  - Amines/therapeutic use
MH  - Analgesia, Patient-Controlled/adverse effects/*methods
MH  - Analgesics, Opioid/adverse effects/*therapeutic use
MH  - Cyclohexanecarboxylic Acids/therapeutic use
MH  - Double-Blind Method
MH  - Drug Therapy, Combination
MH  - Early Termination of Clinical Trials
MH  - Female
MH  - Gabapentin
MH  - Humans
MH  - Hysterectomy/*adverse effects/methods
MH  - Meloxicam
MH  - Middle Aged
MH  - Morphine/adverse effects/*therapeutic use
MH  - Ontario
MH  - Pain Measurement
MH  - Pain, Postoperative/diagnosis/*drug therapy/physiopathology
MH  - Recovery of Function
MH  - Thiazines/therapeutic use
MH  - Thiazoles/therapeutic use
MH  - Time Factors
MH  - Treatment Outcome
MH  - gamma-Aminobutyric Acid/therapeutic use
EDAT- 2014/12/09 06:00
MHDA- 2016/05/18 06:00
CRDT- 2014/12/09 06:00
PHST- 2014/12/09 06:00 [entrez]
PHST- 2014/12/09 06:00 [pubmed]
PHST- 2016/05/18 06:00 [medline]
AID - 10.1097/EJA.0000000000000190 [doi]
PST - ppublish
SO  - Eur J Anaesthesiol. 2015 Apr;32(4):269-76. doi: 10.1097/EJA.0000000000000190.