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Eur J Cardiothorac Surg 2004;26:694-700
© 2004 Elsevier Science NL
a Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, Ont., Canada
b Division of
Cardiac Anesthesia, University of Ottawa Heart Institute, Ottawa, Ont.,
Canada
c Department of Epidemiology, University
of Ottawa, Ottawa, Ont., Canada
d Department of
Anesthesiology, University of Ottawa, Ottawa, Ont., Canada
Received 5 May 2004; received in revised form 22 June 2004; accepted 1 July 2004.
* Corresponding author.
Tel.: +1-613-761-4313; fax: +1-613-761-5107. (E-mail: pbedard{at}ottawaheart.ca).
Objective: Non-steroidal anti-inflammatory drugs (NSAIDs) are routinely used after coronary artery bypass surgery (CABG), yet their effects have seldom been evaluated in randomized controlled settings. The aim of this study was to examine the efficacy and safety of a commonly used NSAID, naproxen. We hypothesized that naproxen would reduce postoperative pain following CABG without increasing complications. Methods: Patients (N=98) undergoing primary CABG were randomized to receive naproxen (500mg q12hx5 doses via suppository started 1h after operation, followed by oral 250mg q8hx6 doses) or placebo. Standard analgesic and anti-emetic regimens were available to both patient groups. Interventions were double-blinded. Primary end-points were postoperative pain measured before and after chest physiotherapy by visual analog scale and pulmonary slow vital capacity (SVC). Results: Baseline characteristics were equivalent between the two groups. Over the first 4 postoperative days, naproxen decreased pain by 47±17% on average before chest physiotherapy (P=0.034), and 44±13% after chest physiotherapy (P=0.0092). Patients who received naproxen also had better preservation of SVC over the first 4 postoperative days (mean loss of SVC from baseline: 2.1±0.1 vs. 2.5±0.1l, naproxen vs. placebo, P=0.0032). This was concomitant with a lower white blood cell count observed in naproxen patients (9.2±0.3 vs. 12.7±1.5x109/l, naproxen vs. placebo, P=0.03). Patients who received naproxen had more chest tube drainage after 4h postoperatively, but there was no difference in the incidence or amount of transfusions. There was no difference in medication use, length of stay, or in the incidence of atrial fibrillation, azotemia, and other complications. Conclusions: Naproxen is an effective and low-cost adjunct for optimization of pain control and lung recovery after CABG. Its use may result in increased chest tube drainage, but no apparent increase in other complications.
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