Samulak, D., Michalska, M., Gaca, M., Wilczak, M., Mojs, E., & Chuchracki, M. (2011). Efficiency of postoperative pain management after gynecologic oncological surgeries with the use of morphine + acetaminophen + ketoprofen versus morphine + metamizol + ketoprofen. European Journal of Gynaecological Oncology, 32(2), 168–170.

To compare the efficacy of two medication schemes for the management of pain after gynecologic surgery

Consecutive patients were randomly assigned to two groups. Group 1 received, on the day of surgery, 1 mg morphine/10 kg body mass subcutaneously (SC) every four hours. After surgery Group 1 received 1 g acetaminophen IV every six hours and 500 mg naproxen per rectum every 12 hours daily. Group 2 received 1 mg morphine/10 kg body mass SC every 4 hours, 1 g metamizol IV every 6 hours, and 500 mg naproxen per rectum every 12 hours. For all patients, in instances of pain rated 5 or more, an additional 100 mg of ketoprofen IV was administered. Pain was rated throughout hospitalization.

• The sample was composed of 128 patients.
• Mean patient age was 68 years; the age range of patients was 42–82 years.
• All patients were female.
• All patients underwent operations of category III or IV, a classification indicating extensive tissue injury and significant postoperative acute pain.

• Single site
• Inpatient
• Poland

Randomized parallel group

Numeric pain rating scale of  0–10

• Patients in group 1 had significantly less pain than did the other group (p < 0.05).
• On the operative day, 34% of group 1 patients required rescue medication compared to 52% of patients in group 2.
• By postoperative day 3, 3.12% of group 1 patients required rescue medication compared to 4.69% in group 2.
• During the entire postoperative period, no side effects were associated with either treatment regimen.

For the management of postoperative pain following gynecologic surgery, the combination of morphine, acetaminophen, ketoprofen, and metamizol as used in this study was more effective than the combination of morphine, metamizol, and ketoprofen.

• Authors did not report the anesthesia regimen used.
• Authors did not analyze the demographic differences or other factors, such as type of surgery, that could impact pain scores.

This study describes a perioperative pain management regimen that appears to have decreased the pain of patients who underwent  extensive gynecologic surgery. Note, however, that the more effective regimen did not provide complete control for more than 30% of patients on the day of surgery and for more than 15% on the first postoperative day. This study adds to the growing research regarding  perioperative adjuvant medications for acute pain control.