Postoperative naproxen after coronary artery bypass surgery: a double-blind randomized controlled trial

• Published in: European journal of cardio-thoracic surgery Vol. 26; no. 4; pp. 694 - 700
• Main Authors: KULIK, Alexander, RUEL, Marc, BOURKE, Michael E, SAWYER, Lynn, PENNING, John, NATHAN, Howard J, MESANA, Thierry G, BEDARD, Pierre
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science 01.10.2004
• Subjects: Analysis of Variance; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biological and medical sciences; Blood Loss, Surgical; Blood Transfusion; Coronary Artery Bypass; Double-Blind Method; Female; Humans; Male; Medical sciences; Middle Aged; Naproxen - therapeutic use; Pain, Postoperative - prevention & control; Postoperative Care - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Vital Capacity - drug effects; Postoperative; Lung; Coronary artery; Surgical anastomosis; Cardiovascular disease; Lung physiology; Postoperative care; Care; Coronary artery bypass surgery; Randomization; Treatment; Aortocoronary; Bypass; Heart disease; Surgery; Naproxen; Double blind study; Anesthesia; Physiology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2004.07.004

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. Patients (N=98) undergoing primary CABG were randomized to receive naproxen (500 mg q12hX5 doses via suppository started 1h after operation, followed by oral 250 mg 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). 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+/-1.5x10(9)/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. 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.