Management of postoperative inflammatory response and pain with nimesulide after cardiac surgery]

Nimesulid (Mesulid) is a non-steroid anti-inflammatory drug (NSAID), acting by the selective inhibition of the Cyclooxygenase-2 (COX-2) isoenzyme. In this study the efficacy of nimesulid following cardiac surgery has been investigated in comparison with that of a COX-1 isoenzyme inhibitor drug.200 cardiac surgical patients operated on cardiopulmonary bypass have been involved in this prospective study. 100 patients received 100 mg. nimesulid bd. routinely in the postoperative period (group M). Another 100 patients were given 275 mg naproxen bd. (group A). In both groups the White Blood Cell (WBC), the blood sedimentation (We), the C-Reactive Protein (CRP) levels were determined from venous blood samples before the operation and on the first five postoperative days. Venous blood samples of 20 patients of each group in the same period were used to determine the Interleukin-6 (IL-6), and the Soluble Tumour Necrosis Factor Receptor-I (sTNF-RI) levels. Postoperative complications related to the use of the investigated drugs as well as the side effects have been compared in the two groups. A visual analogue pain scale was used before and after drug administration. Kruskal Wallis and student t tests were used for the statistical analysis.No serious complication related to the use of the investigated drugs has developed in either group. In group A gastrointestinal side effect were recorded in 7 cases (7%) whilst in group M no such complaints were found. Drug doses defined in the study protocol had to be raised or another drug had to be added in 11 and 3 cases in group A and M respectively. Neither the laboratory findings, nor the visual pain scale results have not shown any significant difference between the groups.The efficacy of nimesulid in postoperative inflammatory inhibition and pain relief has proved equal to that of the investigated COX-1 inhibitor drug, however less gastrointestinal side effects have been related to its administration.