Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Reduce Nonsteroidal Antiinflammatory Drugs Doses for Analgesia After Sternotomy
Brief Summary: Currently, the management of pain after cardiac surgery is based on the concept of multimodal analgesia: Combined use of non-opioid analgesics associated with morphine intravenous analgesia by a system controlled by the patient (patient-controlled analgesia-PCA).

The combination of paracetamol and morphine PCA is very effective on pain at rest, but is limited on pain mobilization and causes the problem of side effects associated with opioid (overdose, sedation, respiratory depression, gastrointestinal intolerance, urinary retention ...) which are contributing factors to increase the length of stay in Intensive Care Unit, an additional cost of care and an increase postoperative morbidity and mortality.

Methods that have proved their effectiveness on pain and mobilization used in postoperative cardiac surgery are: anti-inflammatory drugs (NSAIDs) and / or loco-regional analgesia techniques. NSAIDs enhance analgesia produced by PCA Morphine and allow a reduction in morphine consumption, improved postoperative pain, decreased sedation and decreased postoperative morbidity and mortality.

Adverse effects of NSAIDs are commensurate with their time and exposure dose. Consequently, NSAIDs, in the absence of against-indications, should always be prescribed and used at the lowest effective dose and for the shortest possible time.

Some studies have suggested that lower doses of NSAIDs didn't appear to affect their effectiveness. At present, the investigators have no studies that address the hypothesis from which minimum dose of ketoprofen analgesic effect is obtained.

The investigators hypothesis is that lower dose ketoprofen may have efficacy on pain in the postoperative mobilization of cardiac surgery. The investigators want to find, in their study, this "optimal" ketoprofen dose which would be the minimum dose for clinical efficacy demonstrated dose.

This optimal dose could reduce the number of adverse effects of NSAIDs, but their study will probably not have enough power to prove it. NSAID use at these low doses, in postoperative cardiac surgery, could be extended to patient populations most at risk or for a duration longer than 48 hours.


Options:
A: Arm Label: placebo group; Type: PLACEBO_COMPARATOR; Interventions: Drug: Ketoprofen | Arm Label: ketopofen quarter dose; Type: OTHER; Interventions: Drug: Ketoprofen | Arm Label: ketoprofen half-dose; Type: OTHER; Interventions: Drug: Ketoprofen | Arm Label: Ketoprofen full dose; Type: OTHER; Interventions: Drug: Ketoprofen | Intervention Type: DRUG; Name: Ketoprofen; Assigned to Arm(s): Ketoprofen full dose, ketopofen quarter dose, ketoprofen half-dose, placebo group
B: Arm Label: Active Clonidine and Active ASA; Type: EXPERIMENTAL; Interventions: Drug: Active Clonidine, Drug: Active ASA | Arm Label: Active Clonidine and Placebo ASA; Type: EXPERIMENTAL; Interventions: Drug: Active Clonidine, Drug: Placebo ASA | Arm Label: Placebo Clonidine and Active ASA; Type: EXPERIMENTAL; Interventions: Drug: Placebo Clonidine, Drug: Active ASA | Arm Label: Placebo Clonidine and Placebo ASA; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo Clonidine, Drug: Placebo ASA | Intervention Type: DRUG; Name: Active Clonidine; Assigned to Arm(s): Active Clonidine and Active ASA, Active Clonidine and Placebo ASA | Intervention Type: DRUG; Name: Placebo Clonidine; Assigned to Arm(s): Placebo Clonidine and Active ASA, Placebo Clonidine and Placebo ASA | Intervention Type: DRUG; Name: Active ASA; Assigned to Arm(s): Active Clonidine and Active ASA, Placebo Clonidine and Active ASA | Intervention Type: DRUG; Name: Placebo ASA; Assigned to Arm(s): Active Clonidine and Placebo ASA, Placebo Clonidine and Placebo ASA
C: Arm Label: intravenous ibuprofen; Type: ACTIVE_COMPARATOR; Interventions: Drug: Intravenous ibuprofen | Arm Label: normal saline; Type: PLACEBO_COMPARATOR; Interventions: Other: Normal saline as placebo comparator | Intervention Type: OTHER; Name: Normal saline as placebo comparator; Assigned to Arm(s): normal saline | Intervention Type: DRUG; Name: Intravenous ibuprofen; Assigned to Arm(s): intravenous ibuprofen
D: Arm Label: Multimodal; Type: EXPERIMENTAL; Interventions: Drug: Ibuprofen, Drug: Gabapentin, Drug: Paracetamol | Arm Label: Morphine; Type: ACTIVE_COMPARATOR; Interventions: Drug: Morphine, Drug: Paracetamol | Intervention Type: DRUG; Name: Ibuprofen; Assigned to Arm(s): Multimodal | Intervention Type: DRUG; Name: Gabapentin; Assigned to Arm(s): Multimodal | Intervention Type: DRUG; Name: Morphine; Assigned to Arm(s): Morphine | Intervention Type: DRUG; Name: Paracetamol; Assigned to Arm(s): Morphine, Multimodal

Answer: A