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Comparison of effects of preoperatively administered lornoxicam and tenoxicam on morphine consumption after laparoscopic cholecystectomy

Published online by Cambridge University Press:  01 August 2007

E. Kocaayan
Affiliation:
Universal Hospital, Department of Anaesthesiology, Manisa, Turkey
S. Ozkardeşler
Affiliation:
Dokuz Eylül University, Medical School, Department of Anaesthesiology, Izmir, Turkey
D. Ozzeybek*
Affiliation:
Dokuz Eylül University, Medical School, Department of Anaesthesiology, Izmir, Turkey
S. Bayındır
Affiliation:
Niksar State Hospital, Department of Anaesthesiology, Tokat, Turkey
M. Akan
Affiliation:
Dokuz Eylül University, Medical School, Department of Anaesthesiology, Izmir, Turkey
*
Correspondence to: Deniz Ozzeybek, Department of Anaesthesiology, Medical School, Dokuz Eylül University, 752 sok. No: 54/17 Özege Sitesi 35310, Güzelbahçe, İzmir, Turkey. E-mail: deniz.ozzeybek@deu.edu.tr; Tel: +90 232 4122816; Fax: +90 232 4122800
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Summary

Background and objective

The efficacy, tolerability and the morphine-sparing effects of lornoxicam were compared with those of tenoxicam when used preoperatively in patients undergoing laparoscopic cholecystectomy.

Methods

In this prospective, double-blind study, 60 ASA I–II patients undergoing laparoscopic cholecystectomy were randomized equally to receive intravenous tenoxicam 40 mg (Group T) or lornoxicam 16 mg (Group L), preemptively. Three patients withdrew from the study, so 57 patients were included in the analysis. In the postoperative period, the first morphine demand times, pain scores, side-effects and cumulative morphine consumptions were evaluated during the first 24 h.

Results

The patient characteristics data and the duration of surgery were similar between two groups, except for body weights (P = 0.002). The first morphine demand time was significantly longer in Group L (P = 0.037), but the pain levels did not differ. The mean pain scores were higher in Group T in the 15 min (P = 0.036), 1 h (P = 0.020), 2 h (P = 0.001) and 4 h (P = 0.0042) after extubation. A statistically significant difference between two groups was found in calculated cumulative morphine consumptions per kilogram in the 15 min (P = 0.037), 30 min (P = 0.016), and 1 h (P = 0.004) and 2 h (P = 0.013) between two groups. There was no difference in the severity of nausea but 13 patients in Group T and five patients in Group L had vomiting (P = 0.018). Patient satisfaction was similar in the two groups.

Conclusions

Preoperatively administered lornoxicam 16 mg significantly prolonged the first morphine demand time, reduced postoperative morphine consumption during the first 4 h and caused significantly fewer adverse effects when compared with tenoxicam after laparoscopic cholecystectomy.

Type
Original Article
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Joshi, GP, White, PF. Management of acute and postoperative pain. Curr Opin Anaesthesiol 2001; 14: 417421.CrossRefGoogle ScholarPubMed
2.Bisgaard, T. Analgesic treatment after laparoscopic cholecystectomy. Anesthesiology 2006; 104: 835846.CrossRefGoogle ScholarPubMed
3.White, PF. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg 2002; 94: 577585.CrossRefGoogle ScholarPubMed
4.Gonzalez, JP, Todd, PA. Tenoxicam. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy. Drugs 1987; 34: 289310.CrossRefGoogle ScholarPubMed
5.Balfour, JA, Fitton, A, Barradell, LB. Lornoxicam. A review of its pharmacology and therapeutic potential in the management of painful and inflammatory conditions. Drugs 1996; 51: 639657.CrossRefGoogle ScholarPubMed
6.Pruss, TP, Stroissnig, H, Radhover-Welte, S et al. . Overview of the pharmacological properties, pharmacokinetics and animal safety assessment of lornoxicam. Postgrad Med J 1990; 66: 1821.Google ScholarPubMed
7.Rosenow, DE, Albrechtsen, M, Stolke, D. A comparison of patient-controlled analgesia with lornoxicam versus morphine in patients undergoing lumbar disk surgery. Anesth Analg 1998; 86: 10451050.Google ScholarPubMed
8.Ilias, W, Jansen, M. Pain control after hysterectomy: an observer-blind, randomised trial of lornoxicam versus tramadol. Br J Clin Pract 1996; 50: 197202.CrossRefGoogle ScholarPubMed
9.Straunstrup, H, Ovesen, J, Larsen, U, Elbaek, T, Larsen, U, Kroner, K. Efficacy and tolerability of lornoxicam versus tramadol in postoperative pain. J Clin Pharmacol 1999; 39: 18.Google Scholar
10.Trampitsh, E, Pipam, W, Moertl, M et al. . Lornoxicam bei gynakologischen eingriffen. Schmerz 2003; 17: 410.CrossRefGoogle Scholar
11.Visalyaputra, S, Nuchsaroach, P, Sritisarn, S et al. . Postoperative analgesic effects of intravenous lornoxicam and morphine with pre-emptive ropivacaine skin infiltration and preperitoneal instillation after trans-abdominal hysterectomy. J Med Assoc Thai 2002; 85: 10101016.Google Scholar
12.Kelly, DJ, Ahmad, M, Brull, SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth 2001; 48: 10001010.CrossRefGoogle ScholarPubMed
13.Katz, J, McCartney, CJL. Current status of pre-emptive analgesia. Curr Opin Anaesthesiol 2002; 15: 435441.Google Scholar
14.Yamamoto, T, Yaksh, TL. Comparison of the antinociceptive effects of pre- and post-treatment with intrathecal morphine and MK801, an NMDA antagonist, on the formalin test in the rat. Anesthesiology 1992; 77: 757763.Google Scholar
15.Colbert, SA, McCrory, C, O’Hanlon, DM, Tanner, A, Doyle, M. A prospective study comparing intravenous tenoxicam with rectal diclofenac for pain relief in day case surgery. Eur J Anaesthesiol 1998; 15: 544548.CrossRefGoogle ScholarPubMed
16.O’Hanlon, DM, Thambipillai, T, Colbert, ST, Keane, PW, Given, HF. Timing of pre-emptive tenoxicam is important for postoperative analgesia. Can J Anaesth 2001; 48: 162166.Google Scholar
17.Merry, AF, Wardall, GJ, Cameron, RJ, Peskett, MJ, Wild, CJ. Prospective, controlled, double-blind study of i.v. tenoxicam for analgesia after thoracotomy. Br J Anaesth 1992; 69: 9294.Google Scholar
18.Merry, AF, Sidebotham, DA, Middleton, NG, Calder, MV, Webster, CS. Tenoxicam 20 mg or 40 mg after thoracotomy: a prospective, randomized, double-blind, placebo-controlled study. Anaesth Intensive Care 2002; 30: 160166.Google Scholar
19.Munro, EJ, Yount, SJ, Broome, IJ, Robb, HM, Wardall, GJ. Intravenous tenoxicam for analgesia following laparoscopic cholecystectomy. Anaesth Intensive Care 1998; 26: 5660.Google Scholar
20.Salman, MA, Yücebaş, ME, Coşkun, F, Aypar, Ü. Day-case laparoscopy: a comparison of prophylactic opioid, NSAID or local anesthesia for postoperative analgesia. Acta Anaesthesiol Scand 2000; 44: 536542.CrossRefGoogle ScholarPubMed
21.Windsor, A, Mc Donald, P, Mumtaz, T, Millar, JM. The analgesic efficacy of tenoxicam versus placebo in day case laparoscopy: a randomised parallel double-blind trial. Anaesthesia 1996; 51: 10661069.Google Scholar
22.De Decker, K, Vercauteren, M, Hoffmann, V, Lasters, B, Adriaensen, H. Piroxicam versus tenoxicam in spine surgery: a placebo controlled study. Acta Anaesthesiol Belg 2001; 52: 265269.Google Scholar
23.Vandermeulen, EP, Van Aken, H, Scholtes, JL, Singelyn, F, Buelens, A, Haazen, L. Intravenous administration of tenoxicam 40 mg for post-operative analgesia: a double-blind, placebo-controlled multicentre study. Eur J Anaesthesiol 1997; 14: 250257.CrossRefGoogle ScholarPubMed
24.Rosenow, DE, van Krieken, F, Stolke, D, Kursten, FW. Intravenous administration of lornoxicam, a new NSAID, and pethidine for postoperative pain. Clin Drug Invest 1996; 11: 1119.CrossRefGoogle Scholar
25.Papadima, A, Lagoudianakis, EE, Antonakis, PT et al. . Parecoxib vs. lornoxicam in the treatment of postoperative pain after laparoscopic cholecystectomy: a prospective randomized placebo-controlled trial. Eur J Anaesthesiol 2007; 24: 154158.CrossRefGoogle ScholarPubMed
26. Pektas ZO, Sener M, Bayram B et al. A comparison of pre-emptive analgesic efficacy of diflunisal and lornoxicam for postoperative pain management: a prospective, randomized, single-blind, cross-over study. Int J Oral Maxillofac Surg 2006; December 6 (Epub ahead of print).Google Scholar
27.Souter, AJ, Fredman, B, White, PF. Controversies in the perioperative use of nonsteroidal anti-inflammatory drugs. Anesth Analg 1994; 79: 11781190.CrossRefGoogle Scholar
28.Dobbs, FF, Kumar, V, Alexander, JI, Hull, MGR. Pain after laparoscopy related to posture and ring versus clip sterilization. Br J Obstet Gynaecol 1987; 94: 262266.CrossRefGoogle ScholarPubMed