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

  • E. Kocaayan (a1), S. Ozkardeşler (a2), D. Ozzeybek (a2), S. Bayındır (a3) and M. Akan (a2)...

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.

Copyright

Corresponding author

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

References

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1.Joshi, GP, White, PF. Management of acute and postoperative pain. Curr Opin Anaesthesiol 2001; 14: 417421.
2.Bisgaard, T. Analgesic treatment after laparoscopic cholecystectomy. Anesthesiology 2006; 104: 835846.
3.White, PF. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg 2002; 94: 577585.
4.Gonzalez, JP, Todd, PA. Tenoxicam. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy. Drugs 1987; 34: 289310.
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.
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.
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.
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.
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.
10.Trampitsh, E, Pipam, W, Moertl, M et al. . Lornoxicam bei gynakologischen eingriffen. Schmerz 2003; 17: 410.
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.
12.Kelly, DJ, Ahmad, M, Brull, SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth 2001; 48: 10001010.
13.Katz, J, McCartney, CJL. Current status of pre-emptive analgesia. Curr Opin Anaesthesiol 2002; 15: 435441.
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.
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.
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.
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.
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.
19.Munro, EJ, Yount, SJ, Broome, IJ, Robb, HM, Wardall, GJ. Intravenous tenoxicam for analgesia following laparoscopic cholecystectomy. Anaesth Intensive Care 1998; 26: 5660.
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.
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.
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.
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.
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.
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.
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).
27.Souter, AJ, Fredman, B, White, PF. Controversies in the perioperative use of nonsteroidal anti-inflammatory drugs. Anesth Analg 1994; 79: 11781190.
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.

Keywords

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

  • E. Kocaayan (a1), S. Ozkardeşler (a2), D. Ozzeybek (a2), S. Bayındır (a3) and M. Akan (a2)...

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