Lornoxicam - a newer oxicam for postoperative pain relief in patients undergoing abdominal hysterectomy
Öz
Abstract
Aim. The present study evaluated the analgesic effect of lornoxicam- a new thienothiazine derivative of the oxicam class of non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative pain relief in patients undergoing abdominal hysterectomy. Method. The study included 50 adult female patients having physical status ASA grade I & II undergoing abdominal hysterectomy under general anaesthesia. Patients were administered lornoxicam 8 mg intramuscular at closure of the wound and were repeated 12 hourly for the next 48 hours. Intravenous morphine was used as rescue analgesia with patient controlled analgesia pump. Result. The total mean requirement of morphine was 50.0±4.74 mg during the study period. Mean requirement of morphine in first 24 hours and between 24-48 hours was 37.80±3.81 mg and 12.20±4.99 mg respectively. The mean requirement of morphine at different time intervals during the study i.e. from 0-6 hours was 14.7±2.13 mg, from 6-12 hours was 11.80±3.69 mg and from 12-24 hours, it was 11.30±3.05 mg. The requirement of morphine from 24-36 and 36-48 hours was 6.20±3.40 and 6.0±3.24 mg respectively. Conclusion. The requirement of morphine decreased significantly in the second half of the study. The requirement of morphine continued to decrease with each passing hour in the present study. Further, larger trials are needed to establish its efficacy as an analgesic for postoperative pain relief in different surgeries.
Keywords: Lornoxicam, post operative pain, abdominal hysterectomy
Özet
Amaç. Bu çalışmada abdominal histerektomi uygulanan hastalarda postoperatif ağrı tedavisinde nonsteroid antiinflamatuardan oksikam sınıfının yeni bir thienothiazine türevi olan larnoksikamın analjezik etkinliğini değerlendirdik. Yöntem. Bu çalışma ASA I-II grubundan genel anestezi altında abdominal histerektomi uygulanan 50 kadın hastayı içermektedir. Tüm hastalara cilt kapanma sırasında 8mg lornoksikam intramuskuler uygulandı ve sonraki 48 saat içinde 12 saatte bir tekrarlandı. Hasta kontrolü analjeziği içinde intravenöz morfin kullanıldı. Bulgular. Çalışma periyodu boyunca ortalama total morfin ihtiyacı 50,0±4,74 mg idi. İlk 24 saat için ortalama morfin ihtiyacı 37,80±3,81 mg, 24-48 saat süresince ise 12,20±4,99 mg idi. Çalışma boyunca farklı zamanlarda ortalama morfin ihtiyacı; örneğin 0-6. saat 14,7±2,13 mg, 6-12. saat 11,80±3,69 mg ve 12-24. saat ve 12-24. saat 11,30±3,05 mg idi. 24-36. saat morfin gereksinimi 6,20±3,40 mg ve34-48. saat 6,0±3,24 mg idi. Sonuç. Çalışmanın ikinci yarısında morfin ihtiyacı önemli derecede azaldı. Bu çalışmada morfin ihtiyacı her geçen saat azalmaya devam etti. Sonuç olarak farklı cerrahilerde postoperatif ağrı tedavisinde bir analjezik olarak lornoksikam etkinliğini belirlemek için daha geniş çalışmalara ihtiyaç olduğunun kanısındayız.
Anahtar sözcükler: Lornoksikam, post operatif ağrı, abdominal histerektomiAnahtar Kelimeler
Kaynakça
- Moote C. Efficacy of nonsteroidal anti-inflammatory drugs in the management of postoperative pain. Drugs 1992; 44(Suppl 5): 14-30.
- Arslan M, Tuncer B, Babacan A, Taneri F, Karadenizli Y, Onuk E, Ege B. Postoperative analgesic effects of lornoxicam after thyroidectomy: a placebo controlled randomized study. Agri 2006; 18: 27-33.
- Pruss TP, Stroissnig H, Radhofer-Welte S, Wendtlandt W, Mehdi N, Takacs F, Fellier H. Overview of the pharmacological properties, pharmacokinetics and animal safety assessment of lornoxicam. Postgrad Med J 1990; 66 (Suppl 4): S18Todd PA, Clissold SP. Tenoxicam. An update of its pharmacology and therapeutic efficacy in rheumatic diseases. Drugs 1991; 41: 625-46.
- Paulus HE. Non steroidal anti-inflammatory drugs. In: Saunders WB, Ed. Textbook of rheumatology. Philadelphia: 1989; 776.
- Macintyre PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth 2001; 87: 36-46.
- Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003; 97: 534-40.
- Austrup ML, Korean G. Analgesic agents for the postoperative period. Opioids. Surg Clin North Am 1999; 79: 253-73.
- Nayman J. Measurement and control of postoperative pain. Ann R Coll Surg Engl 1979; 61: 419-26.
- Tamsen A. Comparison of patient-controlled analgesia with constant infusion and intermittent intramuscular regimes. In: Harmer M, Rosen M, Vickers MD. eds. Patient-controlled analgesia. London: Blackwell Scientific Publications 1985; 111Beilin B, Bessler H, Mayburd E, Smirnov G, Dekel A, Yardeni I, Shavit Y. Effects of preemptive analgesia on pain and cytokine production in the postoperative period. Anesthesiology 2003; 98: 151-5.
- McCrory CR, Lindahl SG. Cyclooxygenase inhibition for postoperative analgesia. Anesth Analg 2002; 95: 169-76.
- Reasbeck PG, Rice ML, Reasbeck JC. Double-blind controlled trial of indomethacin as an adjunct to narcotic analgesia after major abdominal surgery. Lancet 1982; 2: 115-8.
- Gillies GW, Kenny GN, Bullingham RE, McArdle CS. The morphine sparing effect of ketorolac tromethamine. A study of a new, parenteral non-steroidal antiinflammatory agent after abdominal surgery. Anaesthesia 1987; 42: 727-31.
- Radhofer-Welte S, Rabasseda X. Lornoxicam, a new potent NSAID with an improved tolerability profile. Drugs of today 2000; 36: 55-76.
- Norholt SE, Sindet-Pedersen S, Larsen U, Bang U, Ingerslev J, Nielsen O, Hansen HJ, Ersboll AK. Pain control after dental surgery: a double-blind, randomised trial of lornoxicam versus morphine. Pain 1996; 67: 335-43.
- 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: 11-9.
- Ilias W, Jansen M. Pain control after hysterectomy: an observer-blind, randomised trial of lornoxicam versus tramadol. Br J Clin Pract 1996; 50: 19720
- Ravic M, Salas-Herrera I, Johnston A, Turner P, Foley K, Rosenow DE. A pharmacokinetic interaction between cimetidine or ranitidine and lornoxicam. Postgrad Med J 1993; 69: 865-6.
- Dittrich P, Radhofer-Welte S, Magometschnigg D, Kukovetz WR, Mayerhofer S, Ferber HP. The effect of concomitantly administered anacids on the bioavailability of lornoxicam, a novel highly potent NSAID. Drug Exp Clin Res 1990; 16: 57-62.
- Sapolya O, Karamanhoglu B, Memis D. Analgesic effects of lornoxicam after total abdominal hysterectomy. J Opiod Manag 2007; 3: 155-9.
- Kemal SO, Sahin S, Apan A. Comparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain. Agri 2007; 19: 24-31.
- Sener M, Yilmazer C, Yilmaz I, Bozdogan N, Ozer C, Donmez A, Arslan G. Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone. J Clin Anesth 2008; 20: 103İnan N, Özcan N, Takmaz SA, Özcan A, Erdoğan I, Baltacıi B. Efficacy of lornoxicam in postoperative analgesia after total knee replacement surgery. Agri 2007; 19: 38-45.
- Trampitsch E, Pipam W, Moertl M, Sadjak A, Dorn C, Sittl R, Likar R. Preemptive randomized, double-blind study with lornoxicam in gynecological surgery. Schmerz 2003; 17: 4-10.
Öz
Amaç. Bu çalışmada abdominal histerektomi uygulanan hastalarda postoperatif ağrı tedavisinde nonsteroid antiinflamatuardan oksikam sınıfının yeni bir thienothiazine türevi olan larnoksikamın analjezik etkinliğini değerlendirdik. Yöntem. Bu çalışma ASA I-II grubundan genel anestezi altında abdominal histerektomi uygulanan 50 kadın hastayı içermektedir. Tüm hastalara cilt kapanma sırasında 8mg lornoksikam intramuskuler uygulandı ve sonraki 48 saat içinde 12 saatte bir tekrarlandı. Hasta kontrolü analjeziği içinde intravenöz morfin kullanıldı. Bulgular. Çalışma periyodu boyunca ortalama total morfin ihtiyacı 50,0±4,74 mg idi. İlk 24 saat için ortalama morfin ihtiyacı 37,80±3,81 mg, 24-48 saat süresince ise 12,20±4,99 mg idi. Çalışma boyunca farklı zamanlarda ortalama morfin ihtiyacı; örneğin 0-6. saat 14,7±2,13 mg, 6-12. saat 11,80±3,69 mg ve 12-24. saat ve 12-24. saat 11,30±3,05 mg idi. 24-36. saat morfin gereksinimi 6,20±3,40 mg ve3448. saat 6,0±3,24 mg idi. Sonuç. Çalışmanın ikinci yarısında morfin ihtiyacı önemli derecede azaldı. Bu çalışmada morfin ihtiyacı her geçen saat azalmaya devam etti. Sonuç olarak farklı cerrahilerde postoperatif ağrı tedavisinde bir analjezik olarak lornoksikam etkinliğini belirlemek için daha geniş çalışmalara ihtiyaç olduğunun kanısındayız.
Anahtar Kelimeler
Kaynakça
- Moote C. Efficacy of nonsteroidal anti-inflammatory drugs in the management of postoperative pain. Drugs 1992; 44(Suppl 5): 14-30.
- Arslan M, Tuncer B, Babacan A, Taneri F, Karadenizli Y, Onuk E, Ege B. Postoperative analgesic effects of lornoxicam after thyroidectomy: a placebo controlled randomized study. Agri 2006; 18: 27-33.
- Pruss TP, Stroissnig H, Radhofer-Welte S, Wendtlandt W, Mehdi N, Takacs F, Fellier H. Overview of the pharmacological properties, pharmacokinetics and animal safety assessment of lornoxicam. Postgrad Med J 1990; 66 (Suppl 4): S18Todd PA, Clissold SP. Tenoxicam. An update of its pharmacology and therapeutic efficacy in rheumatic diseases. Drugs 1991; 41: 625-46.
- Paulus HE. Non steroidal anti-inflammatory drugs. In: Saunders WB, Ed. Textbook of rheumatology. Philadelphia: 1989; 776.
- Macintyre PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth 2001; 87: 36-46.
- Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003; 97: 534-40.
- Austrup ML, Korean G. Analgesic agents for the postoperative period. Opioids. Surg Clin North Am 1999; 79: 253-73.
- Nayman J. Measurement and control of postoperative pain. Ann R Coll Surg Engl 1979; 61: 419-26.
- Tamsen A. Comparison of patient-controlled analgesia with constant infusion and intermittent intramuscular regimes. In: Harmer M, Rosen M, Vickers MD. eds. Patient-controlled analgesia. London: Blackwell Scientific Publications 1985; 111Beilin B, Bessler H, Mayburd E, Smirnov G, Dekel A, Yardeni I, Shavit Y. Effects of preemptive analgesia on pain and cytokine production in the postoperative period. Anesthesiology 2003; 98: 151-5.
- McCrory CR, Lindahl SG. Cyclooxygenase inhibition for postoperative analgesia. Anesth Analg 2002; 95: 169-76.
- Reasbeck PG, Rice ML, Reasbeck JC. Double-blind controlled trial of indomethacin as an adjunct to narcotic analgesia after major abdominal surgery. Lancet 1982; 2: 115-8.
- Gillies GW, Kenny GN, Bullingham RE, McArdle CS. The morphine sparing effect of ketorolac tromethamine. A study of a new, parenteral non-steroidal antiinflammatory agent after abdominal surgery. Anaesthesia 1987; 42: 727-31.
- Radhofer-Welte S, Rabasseda X. Lornoxicam, a new potent NSAID with an improved tolerability profile. Drugs of today 2000; 36: 55-76.
- Norholt SE, Sindet-Pedersen S, Larsen U, Bang U, Ingerslev J, Nielsen O, Hansen HJ, Ersboll AK. Pain control after dental surgery: a double-blind, randomised trial of lornoxicam versus morphine. Pain 1996; 67: 335-43.
- 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: 11-9.
- Ilias W, Jansen M. Pain control after hysterectomy: an observer-blind, randomised trial of lornoxicam versus tramadol. Br J Clin Pract 1996; 50: 19720
- Ravic M, Salas-Herrera I, Johnston A, Turner P, Foley K, Rosenow DE. A pharmacokinetic interaction between cimetidine or ranitidine and lornoxicam. Postgrad Med J 1993; 69: 865-6.
- Dittrich P, Radhofer-Welte S, Magometschnigg D, Kukovetz WR, Mayerhofer S, Ferber HP. The effect of concomitantly administered anacids on the bioavailability of lornoxicam, a novel highly potent NSAID. Drug Exp Clin Res 1990; 16: 57-62.
- Sapolya O, Karamanhoglu B, Memis D. Analgesic effects of lornoxicam after total abdominal hysterectomy. J Opiod Manag 2007; 3: 155-9.
- Kemal SO, Sahin S, Apan A. Comparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain. Agri 2007; 19: 24-31.
- Sener M, Yilmazer C, Yilmaz I, Bozdogan N, Ozer C, Donmez A, Arslan G. Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone. J Clin Anesth 2008; 20: 103İnan N, Özcan N, Takmaz SA, Özcan A, Erdoğan I, Baltacıi B. Efficacy of lornoxicam in postoperative analgesia after total knee replacement surgery. Agri 2007; 19: 38-45.
- Trampitsch E, Pipam W, Moertl M, Sadjak A, Dorn C, Sittl R, Likar R. Preemptive randomized, double-blind study with lornoxicam in gynecological surgery. Schmerz 2003; 17: 4-10.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Dahili Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Ocak 2013 |
| Yayımlandığı Sayı | Yıl 2013Cilt: 35 Sayı: 2 |