Epidural lornoxicam administration – innocent

Canduz, Basak; Aktuğ, Hüseyin; Mavioğlu, Ömür; Erkin, Yüksel; Dilsiz, Ozlem Yilmaz; Uyanıkgil, Yiğit; Korkmaz, Hasan; Baka, Meral

doi:10.1016/j.jocn.2006.10.006

Cited by 14 publications

(6 citation statements)

References 21 publications

(23 reference statements)

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“…Of note, a toxicity study of epidural administration of parecoxib in rats showed no neurologic behavioral or histological evidence of neurotoxicity [ 84 ]. However, lornoxicam, another NSAID, was shown to have dose-dependent neurotoxic effects after epidural administration to rabbits [ 85 ]. The perineural use of anti-inflammatory medications other than dexamethasone merits further pre-clinical and clinical study with appropriate federal approval; however, their use cannot be recommended at this time.…”

Section: Resultsmentioning

confidence: 99%

Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review

et al. 2015

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BackgroundThe use of peripheral nerve blocks for anesthesia and postoperative analgesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Numerous randomized controlled trials and meta-analyses have examined the pros and cons of the use of various individual adjuvants.ObjectivesTo systematically review adjuvant-related randomized controlled trials and meta-analyses and provide clinical recommendations for the use of adjuvants in peripheral nerve blocks.MethodsRandomized controlled trials and meta-analyses that were published between 1990 and 2014 were included in the initial bibliographic search, which was conducted using Medline/PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Only studies that were published in English and listed block analgesic duration as an outcome were included. Trials that had already been published in the identified meta-analyses and included adjuvants not in widespread use and published without an Investigational New Drug application or equivalent status were excluded.ResultsSixty one novel clinical trials and meta-analyses were identified and included in this review. The clinical trials reported analgesic duration data for the following adjuvants: buprenorphine (6), morphine (6), fentanyl (10), epinephrine (3), clonidine (7), dexmedetomidine (7), dexamethasone (7), tramadol (8), and magnesium (4). Studies of perineural buprenorphine, clonidine, dexamethasone, dexmedetomidine, and magnesium most consistently demonstrated prolongation of peripheral nerve blocks.ConclusionsBuprenorphine, clonidine, dexamethasone, magnesium, and dexmedetomidine are promising agents for use in prolongation of local anesthetic peripheral nerve blocks, and further studies of safety and efficacy are merited. However, caution is recommended with use of any perineural adjuvant, as none have Food and Drug Administration approval, and concerns for side effects and potential toxicity persist.

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Section: Resultsmentioning

confidence: 99%

Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review

et al. 2015

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“…Neurotoxicity of neuraxial or perineural non-steroidal anti-inflammatory drugs (NSAIDs) as adjuvants has been a major concern. Although there are studies showing prolongation of the effect of local anaesthetics with epidural instillation of Parecoxib and Lornoxicam[ 161 , 162 ], the use of epidural Lornoxicam has also shown “histopathological signs of neurotoxicity”. There is very little research evidence available on the use of anti-inflammatory medications in peripheral nerve blocks and further studies are warranted.…”

Section: Discussionmentioning

confidence: 99%

Adjuvants to local anesthetics: Current understanding and future trends

Swain

Nag

Sahu

et al. 2017

WJCC

194

138

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Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action. A large array of opioids ranging from morphine, fentanyl and sufentanyl to hydromorphone, buprenorphine and tramadol has been used with varying success. However, their use has been limited by their adverse effect like respiratory depression, nausea, vomiting and pruritus, especially with its neuraxial use. Epinephrine potentiates the local anesthetics by its antinociceptive properties mediated by alpha-2 adrenoreceptor activation along with its vasoconstrictive properties limiting the systemic absorption of local anesthetics. Alpha 2 adrenoreceptor antagonists like clonidine and dexmedetomidine are one of the most widely used class of local anesthetic adjuvants. Other drugs like steroids (dexamethasone), anti-inflammatory agents (parecoxib and lornoxicam), midazolam, ketamine, magnesium sulfate and neostigmine have also been used with mixed success. The concern regarding the safety profile of these adjuvants is due to its potential neurotoxicity and neurological complications which necessitate further research in this direction. Current research is directed towards a search for agents and techniques which would prolong local anaesthetic action without its deleterious effects. This includes novel approaches like use of charged molecules to produce local anaesthetic action (tonicaine and n butyl tetracaine), new age delivery mechanisms for prolonged bioavailability (liposomal, microspheres and cyclodextrin systems) and further studies with other drugs (adenosine, neuromuscular blockers, dextrans).

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“…The neurotoxic effects of intrathecally administered drugs is dependent on the type of drug and dosage employed, and the effects may be more subtle and not always be evident in physical pain or motor function tests. Canduz et al 27 demonstrated the neurotoxic effects caused by three different doses of lornoxicam delivered through an epidural catheter. Yaksh et al 26 delivered ketorolac infusions to dogs through an intrathecal catheter for 28d, and administered intrathecal ketorolac injections to rats 4 times a day for 6d, and found no signs of toxicity in the spinal cord or the nerve roots.…”

Section: Discussionmentioning

confidence: 99%