Tenoxicam IV for Major Gynaecological Surgery—Effects on Renal Function

Abstract

Thirty women presenting for major gynaecological oncology surgery under a standardized, combined epidural/general anaesthetic technique received either placebo or tenoxicam 20 mg intravenously, in a randomized double-blinded manner prior to surgery. Plasma and urinary electrolytes, creatinine, prostaglandins PgE 2 and PgF1α, and thromboxane (T x B 2) were collected 12 hours preoperatively and then for four days postoperatively. There were no significant differences in any of the measured parameters between the groups, at any of the measurement times.

Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function

“…Several such studies (Aitken 1992;Irwin 1995;Perttunen 1992;Power 1992) showed that NSAIDs caused changes in electrolyte balance and urine output. In contrast, others have failed to show any significant e ect of NSAIDS on renal function (Brinkmann 1998;Jones 2000, Laisalmi 2001aPerttunen 1999;Turner 1994;Varrassi 1994). Most of these RCTs were limited to the e ects of NSAIDs on the renal system within the first 48 hours in adults with normal renal function, and did not address the longer term e ects on renal function or the safety of NSAIDs in patients with impaired renal function.…”

“…Where specific details were given, surgery was on an elective basis. All patients underwent general anaesthesia, with additional regional anaesthesia in three studies (Brinkmann 1998;Jones 2000;Perttunen 1992). Adequate preoperative and postoperative hydration treatment was described in only one study (Slaven 1998).…”

“…The route of NSAID administration varied (intravenous bolus, intravenous infusions, suppositories, intramuscular, orally or combinations of these). A single dose NSAID regimen was used in four studies (Brinkmann 1998;Jones 2000;Khalil 2006;Slaven 1998). Creatinine clearance was collected in nine studies (Nuutinen 1991;Aitken 1992;Brinkmann 1998;Immer 2003;Irwin 1995;Jones 2000;Khalil 2006;Nuutinen 1991; Slaven 1998) but su icient data for meta-analysis was available in seven studies (Aitken 1992;Brinkmann 1998;Jones 2000;Khalil 2006;Power 1992;Slaven 1998).…”

“…A single dose NSAID regimen was used in four studies (Brinkmann 1998;Jones 2000;Khalil 2006;Slaven 1998). Creatinine clearance was collected in nine studies (Nuutinen 1991;Aitken 1992;Brinkmann 1998;Immer 2003;Irwin 1995;Jones 2000;Khalil 2006;Nuutinen 1991; Slaven 1998) but su icient data for meta-analysis was available in seven studies (Aitken 1992;Brinkmann 1998;Jones 2000;Khalil 2006;Power 1992;Slaven 1998). The intermittent ketorolac arm (10 mg every four hours intramuscular) was chosen randomly over the continuous ketorolac arm (intramuscular infusion) in the Aitken 1992 trial for the purposes of this review.…”

“…Ten trials (Hynninen 2000;Jones 2000;Laisalmi 2001a;Kulik 2004;Khalil 2006;Perttunen 1999;Rao 2000;Rapanos 1999;Ready 1994;Turner 1994) had adequate allocation of concealment (A). The remaining trials received an allocation score of B (unclear).…”