Tenoxicam IV in Major Gynaecological Surgery— Pharmacokinetic, Pain Relief and Haematological Effects

Abstract

This study compared postoperative analgesic dispensation and measures relating to haemostasis following intravenous administration, in a randomized double-blinded manner, of either placebo or tenoxicam 20 mg to 30 women presenting for major gynaecological oncology surgery under a standardized, combined epidural/general anaesthetic technique. Pharmacokinetic disposition of tenoxicam in this patient cohort was also described. There was no objective or subjective alteration in haemostatic function or increase in blood loss, nor any deviation from the normal range of values. Postoperative analgesia during the first 48 hours was delivered to achieve a VAS endpoint of less than five on leg-raising, by a combination of a nurse-controlled low-dose background epidural infusion and patient-administered epidural bolus. Greater VAS variability was observed during the first four postoperative hours (P=0.08). The tenoxicam group self-administered significantly fewer epidural bolus doses to maintain satisfactory analgesia compared with the placebo group during the first 24 hours (P=0.004) and 48 hours (P=0.01) postoperatively. Similar differences between the groups in the total dose of the epidural bupivacaine/fentanyl mixture delivered were described (4 h: P=0.148; 24 h: P=0.033; 48 h: P=0.001) (Figure 2). Despite surgery, transfusion and the use of a renal protective fluid administration strategy, tenoxicam disposition was not greatly different from that widely described for healthy volunteers. There were no significant side-effects and no adverse events attributable to tenoxicam. In this small study we have shown that tenoxicam administered preoperatively reduced the epidural analgesic requirements during the first 48 hours following major gynaecological surgery. There was no clinical or pathological evidence of haematological impairment following a single IV administration of tenoxicam 20 mg.

Effect on Pain Relief and Inflammatory Response Following Addition of Tenoxicam to Intravenous Patient-Controlled Morphine Analgesia: A Double-Blind, Randomized, Controlled Study in Patients Undergoing Spine Fusion Surgery

“…Multimodal analgesia has been shown to induce superior postoperative pain control as compared with M alone in many surgeries and several studies involving T for postoperative pain in different types of surgeries have reported results similar to those observed in the current study . Based on the results of other studies, application of a single dose of T before or immediately after induction of anesthesia produced analgesic effects lasting for 24–48 hours postoperatively .…”

“…Multimodal analgesia has been shown to induce superior postoperative pain control as compared with M alone in many surgeries and several studies involving T for postoperative pain in different types of surgeries have reported results similar to those observed in the current study . Based on the results of other studies, application of a single dose of T before or immediately after induction of anesthesia produced analgesic effects lasting for 24–48 hours postoperatively . T, an NSAID in the oxicam group that inhibits both cyclooxygenase‐1 and 2, takes about 30 minutes to onset, reaches a plasma peak concentration within 2 hours, and remains in the body with an average elimination half‐life of 72 hours after drug administration .…”

“…Tenoxicam (T), an NSAID extremely suitable for postoperative analgesia , has demonstrated both analgesic effects and anti‐inflammatory effects on the upregulated expression of prostaglandin E 2 (PGE 2 ), interleukin (IL)‐6, and IL‐8 in response to surgery . This is particularly important because IL‐6, IL‐8, and PGE 2 have been implicated in the pathogenesis of pain .…”

Comparison of paravertebral block versus fast-track general anesthesia via laryngeal mask airway in outpatient inguinal herniorrhaphy

“…To provide pre-emptive analgesia, we administered 20 mg tenoxicam IV, which other studies have shown to be effective [31][32][33]. Also, just before skin closure, we infiltrated the wound with 0.25% levobupivacaine for 2-3 h, which has also been shown to be effective [8].…”

Effects of tenoxicam in experimental corrosive esophagitis model

“…To test this study's hypothesis that anti‐inflammatory drugs could prevent the development of this cascade, a potent anti‐inflammatory drug such as tenoxicam was used. Tenoxicam as a non‐steroid anti‐inflammatory drug with a long half‐life prevents various leukocyte functions including removing various oxygen radicals found in the inflammation area and releasing phagocyte and histamine by inhibiting prostaglandin synthesis …”