Timing of pre-emptive tenoxican is important for postoperative analgesia

Abstract

162Purpose: In this prospective randomized study, a comparison was made between the efficacy of 20 mg tenoxicam, administered either, 30 min preoperatively or at induction of anesthesia, for the relief of postoperative pain in patients undergoing ambulatory breast biopsy.Methods. Seventy-three patients were recruited and all received a standard anesthetic consisting of induction with 2 mg·kg -1 propofol followed by 5 µg·kg -1 alfentanyl. No premedication was administered and at the end of the procedure the wounds were infiltrated with 10 ml of bupivacaine (0.5 %). Patients were randomized to receive 20 mg tenoxicam intraveneously either 30 min before surgery or at induction of anesthesia.Results: Demographic criteria were similar in both groups. There were differences in pain scores at 30, 60, 120 and 240 min postoperatively (VAS at 30 min 3.2 ± 1.2 vs 5.5 ± 1.8; P < 0.001: VAS at 60 min 1.8 ± 1.2 vs 3.7 ± 1.9; P < 0.001: VAS at 120 min 0.9 ± 0.9 vs 1.7 ± 1.0; P = 0. 003: VAS at 240 min 0.5 ± 0.5 vs 1.1 ± 0.8; P < 0.001: Expressed as mean ± SD). There was a difference in the number of patients requiring additional analgesia, in the first four hours postoperatively (12 (33%) vs 27 (73%); P = 0.001) and a difference in the time to additional analgesia in these patients (87.5 ± 32.5 vs 55.0 ± 26.8 min; P = 0.002). Conclusion:Early administration of pre-emptive tenoxicam 30 min before induction of anesthesia improves postoperative analgesia in patients undergoing ambulatory breast biopsy.Objectif : Notre étude porte sur la comparaison de l'efficacité de 20 mg de ténoxicam, administrés 30 min avant l'opération ou à l'induction de l'anesthésie pour le soulagement de la douleur postopératoire de patientes qui subissent une biopsie du sein en chirurgie ambulatoire.Méthode : Nous avons recruté 73 patientes qui ont toutes reçu un régime anesthésique normal constitué d'une induction avec 2 mg·kg -1 de propofol suivi de 5µg·kg -1 d'alfentanil. Aucune prémédication n'a été administrée et, à la fin de l'intervention, 10 ml de bupivacaïne (0,5 %) ont été infiltrés dans la plaie chirurgicale. Les patientes, réparties de façon aléatoire, ont reçu 20 mg de ténoxicam intraveineux, soit 30 min avant l'opération, soit à l'induction de l'anesthésie.Résultats : Les informations personnelles étaient similaires dans les deux groupes. Les scores de douleur ont été différents pour les mesures réalisées 30, 60, 120 et 240 min après l'opération (selon l'EVA à 30 min 3,2 ± 1,2 vs 5,5 ± 1,8; P < 0,001: EVA à 60 min 1,8 ± 1,2 vs 3,7 ± 1,9; P < 0,001: EVA à 120 min 0,9 ± 0,9 vs 1,7 ± 1,0; P = 0,003: EVA à 240 min 0,5 ± 0,5 vs 1,1 ± 0,8; P < 0,001: moyenne ± écart type). Un nombre différent de patientes a demandé de l'analgésie supplémentaire, pendant les quatre premières heures postopéra-toires (12 (33 %) vs 27 (73 %); P = 0,001). Le temps écoulé avant cette demande d'analgésie diffère également (87,5 ± 32,5 vs 55,0 ± 26,8 min; P = 0,002).Conclusion : L'administration précoce de ténoxicam préventif, 30 min avant l'induction de l'anesthésie, amé...

Pre-emptive analgesia: importance of timing

“…Pre-emptive analgesic effects were reported by six studies (~33 %); three (~16.5%) of which found narrow effects 13,29,32 and three (~16.5%), broad effects. 17,30,31 Not only is the proportion of positive studies small, but the magnitude of the effects, when present, is modest at best.…”

“…Of the 18 randomized, single-or double-blind studies that used an NSAID as the target intervention, five evaluated broad pre-emptive effects, [17][18][19][20][21] nine evaluated narrow pre-emptive effects, 13,[22][23][24][25][26][27][28][29] and four both broad and narrow effects. [30][31][32][33] Studies of patients undergoing oral surgery such as third molar extraction 17,18,20,[22][23][24][25] or pulpectomy 3 0 were among the earliest to be conducted.…”

“…More recently, other procedures have been studied, including abdominal hysterectomy, 26,33 orthopedic surgery, 21,27,28,31,32 laparoscopy, 1 9 and breast biopsy. 13,29 Routes of administration include oral, rectal, intramuscular and intravenous. A variety of NSAIDs have been used including the propionic acids, acetic acids, oxicams and paracetamol that differ in the extent of their anti-inflammatory activity, analgesic effects, antipyretic actions and pharmacokinetics.…”

“…17,30,31 Not only is the proportion of positive studies small, but the magnitude of the effects, when present, is modest at best. The one exception to this is a randomized study 2 9 conducted at the same institution as the study by O'Hanlon et al 13 in which 20 mg tenoxicam iv was administered to women undergoing breast biopsy either 30 min before surgery or an unspecified period of time after incision. Patients in the pre-emptive tenoxicam group took longer to request postoperative analgesics, required less meperidine and reported lower pain scores over the four hour observation period.…”

Atividade preemptiva da infiltração da incisão com ropivacaína a 0,75%, em pacientes submetidos à herniorrafia inguinal

“…However, its effectiveness as compared to conventional regimens to manage postoperative acute pain is still controversial. Some studies could not show beneficial effects with any preemptive drug, although others have shown preemptive effect only with non-steroid anti-inflammatory drugs (NSAIDS), local anesthetics and other drugs [2][3][4][5][6][7] . Local wound infiltration with local anesthetics has been recommended to decrease perioperative opioid consumption and postoperative pain, however there is a study which could not show differences in postoperative pain intensity with pre or postoperative infiltration with bupivacaína or lidocaine 2,8,9 .…”