lornoxicam and Varicocele

The oxicam NSAID lornoxicam is a potent analgesic with excellent anti-inflammatory properties in a range of painful and/or inflammatory conditions, including postoperative pain. Levobupivacaine, the S-(-)-isomer of bupivacaine, is a long-acting local anaesthetic that can be infiltrated into wounds for management of postoperative pain. We assessed the analgesic efficacy of lornoxicam when administered as an adjuvant to levobupivacaine wound infiltration after varicocoele operation.. Sixty patients who underwent varicocoele surgery were randomly assigned to three different treatment groups. Before skin closure, patients received the following treatments: group I (n=20) patients received normal saline 20 mL wound infiltration and intravenous lornoxicam (Xefo, Nycomed Pharma AS, Roskilde, Denmark) 2 mL (8 mg); group II (n=20) patients received 0.25% levobupivacaine (Chirocaine, Abbott Scandinavia AB, Solna, Sweden) 10mL with normal saline 10 mL wound infiltration and intravenous normal saline 2 mL; group III (n=20) patients received 0.25% levobupivacaine 10 mL with normal saline 10 mL wound infiltration and intravenous lornoxicam 2 mL (8 mg). Pain scores and total pethidine (meperidine) consumption were measured at 1, 2, 4, 6, 12 and 24 hours postoperatively. Time to first analgesic requirement and patient satisfaction were also compared post-surgery.. Pain scores during the first 6 hours postoperatively were significantly lower in group III than in group I and group II (p<0.01). Total pethidine consumption was significantly lower in group III (34.0+/-28.0 mg) than in group I (74.0+/-25 mg) and group II (76.0+/-29 mg) [p<0.01]. Time to first analgesic was also significantly longer in group III (14.8+/-8.4 hours) than in group I (6.2+/-5.2 hours) and group II (5.8+/-7.1 hours) [p<0.01]. The incidence of postoperative nausea and vomiting was significantly lower in group III than in group I and group II (p<0.05). More patients in group III described their analgesia as good or excellent than in group I or group II (p<0.01).. In this study, levobupivacaine wound infiltration with adjuvant intravenous lornoxicam administration was associated with better postoperative analgesia during the early postoperative hours after varicocoele surgery than that induced by lornoxicam alone or levobupivacaine wound infiltration alone.

Topics: Adult; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Bupivacaine; Double-Blind Method; Drug Therapy, Combination; Humans; Levobupivacaine; Male; Pain, Postoperative; Piroxicam; Varicocele

To determine whether intravenous injection of lornoxicam 30 minutes before skin incision provides better pain relief after varicocelectomy than postoperative administration of lornoxicam.. Prospective, double-blind, randomized clinical investigation.. Operating room and postoperative recovery area.. 44 ASA physical status I and II adult male patients undergoing varicocelectomy.. Patients were randomized either to receive 8 mg lornoxicam infusion 30 minutes before skin incision, followed by saline infusion immediately after skin closure (group 1), or to receive the identical injections but in reverse order (group 2). All patients received local anesthesia with bupivacaine.. Postoperative pain scores were evaluated hourly for the first 8 hours after surgery, then at 12, 16, 20, and 24 hours after surgery, using a 10-cm visual analog scale. Time to first analgesic request and patients' global assessments also were recorded.. Patients in group 1 reported significantly lower pain scores (P < 0.05) at all time intervals except at 24 hours and better global assessment (P = 0.001) than did group 2. There were significantly fewer patients in the preemptive group than group 2 who required rescue analgesic within the first 24 hours (0% vs 22.7%; P = 0.024). Mean time to first analgesic request was also significantly longer in the preemptive group (P = 0.001).. Intravenous lornoxicam administered before surgery has a better analgesic effect for varicocelectomy than when administered postoperatively.

Topics: Adult; Ambulatory Surgical Procedures; Analgesia; Anesthesia, Local; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Humans; Injections, Intravenous; Male; Pain Measurement; Pain, Postoperative; Piroxicam; Postoperative Care; Preoperative Care; Prospective Studies; Sodium Chloride; Time Factors; Treatment Outcome; Varicocele