mobiflex and Pain--Postoperative

Tenoxicam is a non-steroidal anti-inflammatory drug (NSAID) licensed for use in rheumatic disease and other musculoskeletal disorders in the UK, and is widely available in other countries worldwide. This review sought to evaluate the efficacy and safety of oral tenoxicam in acute postoperative pain, using clinical studies of patients with established pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties.. To assess the efficacy of single dose oral tenoxicam in acute postoperative pain, and any associated adverse events.. We searched The Cochrane Library (Issue 1, 2009), MEDLINE (March 2009); EMBASE via Ovid (March 2009); the Oxford Pain Relief Database.. Randomised, double-blind, placebo-controlled clinical trials of oral tenoxicam for relief of acute postoperative pain in adults.. Two review authors independently assessed trial quality and extracted data. The area under the "pain relief versus time" curve was used to derive the proportion of participants with tenoxicam experiencing least 50% pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected.. Not one of sixteen studies identified by the searches and examined in detail studied oral tenoxicam in patients with established postoperative pain and therefore no results are available.. In the absence of evidence of efficacy for oral tenoxicam in acute postoperative pain, its use in this indication is not justified at present. Because trials clearly demonstrating analgesic efficacy in the most basic of acute pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes which are effective, there is no urgent research agenda for this particular drug.

Topics: Acute Disease; Administration, Oral; Adult; Anti-Inflammatory Agents, Non-Steroidal; Humans; Pain, Postoperative; Piroxicam

Pain after soft tissue injuries in and around the ankle is a troublesome process in terms of patient comfort and mobilization. The aim of this study was to compare the analgesic efficacy of intravenous ibuprofen and intravenous tenoxicam in patients with acute musculoskeletal pain due to ankle injury.. We conducted a prospective, double-blind, randomized controlled study in a tertiary hospital. The patients were divided into two groups as those administered IV 400 mg ibuprofen and IV 20 mg tenoxicam. After the treatment of the patients, visual analog scale (VAS) scores were recorded at 15, 30, 60, and 120 min. VAS scores were compared with the effectiveness of drugs, their side effects, and the need for rescue drugs.. One hundred and twenty-four patients were included in the study. There were 62 patients in the tenoxicam group and 62 patients in the ibuprofen group. When VAS scores were compared, it was found that the VAS scores of the ibuprofen group were statistically significantly lower (p < 0.001). When the ΔVAS scores were compared, it was observed that the ΔVAS scores of the ibuprofen group were statistically significantly higher from 30 min (p < 0.001). There was a statistically significant difference in favor of ibuprofen between the two drug groups in terms of the need for rescue analgesics (p < 0.001). Conclusıon. The analgesic efficacy of intravenous ibuprofen and tenoxicam is equal after an ankle injury. However, after 30 min of drug administration, ibuprofen provides more effective analgesia than tenoxicam.

Topics: Analgesics; Ankle Injuries; Double-Blind Method; Humans; Ibuprofen; Pain, Postoperative; Prospective Studies; Treatment Outcome

There are many alternatives for post-operative pain relief in patients who have had general anaesthesia. The aim of this study was to evaluate the efficacy of intra-articular bupivacaine + morphine and bupivacaine + tenoxicam applications in post-operative pain control in patients undergoing knee arthroscopy with general anaesthesia.. This was a prospective study. Standard anaesthesia procedures were applied to each patient, and the 240 patients chosen at random were then divided into two groups. Each group received a different combination of drugs for this double-blind study. The first group (group A: 120 patients) received 0.5% bupivacaine 100 mg + tenoxicam 20 mg (22 ml); the second group (group B) received 0.5% bupivacaine 100 mg + morphine 2 mg (22 ml); both groups received their drugs at the end of the intra-articular operation before tourniquet deflation. Before the operation, patients were asked about their post-operative pain at particular periods over the following 24 hours using the visual analogue scale (VAS) and the numeric rating scale (NRS). An additional analgaesic requirement and possible side effects were also recorded.. Group A patients needed analgaesics sooner after operation than patients in group B. In Group B, VAS and NRS values were statistically higher compared with group A at the 12th hour. There were also fewer side effects seen in group A versus group B.. Effective and reliable results were obtained in post-operative pain control in bupivacaine added to the morphine or tenoxicam groups following arthroscopic meniscectomy. In the tenoxicam group, patients reported less pain, fewer side effects and less need for analgesics at 12 hours after the operation.. level 1, therapeutic, randomised, multicentric study.

Topics: Adult; Analgesia; Analgesics; Anesthetics, Combined; Anesthetics, Local; Arthroscopy; Bupivacaine; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Menisci, Tibial; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Piroxicam; Prospective Studies; Young Adult

The aim of the present study was to compare the effects of daily single-dose use of flurbiprofen, diclofenac sodium, and tenoxicam on pain, swelling, and trismus that occur after surgical extraction of impacted wisdom teeth using local anesthesia.. The present study included 3 groups with 30 patients in each group. Those volunteering to participate in this double-blind randomized study (n = 90) were selected from a patient population with an indication for extraction of impacted wisdom teeth. Group 1 patients received 200 mg flurbiprofen, group 2 patients received 100 mg diclofenac sodium, and group 3 patients received 20 mg tenoxicam. All doses were once a day, starting preoperatively. Pain was evaluated postoperatively at 1, 2, 3, 6, 8, and 24 hours and at 2 and 7 days using a visual analog scale (VAS). For comparison with the preoperative measurements, the patients were invited to postoperative follow-up visits 2 and 7 days after extraction to evaluate for swelling and trismus. The statistical analysis was performed using descriptive statistics in SAS, version 9.4 (SAS Institute, Cary, NC), software. Statistical analysis of the pain, swelling, and trismus data was performed using the Kruskal-Wallis, Dunn, and Wilcoxon-Mann-Whitney U tests. The statistical level of significance was accepted at P = .05 and power of 0.80.. Clinically, tenoxicam showed better analgesic and anti-inflammatory efficacy compared with diclofenac sodium and, in particular, flurbiprofen. Although the VAS scores in the evaluation of pain showed statistically significant differences at 2 days, no statistically significant difference was found for swelling and trismus.. Our study evaluated the analgesic and anti-inflammatory effects with a daily single dose of flurbiprofen, diclofenac sodium, and tenoxicam. Daily 20 mg tenoxicam can be accepted as an adequate and safe option for patients after a surgical procedure.

Topics: Adolescent; Adult; Anesthesia, Dental; Anesthesia, Local; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Double-Blind Method; Edema; Female; Flurbiprofen; Humans; Male; Molar, Third; Pain Measurement; Pain, Postoperative; Piroxicam; Tooth, Impacted; Treatment Outcome; Trismus

This study tested the hypothesis that adding tenoxicam (T) to intravenous patient-controlled analgesia (IV-PCA) with morphine (M) would improve postoperative pain relief and wound inflammatory responses compared with M alone after spine surgery.. Randomized, prospective, double-blind, controlled study.. Ninety-four patients eligible for elective spine surgery.. Teaching hospital.. Patients were randomized to one of three groups: the M group (PCA regimen with M), the TM group (PCA regimen with T and M), or the T+TM group (20 mg T administered 30 minutes before wound closure in addition to the TM regimen). The primary end point was the numeric rating scale score for pain intensity, and secondary end points pertaining to postoperative pain management included M consumption, PCA demand/delivery, use of rescue analgesics, adverse events, and levels of inflammatory mediators in wound drainages.. PCA demand was reduced in both the TM and T+TM groups compared with the M group (both P ≤ 0.001). The incidence of skin itching was significantly reduced in the T+TM group compared with the other groups (both P ≤ 0.05). PGE2 and interleukin-6 levels in wound drainages were reduced in the TM and T+TM groups compared with the M group (both P ≤ 0.001).. The combination of T and M for IV-PCA was not more efficacious than IV-PCA with M alone in reducing postoperative pain after spine surgery but reduced PCA demand and suppressed local inflammation at the surgical site. Administration of T before wound closure may ameliorate IV-PCA M-induced skin itching.

Topics: Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Comorbidity; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Inflammation; Injections, Intravenous; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Piroxicam; Prevalence; Risk Assessment; Self Administration; Spinal Fusion; Taiwan; Treatment Outcome

The purpose of this study was to determine the analgesic efficacy and side-effects of paracetamol and tenoxicam in comparison with placebo in patients with postoperative pain after elective abdominal hysterectomy.. A total of 120 patients were randomly divided into three groups to receive either paracetamol 1 g, tenoxicam 20 mg or placebo intravenously at the end of surgery, and then morphine was administered by a patient-controlled analgesia device postoperatively.. Tenoxicam was associated with lower pain scores at the 2nd, 4th, 6th and 24th hour postoperatively. Total morphine consumption was 44.8 +/- 17.4 mg, 64.6 +/- 19.6 mg, 69.2 +/- 22.1 (tenoxicam, paracetamol and placebo group, respectively) and there was a significant difference in the tenoxicam group compared with the other two groups (p < 0.05). Side-effects except for nausea were similar.. A single dose of 20 mg tenoxicam provided effective analgesia and reduced total morphine consumption in comparison with paracetamol and placebo after abdominal hysterectomy.

Topics: Acetaminophen; Adult; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Hysterectomy; Middle Aged; Morphine; Pain, Postoperative; Piroxicam

Tenoxicam is an effective analgesic and anti-inflammatory agent for symptomatic treatment of various conditions. The purpose of this study was to evaluate clinically the effectiveness of prophylactic tenoxicam and prophylactic ibuprofen in reducing post-endodontic pain compared with placebo. A total of 48 patients consented to a double-blind, single dose, prophylactic oral administration of 20 mg of tenoxicam, 200 mg of ibuprofen, or a placebo before root canal treatment. The root canal treatment was performed in one visit. The patients registered their degree of discomfort on a 100-mm visual analog scale, immediately postoperative, and 6, 12, 24, 48 and 72 h after initiation of root canal treatment. The two-way ANOVA test and Tukey HSD post hoc test showed that in the 6-h period, both 20 mg of tenoxicam and 200 mg of ibuprofen provided significantly better pain relief than the placebo. Prophylactic administration of a single dose of 20 mg tenoxicam or 200 mg ibuprofen before RCT provides an effective reduction at 6 h (P < 0.05). Because of the advantages of tenoxicam, it may be useful as a prophylactic analgesic when post-endodontic pain is anticipated.

Topics: Administration, Oral; Adolescent; Adult; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Calcium Hydroxide; Double-Blind Method; Female; Follow-Up Studies; Gutta-Percha; Humans; Ibuprofen; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Piroxicam; Placebos; Premedication; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Salicylates; Sodium Hypochlorite; Treatment Outcome; Young Adult

Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery.. A randomized double-blind study was performed in Hospital São Paulo.. During the postoperative period, in the presence of pain, 29 patients were divided into two groups: group 1 (n = 14) received 100 microg of fentanyl epidurally and 2 ml of saline intravenously; group 2 (n = 15) received 5 ml of saline epidurally and 100 microg of fentanyl intravenously. The analgesic supplementation consisted of 40 mg of tenoxicam intravenously and, if necessary, 5 ml of 0.25% bupivacaine epidurally. Pain intensity was evaluated on a numerical scale and plasma concentrations of fentanyl were measured simultaneously.. The percentage of patients who required supplementary analgesia with tenoxicam was lower in group 1 (71.4%) than in group 2 (100%): 95% confidence interval (CI) = 0.001-0.4360 (P = 0.001, Fisher's exact test; relative risk, RR = 0.07). Epidural bupivacaine supplementation was also lower in group 1 (14.3%) than in group 2 (53.3%): 95% CI = 0.06-1.05 (P = 0.03, Fisher's exact test; RR = 0.26). There was no difference in pain intensity on the numerical scale. Mean fentanyl plasma concentrations were similar in the two groups.. Intravenous and epidural fentanyl appear to have similar efficacy for reducing pain according to the numerical scale, but supplementary analgesia was needed less frequently when epidural fentanyl was used.. NCT00635986.

Topics: Adult; Age Factors; Aged; Analysis of Variance; Anesthesia, Epidural; Anesthesia, Intravenous; Anesthetics, Intravenous; Bupivacaine; Double-Blind Method; Female; Fentanyl; Humans; Male; Middle Aged; Orthopedic Procedures; Pain, Postoperative; Piroxicam; Sex Factors; Time Factors; Young Adult

The efficacy, tolerability and the morphine-sparing effects of lornoxicam were compared with those of tenoxicam when used preoperatively in patients undergoing laparoscopic cholecystectomy.. In this prospective, double-blind study, 60 ASA I-II patients undergoing laparoscopic cholecystectomy were randomized equally to receive intravenous tenoxicam 40 mg (Group T) or lornoxicam 16 mg (Group L), preemptively. Three patients withdrew from the study, so 57 patients were included in the analysis. In the postoperative period, the first morphine demand times, pain scores, side-effects and cumulative morphine consumptions were evaluated during the first 24 h.. The patient characteristics data and the duration of surgery were similar between two groups, except for body weights (P = 0.002). The first morphine demand time was significantly longer in Group L (P = 0.037), but the pain levels did not differ. The mean pain scores were higher in Group T in the 15 min (P = 0.036), 1 h (P = 0.020), 2 h (P = 0.001) and 4 h (P = 0.0042) after extubation. A statistically significant difference between two groups was found in calculated cumulative morphine consumptions per kilogram in the 15 min (P = 0.037), 30 min (P = 0.016), and 1 h (P = 0.004) and 2 h (P = 0.013) between two groups. There was no difference in the severity of nausea but 13 patients in Group T and five patients in Group L had vomiting (P = 0.018). Patient satisfaction was similar in the two groups.. Preoperatively administered lornoxicam 16 mg significantly prolonged the first morphine demand time, reduced postoperative morphine consumption during the first 4 h and caused significantly fewer adverse effects when compared with tenoxicam after laparoscopic cholecystectomy.

Topics: Adult; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Cholecystectomy, Laparoscopic; Double-Blind Method; Female; Humans; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Piroxicam; Prospective Studies; Time Factors

The analgesic and anti-inflammatory efficacy of tenoxicam and meloxicam were evaluated in this double-masked, randomized, prospective study by analyzing pain scores and the need for rescue-analgesic agents following dental implant surgery.. One hundred patients, in whom 241 dental implants were placed, were divided into two groups. For 4 days beginning the day before surgery, the first group received meloxicam, 15 mg daily, and the second group received tenoxicam, 20 mg daily, followed by 1 hour preoperatively and for 2 days thereafter. Pain intensity was rated by the subjects based on a visual analog scale on the operation day and on the following 6 days. The patients were recommended to use a rescue analgesic if the pain score was > or =4. Postoperative complications, such as edema, hematoma, infection, severe pain, paresthesia, or gastrointestinal complaints, were also noted.. Statistical analysis revealed that 54% of patients in the tenoxicam group and 66% of patients in the meloxicam group used rescue analgesics on day 1. However, the difference between the groups was not significant (chi(2) = 1.05; P = 0.30). The relationship between the reduction of consumption and time was not significant in either group (Z = 0.84; P = 0.40). The relationship between the use of rescue analgesics and the number of implants placed was not significant. Among patients who reported postoperative complications, there was not a statistically significant difference between the groups (chi(2) = 0.04; P = 0.84).. Meloxicam and tenoxicam exhibited a similar analgesic and anti-inflammatory efficacy in the present investigation.

Topics: Analgesics; Cyclooxygenase 2 Inhibitors; Dental Implantation, Endosseous; Double-Blind Method; Female; Humans; Male; Meloxicam; Middle Aged; Pain Measurement; Pain, Postoperative; Piroxicam; Premedication; Prospective Studies; Thiazines; Thiazoles

We conducted a randomized, placebo-controlled, double blinded study to compare the analgesic effects of intraarticular neostigmine, morphine, tenoxicam, clonidine and bupivacaine in 150 patients undergoing arthroscopic knee surgery. General anaesthesia protocol was same in all patients. At the end of the surgical procedure, patients were randomized into six intraarticular groups equally. Group N received 500 mug neostigmine, Group M received 2 mg morphine, Group T received 20 mg tenoxicam, Group C received 1 microg kg(-1) clonidine, Group B received 100 mg bupivacaine and Group S received saline 20 ml. Visual analog scale scores 0, 30 and 60 min and 2, 4, 6, 12, 24, 48 and 72 h, time to first analgesic need, analgesic consumption at 48 h and 72 h and side effects were noted. Demographic and operational parameters were similar in six groups. All study groups provided analgesia when compared with saline group (P<0.05). Duration of analgesia in Group N and C was longer than other groups (P<0.001). Analgesic consumptions of Group N, C and T were lower than other groups (P<0.01). Pain scores during 2 h postoperatively were lower in all study groups than the control group (P<0.001). In Group B, median pain scores were higher than Groups N and C at 0 min and 30 min postoperatively (P<0.001). Side effects were not significantly different among the six groups. We conclude that the most effective drugs that are administered intraarticularly are neostigmine and clonidine among the five drugs we studied. Tenoxicam provided longer analgesia when compared with morphine and bupivacaine, postoperatively.

Topics: Analgesics, Opioid; Arthroplasty, Replacement, Knee; Bupivacaine; Cholinesterase Inhibitors; Clonidine; Double-Blind Method; Female; Humans; Injections, Intra-Articular; Male; Middle Aged; Morphine; Neostigmine; Pain Measurement; Pain, Postoperative; Piroxicam; Sensory System Agents

Uterine cramping pain is related to prostaglandins, which are mediated by cyclooxygenase. However, it is unknown whether the analgesic effects of the non-selective cyclooxygenase inhibitor tenoxicam are different between primiparous and multiparous women. This placebo-controlled, double-blind study compared the analgesic effect of tenoxicam on post-cesarean uterine cramping pain in primiparous and multiparous women.. Forty primiparous women and 40 multiparous women who were scheduled for elective cesarean delivery were allocated into the following 4 groups: saline-primipara (SP) group, tenoxicam-primipara (TP) group, saline-multipara (SM) group, and tenoxicam-multipara (TM) group. Saline or 20 mg tenoxicam was intravenously injected immediately after clamping of the umbilical cord. All patients received patient-controlled analgesia for postoperative pain control. Resting wound pain, uterine cramping pain, morphine consumption, and morphine-related side effects were evaluated at 4 and 24 hours after surgery.. At 24 hours after surgery, tenoxicam-related relief of uterine cramping pain was 2.1 in primiparous women (visual analog scale: SP 5.6 (4.4-6.8) minus TP 3.5 (2.2-4.9); p < 0.01). The tenoxicam-related morphine-sparing effect was 14 mg (45%) in primiparous women (SP 31.4 mg (23.9-38.8) minus TP 17.4 mg (11.6-23.2); p < 0.01). The tenoxicam-related relief of uterine cramping pain and tenoxicam-related morphine-sparing effect were not significant in multiparous women.. This study revealed that the analgesic effect of tenoxicam on post-cesarean uterine cramping pain is greater in primiparous women than in multiparous women. Further studies are required to determine whether a higher dosage of tenoxicam is beneficial to reduce uterine cramping pain in multiparous women.

Topics: Adult; Analgesia, Obstetrical; Analgesia, Patient-Controlled; Anti-Inflammatory Agents, Non-Steroidal; Cesarean Section; Double-Blind Method; Female; Humans; Morphine; Pain Measurement; Pain, Postoperative; Parity; Piroxicam; Pregnancy

Pre-incisional treatment with either N-methyl-D-aspartate (NMDA) receptor antagonists or non-steroidal anti-inflammatory drugs (NSAIDs) improves postoperative pain relief. This study examines the effect on postlaparoscopic cholecystectomy (LC) pain of a combination of dextromethorphan (DM), a NMDA-receptor antagonist, and tenoxicam, a NSAID, given preoperatively.. Eighty-eight ASA I or II patients scheduled for LC were entered into a randomized, double-blind study and randomly allocated to one of four groups. Controls received 20 mg (4 ml) of chlorpheniramine maleate (CPM) IM and 4 ml of normal saline (N/S) IV. Group DM received 40 mg of DM (containing 20 mg of CPM) IM and 4 ml of N/S IV. Group T were given CPM 20 mg IM, and tenoxicam 40 mg (4 ml) IV. Group DM + T were given DM 40 mg (containing 20 mg of CPM) IM, and tenoxicam 40 mg IV. All treatments were given 30 min before skin incision. Analgesic effects were evaluated by Visual Analog Scale (VAS) pain scores at rest and during coughing, at 1, 2, 4, 12, 24 and 48 h after surgery. The time to the first request for meperidine for pain relief, and total meperidine consumption, were recorded for 48 h after surgery.. Compared to controls, patients given DM and DM + T first requested meperidine significantly later, had lower meperidine consumption, made fewer requests for meperidine, and had lower pain scores. There were significant differences between the DM + T and T groups at 2 and 4 h in both resting and incident VAS pain scores, the incidence of meperidine requests and the time to first meperidine injection. There were significant differences between groups DM and T at 1 h for resting pain and at 2 and 4 h for incident pain. Except for a significant difference in the incident pain score 1 h after surgery, there were no other differences in pain scores between the DM and DM + T groups. Neither synergistic nor antagonistic interaction was observed between DM and tenoxicam.. The results suggest that pretreatment with DM, but not tenoxicam, provides significant pre-emptive analgesia for postoperative pain management in patients after LC surgery. Combining DM and tenoxicam also gives good pain relief.

Topics: Adult; Aged; Analgesics, Opioid; Anesthesia, General; Anti-Inflammatory Agents, Non-Steroidal; Chlorpheniramine; Cholecystectomy, Laparoscopic; Dextromethorphan; Double-Blind Method; Female; Histamine H1 Antagonists; Humans; Injections, Intravenous; Male; Meperidine; Middle Aged; Pain Measurement; Pain, Postoperative; Piroxicam

Two non-steroidal anti-inflammatory drugs, tenoxicam and rofecoxib, were compared for the control of postoperative pain following surgical extraction of bilaterally and symmetrically impacted wisdom teeth performed under intravenous sedation and local anaesthesia. Thirty-five young fit adult patients received each analgesic treatment for four days in a randomized, crossover design. The results suggest statistically better pain relief for the selective COX-2 inhibitor rofecoxib compared to tenoxicam, a traditional NSAID. There were side-effects with both treatments. Abdominal discomfort was significantly more common following rofecoxib compared to tenoxicam. Both analgesics were acceptable to most participants in the trial.

Topics: Adolescent; Adult; Confidence Intervals; Cross-Over Studies; Cyclooxygenase Inhibitors; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Lactones; Male; Molar, Third; Odds Ratio; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Piroxicam; Probability; Sulfones; Tooth Extraction; Treatment Outcome

This study compared the analgesic effect of intra-articular injection of tenoxicam with that of morphine on postoperative pain after anterior cruciate ligament (ACL) reconstruction. Forty-two patients undergoing arthroscopically ACL reconstructions using hamstring tendons underwent the same anesthetic protocol. The patients were randomized to receive 25 ml normal saline, 20 mg tenoxicam in 25 ml normal saline, or 2 mg morphine in 25 ml normal saline. Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements. We found both that both intra-articular tenoxicam and intra-articular morphine provided better analgesia than that in the control group. Although pain scores were similar between tenoxicam and morphine groups 30 min postoperative, the analgesic requirements in with tenoxicam were significantly lower than those with morphine group 3-6 h postoperatively.

Topics: Adult; Analgesia; Analgesics, Opioid; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Double-Blind Method; Female; Humans; Injections, Intra-Articular; Male; Morphine; Pain Measurement; Pain, Postoperative; Piroxicam; Plastic Surgery Procedures; Prospective Studies

Arthroscopic knee surgery is one of the most common surgeries done in outpatient settings; however, postoperative pain is believed to be the major barrier for discharge and early rehabilitation. In this study we evaluated and compared the efficacy of intraarticular application of long-lasting non-steroidal analgesic drug tenoxicam, a long-lasting local anaesthetic bupivacaine and combination of the two on postoperative pain after arthroscopic knee surgery. With the approval of the local ethics committee and signed informed consent of the patients, 75 American Society of Anesthesiologists I-II patients aged between 18 and 65 years going under elective arthroscopic meniscectomy were included in this randomized, blind, prospective study. The patients were divided into three groups: group-T (GT) patients ( n=25) had intraarticular 20 mg of tenoxicam in 20 ml normal saline; group-B (GB) patients ( n=25) had 50 mg bupivacaine in 20 ml normal saline (0.25%); group-BT (GBT) patients ( n=25) had intraarticular 20 mg of tenoxicam and 50 mg bupivacaine (0.25%) in 20 ml normal saline after completion of the surgery and before deflation of the tourniquet. Postoperative analgesia was maintained by intravenous tramadol hydrochloride 50 mg/s at the first 4 h and paracetamol 500 mg and codeine 7.5 mg preparation (Pacofen) as needed (maximum six per day) during the study period. The numeric rating scale (NRS) values were at rest and at active-passive motion at 4, 12, 24 and 48 h, total analgesic consumption, at 4 h for tramadol and at the end of 48 h for oral medication; and patient satisfaction at the end of 48 h was evaluated and recorded. The demographic features of the patients, and tourniquet times, were found to be similar between the groups. Group BT had significantly lower NRS values than GB at 12 h at rest. Group BT was found to have significantly lower NRS values at 4 h compared with GT, and significantly lower NRS values at 12 h compared with GB. Group BT was found to have significantly lower NRS values at 48 h compared with GB. Group T had significantly higher NRS values at 4 h compared with GB. Group B had significantly higher values at 12 h compared with GT and GBT. Group B used significantly more analgesics than GBT and GT throughout the study period. Group BT patients had significantly more satisfaction at the end of the study period when compared with GT and GB. Application of intraarticular tenoxicam-bupivacaine solution is a simple, safe and effective me

Topics: Adolescent; Adult; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Bupivacaine; Data Interpretation, Statistical; Drug Therapy, Combination; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Menisci, Tibial; Pain, Postoperative; Patient Satisfaction; Piroxicam; Prospective Studies; Range of Motion, Articular; Tourniquets

Postpartum uterine contraction pain is a common phenomenon after Cesarean delivery. We investigated the effectiveness of tenoxicam in reducing uterine contraction pain.. We enrolled 120 consecutive non-breastfeeding women who were scheduled for elective Cesarean delivery. After the administration of spinal anesthesia with bupivacaine and intrathecal morphine 0.15 mg injection, the patients were randomly divided into two groups. Group I received placebo (normal saline) iv injection, and Group II received tenoxicam 40 mg iv injection after clamping the umbilical cord. Verbal analogue scale of wound pain and uterine contraction pain were recorded at two, four, eight,16, and 24 hr after Cesarean delivery.. There was no significant difference in wound pain scores between the two groups (all scores < or =3). However, the tenoxicam group had significant lower uterine contraction pain scores and required less supplemental meperidine medication than did the placebo group (8.5% vs 41.4%, P <0.05). The incidences of nausea or vomiting, pruritus, and bleeding were not significantly different between groups.. Intravenous tenoxicam 40 mg significantly reduced the intensity of uterine cramps in patients undergoing Cesarean delivery without increasing side effects.

Topics: Adult; Anesthesia; Anti-Inflammatory Agents, Non-Steroidal; Cesarean Section; Double-Blind Method; Female; Humans; Injections, Intravenous; Pain Measurement; Pain, Postoperative; Piroxicam; Postoperative Nausea and Vomiting; Pregnancy; Prospective Studies; Uterine Contraction; Uterine Diseases

Forty-five adults undergoing thoracotomy were randomized to receive placebo, tenoxicam 20 mg or tenoxicam 40 mg IV during chest wall closure. All patients received intraoperative fentanyl and intercostal blocks followed by morphine by patient-controlled analgesia. Patient numbers 13 to 45 also received thoracic epidural analgesia by continuous infusion of bupivacaine 0.125%, patient numbers 25 to 45 having fentanyl 2 microg/ml added to the epidural infusion. Efficacy parameters and adverse reactions were assessed over the first 24 hours postoperatively. On a 100 mm visual analogue scale, mean (SD) pain at rest (adjusted area under curve for hours 1 to 24) was 25.8 (12.5), 17.4 (14.8) and 16.5 (13.3) mm for groups receiving placebo, 20 mg and 40 mg tenoxicam, respectively (ANOVA: P<0.05). There were no significant differences between study groups postoperatively in pain on coughing, opioid consumption, blood gas measurements, nausea, vomiting, sedation, blood loss, haemoglobin or serum creatinine. One patient in each tenoxicam group reported epigastric pain, rated moderate. These data support the inclusion of tenoxicam 20 mg IV in the management of pain at rest for patients undergoing thoracotomy, but do not show additional benefit for a higher dose.

Topics: Analgesia, Patient-Controlled; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Humans; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Piroxicam; Prospective Studies; Thoracotomy

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.. Seventy-three patients were recruited and all received a standard anesthetic consisting of induction with 2 mg x kg(-1) propofol followed by 5 microg x 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.. 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).. Early administration of pre-emptive tenoxicam 30 min before induction of anesthesia improves postoperative analgesia in patients undergoing ambulatory breast biopsy.

Topics: Adult; Ambulatory Surgical Procedures; Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Breast; Female; Humans; Injections, Intravenous; Middle Aged; Pain, Postoperative; Piroxicam; Prospective Studies; Time Factors

In double-blind trial 60 patients undergoing spine surgery were randomized to receive either placebo, tenoxicam 40 mg intravenously (i.v.), tenoxicam 40 mg intramuscularly (i.m.) or piroxicam 40 mg i.m., immediately following the induction of general anesthesia. As compared to placebo, the 24 hour morphine consumption was reduced in all groups. This reduction was only statistically significant (p = 0.023) in the i.v. group (21.7 +/- 11.27 versus 36.53 +/- 20.33 mg). Rest and dynamic pain scores were significantly lower in both tenoxicam groups but more consistently in the i.v. group. With piroxicam only rest pain scores at 24 hours were lower. Less urinary retention was noticed in the i.v. tenoxicam group. This study shows that, following spine surgery, i.v. tenoxicam induces a morphine sparing effect (41%) while offering lower rest and dynamic pain scores and a lower incidence of urinary retention.

Topics: Adult; Analgesia, Patient-Controlled; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Humans; Male; Middle Aged; Morphine; Neurosurgical Procedures; Pain Measurement; Pain, Postoperative; Piroxicam; Spine

Nonsteroidal antiinflammatory drugs may reduce postoperative opioid consumption. We evaluated the analgesic efficacy of preoperatively administered tenoxicam in patients undergoing total abdominal hysterectomy. Patients were randomly assigned to receive IV either normal saline 4 mL (Group NS), tenoxicam 20 mg (Group T20), or tenoxicam 40 mg (Group T40) before the induction of anesthesia in a double-blinded fashion. Patient-controlled analgesia with fentanyl was used to assess postoperative opioid requirements. Pain was evaluated by visual analog scale at 2, 4, 6, 8, and 24 h postoperatively. Intraoperative bleeding as assessed by the surgeon, incidence of nausea, and gastrointestinal symptoms were recorded. No statistically significant difference was identified between groups in fentanyl consumption or pain scores. The incidence of nausea was similar in all groups. Two patients in Group T20 and two in Group T40 exhibited mild gastrointestinal symptoms. Intraoperative oozing was noted in two patients in Group T40. We conclude that patients undergoing total abdominal hysterectomy and receiving fentanyl via patient-controlled analgesia postoperatively do not benefit from tenoxicam pretreatment. On the contrary, the drug may be associated with an increased incidence of side effects.. The preoperative administration of 20 or 40 mg IV tenoxicam does not reduce fentanyl consumption via Patient-Controlled Analgesia, compared with placebo, after total abdominal hysterectomy. Additionally, tenoxicam may increase intraoperative bleeding and gastrointestinal side effects.

Topics: Adult; Analgesia, Patient-Controlled; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Humans; Hysterectomy; Middle Aged; Nausea; Pain, Postoperative; Piroxicam; Pregnancy

The study was aimed to evaluate the analgesic efficacy, postoperative comfort, recovery characteristics and side effects of three different analgesic agents administered prophylactically.. Eighty patients undergoing day-case minor operative laparoscopy were randomly allocated into four groups to receive tenoxicam 20 mg i.v. (Group T), fentanyl 100 microg i.v. (Group F), 5 ml of bupivacaine 2.5 mg/ml for infiltration of trocar sites (Group B), 30, 10 and 5 min before incision respectively. Bupivacaine, 35 ml, 2.5 mg/ml was also administered into the pelvic cavity in Group B. Group P received only placebo. Postoperative pain, analgesic requirements, first response to verbal stimulus, first analgesic requirement, ability to walk without help, to drink and to void, blood pressures, SpO2 and respiration rates were recorded in the PACU. Postoperative pain was evaluated by verbal rating scale. Pain scores, analgesic requirements and side effects were evaluated by telephone calls until the 48th postoperative hour.. Postoperative pain scores were lower and time to requirement of rescue analgesics was longer in groups F and B compared to Group P. In the PACU, analgesic requirements were lower in Group B, compared to Group P. Nausea and vomiting were increased in Group F.. Tenoxicam 20 mg i.v. was found to be ineffective whereas bupivacaine was superior to other groups in reducing pain and analgesic requirements. Bupivacaine also increased time to first analgesics and obtained better recovery characteristics, underlining its value in prophylactic pain management compared to the other two agents.

Topics: Adult; Ambulatory Surgical Procedures; Analgesia; Analgesics, Opioid; Anesthesia Recovery Period; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Bupivacaine; Fentanyl; Humans; Laparoscopy; Pain Measurement; Pain, Postoperative; Piroxicam; Postoperative Nausea and Vomiting

Non-steroidal anti-inflammatory drugs inhibit platelet aggregation and prolong bleeding time in healthy subjects. We have studied the effect of i.v. tenoxicam during caesarean delivery on skin bleeding time, operative, and postoperative blood loss, and beta-thromboglobulin and platelet factor 4 as specific molecular markers for platelet activity.. Fifty women were studied. Twenty-five were given tenoxicam 20 mg i.v. 10 min before induction of general anaesthesia, and 25 formed a control group. Skin bleeding time and platelet markers were determined the day before and 1 h after induction of anaesthesia.. In the tenoxicam group, there was an slight increase in skin bleeding time with no statistically significant changes in platelet marker levels. In the control group, platelet markers increased 1 h after surgery. The surgeon's assessment of uterine relaxation, using a visual analogue score, operating theatre blood loss, and the frequency of bleeding over 24 h after operation, showed no significant difference between the two groups.. During caesarean delivery i.v. tenoxicam causes a slight increase in bleeding time with no significant changes in platelet marker levels.

Topics: Adult; Anesthesia, General; Anesthesia, Obstetrical; Anti-Inflammatory Agents, Non-Steroidal; beta-Thromboglobulin; Bleeding Time; Blood Loss, Surgical; Blood Platelets; Cesarean Section; Female; Humans; Injections, Intravenous; Pain, Postoperative; Piroxicam; Platelet Count; Platelet Factor 4; Pregnancy; Uterus

One puff of beclomethasone inhaler has been shown to reduce the incidence of sore throat following endotracheal intubation. The aim of this study was to determine the effect of a pharyngeal pack on the incidence of sore throat and whether tenoxicam-impregnated gauze pack significantly influenced the frequency of sore throat.. Eighty patients undergoing general anaesthesia for elective surgery of the nasal septum were evaluated. The anaesthetist sprayed the upper airway towards the trachea with one puff of beclomethasone inhaler (50 microg) before orotracheal intubation. Patients were randomly assigned to have either a 0.2% tenoxicam- or a 0.9% saline-impregnated gauze pack in the oropharynx during operation. They were evaluated for occurrence and severity of postoperative sore throat by direct questions 12-24 h after surgery.. Four patients who experienced any symptoms in the tenoxicam group scored mild sore throat compared to 16 patients in the control group scoring mild, gradually developing moderate or severe sore throat (P<0.01). No drug-related side effects were observed.. The intraoperative use of a tenoxicam-impregnated gauze pack is effective in reducing moderate or severe postoperative sore throat following the use of throat pack.

Topics: Administration, Inhalation; Administration, Topical; Adult; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain, Postoperative; Pharyngitis; Pharynx; Piroxicam; Prospective Studies

Previous work has demonstrated that intraperitoneal (i.p.) lidocaine may provide analgesia after laparoscopic cholecystectomy. The aim of this prospective, randomized, double-blind study was to compare pain relief, recovery variables, and side effects after i.p. instillation of lidocaine plus tenoxicam given either i.v. or i.p. after laparoscopic cholecystectomy.. Ninety patients were randomly allocated to one of three groups to receive either 200 ml normal saline i.p. and 2 ml of normal saline i.v. (saline group), 200 ml lidocaine 0.1% i.p. and 2 ml tenoxicam 20 mg i.v. (tenoxicam i.v. group), or 200 ml lidocaine 0.1% with 20 mg tenoxicam i.p. and 2 ml of normal saline i.v. (tenoxicam i.p. group). The i.p. instillation was made under the right diaphragm and on the gall bladder bed. VAS pain scores at rest, on movement and during coughing, were measured 2, 4, 6, 12, and 24 h after operation. The time to first demand of analgesia, total analgesic requirement, recovery variables, and side effects were investigated.. In the tenoxicam i.p. group, pain scores were significantly lower both at rest and on movement and analgesic consumption was reduced compared with the saline group (P<0.05). In the tenoxicam i.v. group, pain scores at rest were significantly lower compared with the saline group. Although recovery of bowel function was significantly faster in the tenoxicam i.p. group (P<0.05), there were no differences in any other recovery characteristics or incidence of nausea between the groups.. Combination of intraperitoneal lidocaine and tenoxicam provided better analgesia on movement, and faster return of bowel function compared with i.p. lidocaine and i.v. tenoxicam during the 24 h period after surgery.

Topics: Adult; Analgesics, Opioid; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Cholecystectomy, Laparoscopic; Digestive System; Digestive System Physiological Phenomena; Female; Humans; Injections, Intraperitoneal; Injections, Intravenous; Lidocaine; Male; Middle Aged; Nalbuphine; Pain Measurement; Pain, Postoperative; Piroxicam; Postoperative Nausea and Vomiting

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 i.v. administration of tenoxicam 20 mg.

Topics: Aged; Anesthesia, Epidural; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Half-Life; Humans; Infusions, Intravenous; Metabolic Clearance Rate; Middle Aged; Ovarian Neoplasms; Pain Measurement; Pain, Postoperative; Piroxicam; Preoperative Care; Uterine Cervical Neoplasms

In this prospective randomised study, pruritus and pain were evaluated in patients undergoing abdominal surgery during which epidural fentanyl was administered. All patients had an epidural catheter inserted at the time of surgery. Epidural fentanyl 100 micrograms was administered intra-operatively and infused at a concentration of 2 micrograms.ml-1 for 48 h postoperatively. All patients received a standard anaesthetic and, in addition, the study group had a 20 mg bolus of tenoxicam intravenously, intra-operatively. Patients receiving tenoxicam demonstrated significantly lower pruritus and pain scores at 30 min, 2, 4, 8 and 24 h postoperatively as well as reduced pethidine requirements for breakthrough pain in the first 24 h. In conclusion, tenoxicam 20 mg significantly reduces the incidence and severity of postoperative pruritus in patients who received peri-operative epidural fentanyl. In addition, it significantly reduces pain and further analgesic requirements postoperatively.

Topics: Abdomen; Aged; Analgesia, Epidural; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Cyclooxygenase Inhibitors; Female; Fentanyl; Humans; Injections, Intravenous; Male; Middle Aged; Pain, Postoperative; Piroxicam; Prospective Studies; Pruritus

A prospective, randomized, double-blind, placebo-controlled, comparative study was undertaken to assess the efficacy of the preemptive use of propacetamol, tenoxicam or the combination of both in arthroscopic, outpatient surgery of the knee. One hundred patients aged 18 to 65 years, ASA 1-2, scheduled for arthroscopy were randomized to receive propacetamol 30 mg/kg i.v. (repeated after 6 hours), tenoxicam 0.5 mg/kg i.v. (max. 40 mg), the combination of both or placebo one hour prior to a standard anesthetic. There were no differences with regard to total dose opioid consumption, sedation scores and side effects in the four groups.

Topics: Acetaminophen; Adolescent; Adult; Aged; Analgesics; Analgesics, Opioid; Anesthetics, Intravenous; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Double-Blind Method; Drug Combinations; Endoscopy; Female; Humans; Injections, Intravenous; Knee Joint; Male; Middle Aged; Pain, Postoperative; Piroxicam; Placebos; Postoperative Nausea and Vomiting; Premedication; Prospective Studies

Non Steroidal Anti-inflammatory drugs have a well documented benefit in the relief of postoperative pain. This study was designed to compare the analgesic effect of intra-articular tenoxicam 20 mg with intravenous tenoxicam on postoperative pain in 88 patients undergoing day case knee arthroscopy.. A prospective, double blind, randomized trial was performed. All patients received a standard general anesthetic. Patients in group A received 20 mg tenoxicam made up to 40 ml with normal saline intra-articularly (ia) and 2 ml normal saline i.v. Patients in group B received 40 ml normal saline intra-articularly and 2 ml, 20 mg of tenoxicam, i.v.. Both groups of patients were similar with respect to age, weight, sex and tourniquet inflation time. Patients receiving ia tenoxicam had lower pain scores (at rest and upon movement) at 30, 60, 120 and 180 min postoperatively (0.8+/-0.2 vs. 2.5+/-0.2 at rest and 1.24+/-0.2 vs. 3.4+/-0.2 at movement at 60 min; P< 0.0001). Fewer patients required additional analgesia in the first four hours postoperatively (33% vs. 84%; P<0.00001) and the time to first analgesia (23.7+/-11.2 vs. 9.4+/-0.6; P<0.02) was longer in those receiving ia tenoxicam.. Intra-articular tenoxicam provides superior postoperative analgesia and reduces postoperative analgesic requirements compared with i.v. tenoxicam in patients undergoing day case knee arthroscopy.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Double-Blind Method; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Pain, Postoperative; Piroxicam; Prospective Studies

Studies of intra-articular non-steroidal anti-inflammatory drugs have revealed an analgesic effect equivalent to that of intra-articular local anaesthetic agents and morphine. The aim of this study was to evaluate the analgesic effect of intra-articular lidocaine, pethidine and tenoxicam compared with that of lidocaine and pethidine on postoperative pain after arthroscopy.. After day-case knee arthroscopy, 60 patients were randomly allocated to one of three groups to receive 20 ml of a solution containing 0.9% saline (group S), 2% lidocaine and 10 mg preservative-free pethidine (group LP) and 2% lidocaine, 10 mg preservative-free pethidine and 20 mg tenoxicam (group LPT). Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements.. Pain scores were significantly lower in the LP group than in the S group at 1 and 2 h after surgery. From 4 h until the end of the first postoperative day, pain scores were significantly lower in the LPT group of patients at rest and on knee flexion than in the other two groups; these patients also used less oral analgesics (P<0.05).. The combination of 20 ml lidocaine 2%, 10 mg pethidine and 20 mg tenoxicam given intra-articularly provided superior analgesia and reduced oral analgesic requirement during the first day after arthroscopy compared with lidocaine and pethidine alone.

Topics: Administration, Oral; Adolescent; Adult; Ambulatory Surgical Procedures; Analgesics, Opioid; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Double-Blind Method; Drug Combinations; Endoscopy; Female; Follow-Up Studies; Humans; Injections, Intra-Articular; Knee Joint; Lidocaine; Male; Meperidine; Middle Aged; Pain Measurement; Pain, Postoperative; Piroxicam; Placebos; Range of Motion, Articular

We have evaluated the effect of oral and i.v. tenoxicam on postoperative pain after unilateral total knee replacement in a double-blind, randomized, controlled study. Tenoxicam was administered to two groups of patients, either before (40 mg orally) or after (40 mg i.v.) surgery, then at 24 h after surgery (40 mg i.v.) and at the end of each day for 8 days (20 mg orally). A third group were given placebo at all times. All patients had access to PCA morphine for the first 48 h and then co-dydramol tablets for the duration of the study. We studied 101 patients, mean age 67 yr. There was no significant reduction in the requirement for PCA morphine for the duration of the study in either of the treatment groups, or for co-dydramol in the first 2 days, but tenoxicam significantly reduced the need for co-dydramol over the remaining 7 days. There were no significant differences in mobility between groups. There was a high incidence of adverse events reported, with a similar number in each of the three groups.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Anesthesia, Spinal; Anti-Inflammatory Agents, Non-Steroidal; Arthroplasty, Replacement, Knee; Double-Blind Method; Female; Humans; Injections, Intravenous; Male; Middle Aged; Morphine; Pain, Postoperative; Piroxicam

In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P < 0.05) we have determined that intraoperative intravenous administration of tenoxicam 40 mg during laparoscopic cholecystectomy, when compared with placebo, was associated with a significant reduction in consumption of morphine at 6 hours and 12 hours (P < 0.05) but not at 24 hours, when assessed by patient-controlled analgesia. Furthermore there was a significantly greater requirement for "rescue" analgesia with intramuscular morphine in the placebo group during the period of the study. There was no difference between the groups in pain scores, either at rest or on movement, nor in the incidence of nausea and vomiting. No patient in either group suffered a respiratory rate less than 8/min or oversedation at any time, and there were no other adverse effects.

Topics: Analgesia, Patient-Controlled; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Cholecystectomy, Laparoscopic; Double-Blind Method; Female; Humans; Injections, Intravenous; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Piroxicam; Prospective Studies

Inadequate analgesia is a major problem following ambulatory surgery. In this prospective randomised study, the use of pre-operative intravenous tenoxicam (a non steroidal anti-inflammatory agent) was compared with post-incision tenoxicam for the relief of post-operative pain in 77 patients undergoing day case breast biopsy.. All patients received a standard general anaesthetic which included infiltration of the wound with bupivacalne after skin closure. Intravenous tenoxicam (20 mg) was administered as a single bolus either 30 min before surgery (37 patients) or after incision (40 patients). Pain scores (100 mm visual analog scale) were obtained at 30, 60, 120 and 240 min after surgery analgesic requirements recorded.. Both groups of patients were similar with respect to age, weight, operative time and length of the incision. Patients receiving the tenoxicam 30 min before surgery had lower pain scores at 30 min (22 +/- 3) vs 46 +/- 3; P < 0.0001), 60 min (9 +/- 2 vs 28 +/- 3); P < 0.0001), 120 min (6 +/- 2 vs 16 +/- 3); P = 0.0002) and 240 min (3 +/- 1) vs 7 +/- 2); P = 0.02) post-operatively. They had a longer time to first analgesia (55.1 +/- 4.6 vs 29.6 +/- 2.6) min; P = 0.0004), required less meperidine (5.4 +/- 2.6 vs 18.8 +/- 3.9) mg; P = 0.007) and were more likely not to require any further analgesia during the first four hours post-operatively.. Pre-operatively administered tenoxicam provides superior post-operative analgesia than tenoxicam administered after surgical incision in patients undergoing breast biopsy.

Topics: Adult; Aged; Ambulatory Surgical Procedures; Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Breast; Double-Blind Method; Female; Humans; Middle Aged; Pain Measurement; Pain, Postoperative; Piroxicam; Prospective Studies

A double blind trial was conducted to evaluate the analgesic efficacy of intramuscular tenoxicam for pain relief following tonsillectomy in children. Fifty children, aged 3-10 years, were randomly allocated to receive intramuscular tenoxicam 0.75 mg.kg-1 or intramuscular morphine sulphate 0.2 mg.kg-1 after induction of anaesthesia. Although the tenoxicam group required significantly more postoperative morphine.(mean 57.8 micrograms.kg-1 compared with 26.9 micrograms.kg-1, P = 0.025), the total morphine dose was significantly reduced after tenoxicam (57.8 micrograms.kg-1 compared with 226.9 micrograms.kg-1, P < 0.0001). There was no difference between the quality of analgesia after discharge from recovery. The incidence of postoperative vomiting was significantly reduced after tenoxicam (20%) compared with morphine (71%).

Topics: Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Child; Child, Preschool; Double-Blind Method; Female; Humans; Injections, Intramuscular; Male; Morphine; Pain, Postoperative; Piroxicam; Prospective Studies; Tonsillectomy

Twenty-five fit patients undergoing third molar surgery received the non-steroidal anti-inflammatory drug tenoxicam 40 mg given orally the night before surgery or intravenously at the time of surgery in a randomised, double-blind, cross-over trial. Propofol was used for intravenous sedation. Pain on injection was noted with propofol in 32-56 percent of subjects, but was mostly of minor nature. There was high (100 percent) acceptance of the method of sedation, with 60-84 percent rate of amnesia. Experience of post-operative pain, intake of medication, and trismus were similar with both methods of administration of tenoxicam. We conclude that both oral and intravenous administration of 40 mg tenoxicam are equally effective in healthy young patients undergoing third molar surgery.

Topics: Administration, Oral; Adult; Anti-Inflammatory Agents, Non-Steroidal; Conscious Sedation; Cross-Over Studies; Double-Blind Method; Female; Humans; Hypnotics and Sedatives; Injections, Intravenous; Intraoperative Care; Male; Memory; Molar, Third; Pain, Postoperative; Piroxicam; Premedication; Propofol; Tooth Extraction; Trismus

In a prospective, randomized, double-blind study, we compared intravenous tenoxicam with rectal diclofenac for post-operative pain relief after day case arthroscopy or laparoscopic sterilization. Intravenous tenoxicam (40 mg) was administered as a single bolus at induction, or rectal diclofenac (100 mg) was administered immediately after induction. Both groups were similar with respect to age, weight, sex of the patients, the operation performed and the operative time. There were no significant differences observed between the groups for pain scores at 30 min, 60 min and 24 h post-operatively. The time to first analgesic requirement, the dose of pethidine administered and total analgesic requirements in the first 24 h post-operatively were equivalent in both groups. In view of the similar efficacy of both of these drugs, patient preference and ease of administration, the use of tenoxicam is appropriate in many patients undergoing day case surgery.

Topics: Administration, Rectal; Adult; Aged; Ambulatory Surgical Procedures; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Diclofenac; Double-Blind Method; Endoscopy; Female; Humans; Injections, Intravenous; Laparoscopy; Male; Meperidine; Middle Aged; Pain, Postoperative; Piroxicam; Premedication; Prospective Studies; Sterilization, Reproductive; Time Factors

The major complaint of herniorrhaphy is postoperative pain which occurs during the first 24 h after operation. Tenoxicam has a long half-life of 60-80 h. Local infiltration of the drug concentrates the pain control effects in the local area. The local infiltration dose can be smaller than the recommended systemic dose needfully to reach the target area to be effective. Therefore we studied the effect of preoperative local infiltration of tenoxicam on postoperative pain.. Sixty patients, belonging to ASA classes I and II, undergoing unilateral herniorrhaphy, were randomly assigned to 4 groups. General anesthesia was induced with thiamylal 5 mg/kg, fentanyl 2 micrograms/kg, and atracurium 5 mg/kg. Group 1 (G1) patients were preoperatively injected with 10 mg of tenoxicam in 10 ml normal saline or distilled water, in the operative area. Group 2 (G2) and Group 3 (G3) patients were preoperatively given intravenous tenoxicam, 20 mg and 10 mg, respectively. Group 4 (G4) patients were not given preoperative local infiltration or intravenous tenoxicam to serve as control group. The pain score was assessed at 2 h, 9 h, 24 h postoperatively in all groups. We recorded the total amount of acetaminophen used and the form of administration of the analgesic drug. All patients received general anesthesia in uniform technique.. Pain score and amount of analgesic drug required in G1 (local infiltration group) patients were significantly decreased compared with the other groups. The postoperative pain score of Visual Analog Scale (VAS) and analgesic requirement in the four groups were ranked as follows: G1 < G2 < G3 < G4. No significant difference was observed between G2, G3 and G4. Only the pain score in G2 patients significantly decreased (p < 0.05) during the late postoperative period (24 h) when compared with G4 patients.. Preoperative local infiltration of tenoxicam can decrease postoperative pain score significantly during the most painful period (24 h) in herniorrhaphy.

Topics: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Hernia, Inguinal; Humans; Injections, Intravenous; Male; Middle Aged; Pain, Postoperative; Piroxicam

Anaesthesia and surgery alter renal function. Inhibition of prostaglandin synthesis by non-steroidal anti-inflammatory drugs (NSAIDs) administered with anaesthesia may further compromise renal function.. To study the effects of tenoxicam (NSAID) administered immediately prior to anaesthesia on renal function in normal individuals undergoing routine surgery.. A randomised single blind placebo controlled study comparing tenoxicam (40 mg intravenously) with placebo was carried out in 20 healthy (ASA I) patients undergoing lower spinal surgery. Glomerular filtration rate (GFR) was determined by creatinine clearance and renal tubular function measured as osmolar and free water clearance.. GFR fell by 60% at the end of surgery but returned to pre-operative values by six hours post-operatively. There was no difference between placebo or tenoxicam with regard to changes in GFR. Tubular function was not altered by tenoxicam.. Current clinical practice of using NSAIDs for post-operative analgesia in low risk individuals appears to have no adverse effects on renal function.

Topics: Adult; Analysis of Variance; Anesthetics, Intravenous; Anti-Inflammatory Agents, Non-Steroidal; Female; Glomerular Filtration Rate; Humans; Intraoperative Complications; Kidney; Kidney Diseases; Laminectomy; Male; Pain, Postoperative; Piroxicam; Postoperative Complications; Premedication; Single-Blind Method; Urodynamics

We studied 32 patients undergoing bilateral symmetrical lower third molar surgery under general anaesthesia to determine if the combined effects of pre-emptive local anaesthetic block using 0.5% bupivacaine, together with i.v. tenoxicam and alfentanil had any benefits over postoperative administration. Patients acted as their own controls and were allocated randomly to have surgery start on one side, the second side always being the pre-emptive side. Difference in pain intensity between the two sides was determined using visual analogue scales completed by each individual at 6 h, and at 1, 3 and 6 days after operation. A long-form McGill pain questionnaire was also used to assess difference in pain intensity between the two sides on the morning after surgery. There was no significant difference in pain intensity at any time after surgery. Our findings indicate that the combined use of pre-emptive analgesia from 0.5% bupivacaine, tenoxicam and alfentanil did not reduce postoperative pain intensity in patients undergoing molar exodontia.

Topics: Adolescent; Adult; Alfentanil; Analgesics; Analgesics, Opioid; Anesthesia, Dental; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Bupivacaine; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Molar, Third; Pain Measurement; Pain, Postoperative; Piroxicam; Preanesthetic Medication; Premedication; Tooth Extraction

We studied 90 adults undergoing surgical removal of at least both lower third molar teeth as day cases under standardized general anaesthesia. Patients were allocated randomly (with stratification for surgeon) to receive tenoxicam 40 mg, tenoxicam 20 mg or placebo i.v. at induction of anaesthesia and orally (effervescent tablets) with food on each of the subsequent 2 days. Panadeine (paracetamol 500 mg-codeine 8 mg) was given before operation and was available as needed for pain thereafter, to a limit of two tablets every 4 h. Nefopam i.v. was also available. Efficacy variables and adverse reactions were assessed over 6 days. Over the 6-day period, patients who received tenoxicam reported less pain on rest (area under the curve; P < 0.05) and less disturbance in sleep (P < 0.01) even though they used fewer Panadeine tablets (P < 0.05). Differences between tenoxicam 40 mg and 20 mg were not significant. There was no significant difference in nefopam requirements or side effects, and no adverse event attributable to the study medication.

Topics: Acetaminophen; Adolescent; Adult; Analgesia; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Codeine; Cyclooxygenase Inhibitors; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Molar, Third; Pain, Postoperative; Piroxicam; Prospective Studies; Tooth Extraction

Arthroscopy of the knee is performed regularly on a day-case basis. Intra-articular bupivacaine produces transient analgesia and reports of analgesia using intra-articular morphine have produced conflicting results. Non-steroidal anti-inflammatory drugs given systemically can provide effective analgesia for this procedure. In this study we attempted to determine if intra-articular tenoxicam provided useful analgesia after day-case arthroscopy. Sixty three ASA I-II patients were allocated randomly to one of three groups to receive 40 ml of a solution containing 0.9% saline (group Pla), 0.25% bupivacaine (group Bup) or tenoxicam 20 mg (group Ten). The injection was made into the knee joint at the end of surgery, 10 min before tourniquet deflation. Verbal rating and visual analogue pain scores (at rest and on knee flexion), use of analgesia, mobilization and disturbance by pain at home were recorded for the next 48 h. There were no differences between pain scores in any of the three groups when tested at rest or on movement. Less analgesia was used in the first 24 h by patients in the tenoxicam group but the difference in time to first analgesia was not statistically significant. Side effects and disturbance by pain were similar in all groups. The use of intra-articular tenoxicam 20 mg at the end of arthroscopy reduced oral analgesic requirements during the first day after operation but did not alter patients' perception of pain.

Topics: Adolescent; Adult; Aged; Ambulatory Surgical Procedures; Analgesia; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Bupivacaine; Double-Blind Method; Endoscopy; Female; Humans; Knee Joint; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Piroxicam

The analgesic efficacy of tenoxicam, a newer injectable non-steroidal anti-inflammatory drug, for post-operative analgesia after abdominal or orthopaedic surgery in ASA Grade I/II patients is reported. Two hundred and fifty-six patients received a single dose of tenoxicam 40 mg intravenous (i.v.) at the end of surgery and this was repeated 24 h later. These patients were compared, with respect to pain or adverse events, with 258 patients that received placebo. All patients were monitored for the next 72 h. Overall, tenoxicam provided reliable analgesia with comparable pain scores at rest, moving and coughing. The cumulative rescue PCA-morphine consumption was always lower in the tenoxicam treated patients and was most marked at 4 and 24 h after the second injection of tenoxicam. This effect was more pronounced after abdominal surgery. The intravenous administration of tenoxicam was associated with a low incidence of adverse events and a high tolerability.

Topics: Abdomen; Adolescent; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Humans; Injections, Intravenous; Male; Middle Aged; Morphine; Orthopedics; Pain Measurement; Pain, Postoperative; Piroxicam; Prospective Studies

Intravenous regional anesthesia (IVRA) is an effective method of producing anesthesia of the extremities. Disadvantages are the rapid loss of anesthesia after the deflation of the tourniquet and the rapid development of postoperative pain. This study compared the effect of four different additives to prilocaine with saline on the development of a complete sensory block, on the return of sensory function after deflation of the tourniquet and on the development of postoperative pain after IVRA for minor orthopedic surgery of the arm. Seventy-five patients, ASA class 1 or 2, were randomly divided into 5 groups. All patients received 30 ml. of prilocaine 1%, together with 5 ml. of additive. In group 1, the additive was saline, in group 2 bupivacaine 0.25%, in group 3 clonidine 150 micrograms in saline, in group 4 sufentanil 25 micrograms in saline and in group 5 tenoxicam 20 mg. The development of a complete sensory block proved significantly faster in the patients receiving sufentanil (4.8 min.) as compared to plain prilocaine (7.5 min.). The return of the sensory function was comparable for all groups. Postoperative pain scores were significantly better in the clonidine and tenoxicam groups.

Topics: Adjuvants, Anesthesia; Adolescent; Adrenergic alpha-Agonists; Adult; Aged; Analgesics, Opioid; Anesthesia, Conduction; Anesthesia, Intravenous; Anesthetics, Intravenous; Anti-Inflammatory Agents; Bupivacaine; Clonidine; Electrocardiography; Female; Humans; Male; Middle Aged; Monitoring, Intraoperative; Pain, Postoperative; Piroxicam; Prilocaine; Steroids; Sufentanil

127 children scheduled for elective tonsillectomy or adenotonsillectomy were studied. Anaesthesia was induced with propofol and maintained with a volatile agent. At induction the child received either rectal diclofenac 1 mg.kg-1 with or without fentanyl 0.75 microgram.kg-1 i.v., or intravenous tenoxicam 0.4 mg.kg-1 with or without fentanyl 0.75 microgram.kg-1 i.v. Blood loss was measured peroperatively. Nausea and vomiting scores, sedation scores and pain scores were recorded in the recovery room, at one, two, four and eight h postoperatively and at discharge. There were no significant differences in blood loss between the groups or between nausea and vomiting scores. Pain scores in the tenoxicam without fentanyl group were significantly higher in recovery (P < 0.05) than the diclofenac group without fentanyl and both fentanyl groups. This group required supplemental analgesia earlier although this was not significant. The pain scores in the diclofenac with fentanyl group were significantly lower at one h and four h than the group receiving diclofenac alone (P = 0.008 and 0.02 respectively).

Topics: Adenoidectomy; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Blood Loss, Surgical; Child; Diclofenac; Fentanyl; Humans; Nausea; Pain Measurement; Pain, Postoperative; Piroxicam; Postoperative Complications; Tonsillectomy; Vomiting

We compared wound infiltration with small-dose tenoxicam (7.5 mg) to intramuscular (IM) administration of the same dose to treat pain after herniorrhaphy. In a randomized, double-blind study, 50 patients received either preoperative wound infiltration with tenoxicam, 7.5 mg in 40 mL of 0.9% saline (WI group; n = 25) or IM tenoxicam 7.5 mg (IM group; n = 25). In each group a saline placebo of equal volume was given by the alternate route, i.e., those who received wound infiltration with tenoxicam received 0.75 mL of 0.9% saline IM; those who received IM tenoxicam received 40 mL of 0.9% saline for wound infiltration. Postoperative pain was assessed with a verbal pain scale and a visual analog scale (VAS) at rest and during movement and cough, 1, 2, 4, 6, and 24 h postoperatively. Wound tenderness was assessed with an electronic algometer preoperatively, and 2, 4, and 6 h postoperatively. The need for supplementary analgesics (acetaminophen and morphine) was registered. No differences were observed between groups in VAS pain scores, verbal rating pain scores, pain pressure thresholds, or in need for supplementary analgesics. We conclude that tenoxicam 7.5 mg has no local analgesic effect on postoperative pain after herniorrhaphy.

Topics: Abdomen; Acetaminophen; Adult; Aged; Aged, 80 and over; Analgesia; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Hernia, Inguinal; Humans; Injections, Intradermal; Injections, Intramuscular; Male; Middle Aged; Morphine; Movement; Pain Measurement; Pain Threshold; Pain, Postoperative; Piroxicam; Placebos; Rest

The analgesic efficacy and duration of action of tenoxicam, an injectable non-steroidal analgesic with a long elimination half-life, were studied in day case laparoscopy in a double-blind randomised prospective parallel placebo-controlled trial. Tenoxicam 20 mg or saline was given intravenously at induction of anaesthesia in 67 women undergoing day case investigative laparoscopy for infertility or abdominal pain. Outcome measures were time to first analgesia, pain levels at 2, 4 and 24 h plus postoperative analgesic consumption in hospital and at home. The study showed no statistically significant difference in any of these measures between the two groups. Tenoxicam 20 mg intravenously immediately pre-operatively cannot be recommended for day case surgery on the basis of this study.

Topics: Adult; Ambulatory Surgical Procedures; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Humans; Laparoscopy; Middle Aged; Pain Measurement; Pain, Postoperative; Piroxicam; Time Factors

Nonsteroidal anti-inflammatory drugs have been documented to be effective in the treatment of postoperative pain. The aim of this study was to evaluate the analgesic effect of local intra-articular injection of tenoxicam compared with intravenous injection on postoperative pain after arthroscopy.. After day-case arthroscopy, 60 patients were randomized to receive either tenoxicam 20 mg in 20 ml of normal saline intra-articularly and 2 ml of normal saline i.v., or 20 ml of normal saline intra-articularly and 2 ml tenoxicam 20 mg i.v. Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements.. Pain scores were significantly lower in the intra-articular group at rest and during active flexion of the knee at 1, 2 and 4 hours postoperatively and during walking at 6 hours postoperatively (P < 0.05). Significantly more patients in the intravenous group required supplemental opioid analgesia within the first 4 hours postoperatively (P < 0.05).. Intra-articular tenoxicam 20 mg provided better analgesia and decreased the requirements for postoperative analgesic compared with i.v. tenoxicam 20 mg.

Topics: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pain, Postoperative; Piroxicam

Tenoxicam and piroxicam were compared for analgesic efficacy in 58 patients undergoing removal of bilateral impacted third molar teeth, under general anaesthesia. Pain intensity was assessed over a 7 day period by the patient using verbal and visual analogue scales. The patients received one hour pre-operatively dormicum 7.5 mg orally and either tenoxicam 40 mg or piroxicam 40 mg rectally. This was followed by tenoxicam 20 mg daily in effervescent form, or piroxicam 20 mg daily in despersible tablet form for 7 days. Surgical and anaesthetic techniques were standardized for all patients. Therapeutic gain was assessed by comparing hourly pain levels 4 hours post-operatively and then twice daily for 7 days. Trismus was evaluated pre-operatively, at one hour, 24 hours and 7 days post-operatively. Analysis of the results showed a statistical significant difference between the treatment groups only 4 hours post-operatively, patients in the tenoxicam group experiencing less pain than those in the piroxicam group (p = < 0.05).

Topics: Adolescent; Adult; Anesthesia, Dental; Anesthesia, General; Anti-Inflammatory Agents, Non-Steroidal; Humans; Pain Measurement; Pain, Postoperative; Piroxicam; Single-Blind Method; Suppositories; Tablets; Tooth Extraction

Tenoxicam and diclofenac sodium were compared with each other for analgesic efficacy following removal of third molars under general anesthesia. Thirty-five healthy patients between the ages of 18 and 28 yr were randomly allocated to two groups to participate in this study. Patients in Group A (n = 17) received a single intravenous injection of tenoxicam 40 mg at induction of anesthesia, followed by a 20-mg tablet given in the evening of the day of the operation and thereafter, one 20-mg tablet daily from days 2 to 7. Group B (n = 18) received a single intramuscular injection of diclofenac sodium 75 mg at induction of anesthesia, followed by a 50-mg tablet 4 to 6 hr after the operation and again, between 2100 hr and 2200 hr the same day. Thereafter, a 50-mg tablet was taken 3 times daily for the next 6 days. Pain was measured hourly for the first 4 hr postoperatively, then at 21 hr, and thereafter in the morning and the evenings on days 2 to 7. The highest pain scores were obtained 1 hr postoperatively for both trial groups. At 1 and 2 hr postoperatively, no statistical significant differences in pain scores could be shown for both groups. However, at 3 and 4 hr postoperatively, patients in the tenoxicam group experienced significantly (P < or = 0.05) less pain than those in the diclofenac sodium group. On the evening of the third postoperative day, the tenoxicam group of patients experienced significantly less pain (P < or = 0.05) than those in the diclofenac sodium group. This was again the case on the morning of the fourth postoperative day. On the fifth, sixth, and seventh postoperative days, the average pain scores for patients in the tenoxicam group were statistically significantly lower, both mornings and evenings, than those in the diclofenac sodium group of patients (P = 0.05).

Topics: Adolescent; Adult; Analysis of Variance; Anesthesia, Dental; Anesthesia, General; Anti-Inflammatory Agents, Non-Steroidal; Chi-Square Distribution; Diclofenac; Humans; Molar, Third; Pain Measurement; Pain, Postoperative; Piroxicam; Statistics, Nonparametric; Time Factors; Tooth Extraction

We have compared the effect of peritonsillar infiltration with tenoxicam 5 mg and placebo on postoperative pain after tonsillectomy. Fifty patients undergoing bilateral elective tonsillectomy under general anaesthesia were allocated randomly to receive peritonsillar infiltration with tenoxicam 5 mg in 8 ml of normal saline (4 ml per tonsil) or normal saline only, before tracheal extubation. Median time to first request for morphine (30 min in each group, P = 0.83), cumulative morphine requirements from 0 to 2 h after surgery (two and one doses, P = 0.50), and from 2 to 24 h after surgery (one dose in each group, P = 0.17) were similar. There were no significant differences between groups in VAS scores at rest or when drinking 100 ml of water at any time. The power of detecting a reduction in VAS scores of 20 mm was 90% at the 5% significance level.

Topics: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Drinking; Female; Humans; Injections, Intralesional; Male; Pain Measurement; Pain, Postoperative; Piroxicam; Time Factors; Tonsillectomy

We have studied the analgesic efficacy of a single i.v. dose of tenoxicam 20 mg, given 10 min before induction of anaesthesia in 25 patients undergoing elective Caesarean section. Another group of 25 similar patients served as controls. Nalbuphine consumption in the first 24 h after operation was reduced by 50% when tenoxicam was given. The median time to first request for analgesia was increased from 25 to 110 min in the tenoxicam group. Subjective experiences of pain and sedation were significantly greater in the control group up to 24 h after operation. The haemodynamic variability after intubation was of shorter duration in the tenoxicam group. There was no significant difference in incidence and severity of postoperative nausea and vomiting between the two groups. The surgeon's assessment of uterine relaxation and bleeding, using a visual analogue score, and infant well-being, as judged by Apgar score and cord blood-gas analysis, showed no significant difference between the two groups. There was no evidence of premature closure of the ductus arteriosus or pulmonary hypertension. We conclude that a single i.v. dose of tenoxicam is a useful pretreatment to minimize the haemodynamic variability of light general anaesthesia at induction-delivery and in reducing 24 h postoperative opioid consumption.

Topics: Adult; Analgesia, Obstetrical; Anti-Inflammatory Agents, Non-Steroidal; Cesarean Section; Double-Blind Method; Female; Humans; Injections, Intravenous; Nalbuphine; Pain, Postoperative; Piroxicam; Pregnancy; Premedication; Time Factors

Among surgical modalities for treatment of palmar hyperhidrosis, endoscopic sympathectomy is the most popular choice in recent years. After surgery, the major complaint was anterior chest pain. This study was conducted to evaluate the analgesic efficacy and side effects of tenoxicam (a thienothiazine derivative) in combination with patient-controlled analgesia (PCA) using morphine in patients who received thoracic endoscopic sympathectomy.. Forty-one ASA class I patients who underwent endoscopic sympathectomy (T2 and T3 ganglia) were randomly divided into two groups. Operation was conducted under general anesthesia with single lumen endotracheal intubation. No narcotic was given during the operation except for fentanyl (3 micrograms/kg) during induction. After surgery, patients in group I received PCA morphine only and patients in group II received PCA morphine plus tenoxicam (20 mg, i.v.) immediately for pain relief. In addition, rescue analgesia with intramuscular meperidine (1 mg/kg) was available to each patient every 4 h prn. The intensity of pain was assessed with VAS pain score every 4 h for 24 h. The frequency of demand and doses of delivered PCA morphine were recorded.. Results showed no statistically significant difference between groups in respect of age, body height, body weight and pain scores. However, based upon similar qualitative pain relief, patients in group II revealed less demand for analgesic, less doses of morphine requirement and less side effects.. Tenoxicam may be an effective adjuvant to PCA morphine for postoperative pain control. This combination reduces the total consumption of PCA morphine with less side effects.

Topics: Adult; Analgesia, Patient-Controlled; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Injections, Intravenous; Male; Morphine; Pain, Postoperative; Piroxicam; Sympathectomy; Thoracoscopy

Tenoxicam and diclofenac sodium were compared as analgesics following the surgical removal of third molars. Twenty-five patients between the ages 17 and 29 years were randomly allocated into two groups. Patients in group A received a single intraoperative intravenous (i.v.) injection of 20 mg of tenoxicam followed by a 20-mg tablet given the evening after the operation; thereafter, one 20-mg tablet was given once daily for the next 6 days. Group B received a single intraoperative intramuscular injection of 75 mg of diclofenac sodium followed by a 50-mg tablet 4 to 6 hours postoperatively and during the evening; thereafter, a 50-mg tablet was taken three times daily for the next 6 days. Pain was postoperatively measured hourly for 4 hours and later in the evening. Pain was also measured in the mornings and evenings for the next 6 days. The highest pain scores were obtained 1 hour postoperatively for both groups. During the first 3 hours following administration, patients in the tenoxicam group experienced significantly more pain than those in the diclofenac group. Preoperatively, both treatments showed identical efficacy after 3 hours. It is therefore suggested that a 40-mg dose of i.v. tenoxicam should be administered at induction of anesthesia to achieve a higher level of analgesia in the immediate postoperative phase.

Topics: Adolescent; Adult; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Chi-Square Distribution; Diclofenac; Female; Humans; Male; Molar, Third; Pain Measurement; Pain, Postoperative; Piroxicam; Premedication; Time Factors; Tooth Extraction

Tenoxicam is a long-acting nonsteroidal anti-inflammatory agent that appears to have the ability to control pain of musculoskeletal origin. A double-blind randomized crossover study was designed to determine the efficacy of tenoxicam for pain relief following third molar surgery by comparing it with paracetamol. Immediately before surgery, 30 Chinese patients with bilateral symmetrically impacted mandibular third molars were given 40 mg of tenoxicam for surgery on one side and 1,000 mg of paracetamol for surgery on the other. Both paracetamol and tenoxicam were efficient as pain relievers after third molar surgery. Tenoxicam had comparable efficacy to paracetamol, but did not provide any advantage in terms of duration of action. The discrepancy between the clinical observation and pharmacokinetic prediction may be related to the strong serum binding property of tenoxicam.

Topics: Acetaminophen; Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Humans; Male; Mandible; Molar, Third; Pain, Postoperative; Piroxicam; Tooth Extraction; Tooth, Impacted

We have shown that a single i.v. dose of tenoxicam 20 mg, after thoracotomy, when compared with placebo in 20 patients (with one exclusion), was associated with a reduction in consumption of papaveretum, assessed by patient-controlled analgesia, of 2.2 mg h-1 (22%) to 4 h and 1.4 mg h-1 (23%) to 12 h after operation (repeated measures analysis of variance: P less than 0.01). There was no reduction from 12 to 24 h. There was no significant difference between groups in pain scores or in side effects.

Topics: Adult; Aged; Analgesia; Analgesia, Patient-Controlled; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Humans; Injections, Intravenous; Male; Middle Aged; Opium; Pain, Postoperative; Piroxicam; Prospective Studies; Thoracotomy

This study reports on the efficacy of a single preoperative administration of Tenoxicam (20 mg intramuscular) after removal of two or more impacted molars. The recording of postoperative pain and swelling on a categorical and linear scale showed that there were no significant differences between the experimental and control groups. However, a significant reduction in pain was noted on the first postoperative day. We concluded that a single dose of Tenoxicam administered one hour preoperatively did have a significant analgesic effect, even though there was no significant reduction in postoperative swelling. Patients who did not have the injection had a 5.37 greater change of having more postoperative pain than those who were injected with Tenoxicam.

Topics: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Male; Molar, Third; Pain, Postoperative; Piroxicam; Tooth, Impacted

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Butanones; Carpal Tunnel Syndrome; Diclofenac; Double-Blind Method; Female; Humans; Male; Middle Aged; Nabumetone; Pain, Postoperative; Pilot Projects; Piroxicam

Postoperative pain is well known and usually disturbing complication of surgery. Inflammation plays an important role in the development and progression of postoperative pain. We aimed to investigate possible relationship between preoperatively measured neutrophil-lymphocyte ratio (NLR) - as an inflammation marker - and postoperative analgesic demand in patients underwent orthognathic surgery.. We retrospectively investigated medical and anesthesia records of 177 patients underwent orthognathic surgery. Demographical data, preoperative NLR, type of surgery, modified Mallampati score, difficulty degree of intubation, duration of surgery, and postoperative analgesic (tenoxicam - as the first drug of choice, paracetamol, tramadol, or pethidine) usage were recorded. A cutoff value of NLR ≥2 was determined for inflammation threshold. Two groups (Group 1 NLR ≥2, Group 2 NLR <2) were compared for analgesic doses, numbers of patients needed analgesic treatment, and other parameters.. Mean administered tenoxicam dose was significantly higher in Group 1 than in Group 2 (P < 0.0001). Further, ratio of patients treated with tenoxicam in Group 1 was significantly higher than that in Group 2 (χ2 = 4.779, P = 0.029).. Preoperatively measured NLR may help to predict postoperative analgesic demand in patients undergoing orthognathic surgery, and thus sufficient postoperative pain control can be achieved with various preventive treatments taken at the perioperative period such as preemptive analgesia, local anesthetic administration at the end of surgery, or early administration of analgesics.

Topics: Acetaminophen; Adult; Anti-Inflammatory Agents, Non-Steroidal; Dose-Response Relationship, Drug; Female; Humans; Lymphocytes; Male; Middle Aged; Neutrophils; Orthognathic Surgery; Pain, Postoperative; Piroxicam; Postoperative Period; Retrospective Studies; Tramadol; Treatment Outcome

NSAIDs and analgesic drugs are used intra-articularly after knee arthroscopy for pain relief. However, synovial effusion is still a common cause of delayed physical therapy. The aim of this study was to demonstrate the beneficial effect of intra-articular injection of Tenoxicam on knee effusion after arthroscopy.. This was a prospective non-randomized study on 134 patients with a mean age of 36.7 years. Knee arthroscopy on a day-case basis was performed; normal saline was used for irrigation. At the end of the procedure, fluid was aspirated from the knee joint and 20 ml of Tenoxicam diluted with 20 ml of 0.9% normal saline was injected into the knee five minutes before deflation of limb tourniquet. The same surgeon performed clinical examination for knee effusion 14 days postoperatively.. Encountered pathologies included meniscal injury, degenerative arthropathy, synovial plica and ACL rupture. Knee effusion developed in 15.7% of the patients, particularly in those with degenerative arthropathy (p = 0.006) and meniscal lesions (p = 0.06).. Intra-articular Tenoxicam is a simple method for the prevention of postoperative knee effusion. Degenerative arthropathy and meniscal lesions are major risk factors for post arthroscopy knee effusion.

Topics: Adolescent; Adult; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Child; Female; Humans; Injections, Intra-Articular; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Piroxicam; Prospective Studies; Synovial Fluid; Tourniquets; Young Adult

The treatment of pain before it initiates may prevent the persistent pain-induced changes in the central nervous system that amplify pain long after the initial stimulus. The effects of pre- or postoperative intraperitoneal administration of morphine (2 to 8 mg/kg), dipyrone (40 and 80 mg/kg), diclofenac (2 to 8 mg/kg), ketoprofen (10 and 20 mg/kg), and tenoxicam (10 and 20 mg/kg) were studied in a rat model of post-incisional pain. Groups of 5 to 8 male Wistar rats (140-160 g) were used to test each drug dose. An incision was made on the plantar surface of a hind paw and the changes in the withdrawal threshold to mechanical stimulation were evaluated with Von Frey filaments at 1, 2, 6 and 24 h after the surgery. Tenoxicam was given 12 or 6 h preoperatively, whereas the remaining drugs were given 2 h or 30 min preoperatively. Postoperative drugs were all given 5 min after surgery. No drug abolished allodynia when injected before or after surgery, but thresholds were significantly higher than in control during up to 2 h following ketoprofen, 6 h following diclofenac, and 24 h following morphine, dipyrone or tenoxicam when drugs were injected postoperatively. Significant differences between pre- and postoperative treatments were obtained only with ketoprofen administered 30 min before surgery. Preoperative (2 h) intraplantar, but not intrathecal, ketoprofen reduced the post-incisional pain for up to 24 h after surgery. It is concluded that stimuli generated in the inflamed tissue, rather than changes in the central nervous system are relevant for the persistence of pain in the model of post-incisional pain.

Topics: Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Dipyrone; Ketoprofen; Male; Mechanoreceptors; Morphine; Pain Threshold; Pain, Postoperative; Physical Stimulation; Piroxicam; Postoperative Care; Preoperative Care; Rats; Rats, Wistar

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP. All patients having HYP reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the medical care costs. The postoperative convalescence was significantly improved after HYP and full return to social or professional activity was significantly shortened. We conclude that HYP is a very efficient technique providing physiological, psychological and economic benefits to the patient.

Topics: Acetaminophen; Adult; Analgesics; Anesthesia, General; Anti-Inflammatory Agents, Non-Steroidal; Conscious Sedation; Female; Health Care Costs; Hospitalization; Humans; Hyperparathyroidism; Hypnosis, Anesthetic; Intraoperative Complications; Length of Stay; Male; Middle Aged; Pain, Postoperative; Parathyroidectomy; Patient Satisfaction; Piroxicam; Prodrugs; Recovery of Function; Thyroidectomy

Non-steroidal anti-inflammatory drugs (NSAIDs) provide effective analgesia after orthopaedic surgery and reduce opioid requirements. The need for parenteral NSAIDs with peripheral surgery is controversial. In this study 10 patients were treated with oral tenoxicam 20 mg preoperatively, and at 4 hours and 28 hours after knee ligament reconstruction surgery. Plasma concentrations of tenoxicam, an NSAID with a long elimination half-life, were measured for 10 days. All patients received patient-controlled intravenous morphine postoperatively, which delayed absorption of the second and third tenoxicam doses. However, plasma concentrations of tenoxicam were achieved and maintained for the five-day surgical admission above the level considered to produce effective analgesia. Oral analgesic administration is a simple and feasible option in the perioperative period.

Topics: Administration, Oral; Adult; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Knee Joint; Male; Pain, Postoperative; Piroxicam

Topics: Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Humans; Injections, Intra-Articular; Knee Joint; Pain Measurement; Pain, Postoperative; Piroxicam