Is Lornoxicam Better Than Low-Dose Tramadol for Post-thyroidectomy Pain?

Yücel, Ali Serdar

doi:10.5505/agri.2016.94546

Cited by 10 publications

(10 citation statements)

References 6 publications

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“…Consistent with previous studies [30–33], 80.0% of patients had NRS scores lower than 4 (only one patient had a NRS score of greater than 6), indicating that thyroidectomy causes mild to moderate postoperative pain. Additional rescue analgesics were not usually required, and the need for additional rescue analgesics did not significantly differ between the groups.…”

Section: Discussionsupporting

confidence: 90%

Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provides enhanced analgesic effects after radical thyroidectomy: a randomized controlled trial

Yang

et al. 2019

BMC Anesthesiol

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Background Thyroidectomy is a common procedure that causes mild trauma. Nevertheless, postoperative pain remains a major challenge in patient care. Multimodal analgesia comprising a combination of analgesics and analgesic techniques has become increasingly popular for the control of postoperative pain. The present study tested the hypothesis that multimodal analgesia with combined ropivacaine wound infiltration and intravenous flurbiprofen axetil after radical thyroidectomy provided better analgesia than a single dosage of tramadol. Methods This randomized controlled trial was conducted in a tertiary hospital. Forty-four patients (age, 18–75 years; American Society of Anesthesiologists status I or II; BMI < 32 kg/m 2 ) scheduled for radical thyroidectomy were randomly assigned to a multimodal analgesia group (Group M) or a control group (Group C) by random numbers assignments, and 40 patients completed the study. All participants and the nurse in charge of follow-up observations were blinded to group assignment. Anesthesia was induced with sufentanil, propofol, and cisatracurium. After tracheal intubation, Group M received pre-incision wound infiltration with 5 ml of 0.5% ropivacaine mixed with epinephrine at 1:200,000 (5 μg/ml); Group C received no wound infiltration. Anesthesia was maintained with target-controlled infusion of propofol, remifentanil, sevoflurane, and intermittent cisatracurium. Twenty minutes before the end of surgery, Group M received 100 mg flurbiprofen axetil while Group C received 100 mg tramadol. Postoperative pain was evaluated with the numerical rating scale (NRS) pain score. Remifentanil consumption, heart rate, and noninvasive blood pressure were recorded intraoperatively. Adverse events were documented. The primary outcome was analgesic effect according to NRS scores. Results NRS scores at rest were significantly lower in Group M than in Group C before discharge from the postoperative anesthetic care unit ( P = 0.003) and at 2 ( P = 0.008), 4 ( P = 0.020), and 8 h ( P = 0.016) postoperatively. Group M also had significantly lower NRS scores during coughing/swallowing at 5 min after extubation ( P = 0.017), before discharge from the postoperative anesthetic care unit ( P = 0.001), and at 2 ( P = 0.002) and 4 h ( P = 0.013) postoperatively. Compared with Group C, NRS scores were significantly lower throughout the first 24 h postoperatively in Group M at rest ( P = 0.008) and during coughing/swallowing ( P = 0.003). No serious adverse events were observed in either group. Conclusion Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provided better ana...

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Section: Discussionsupporting

confidence: 90%

Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provides enhanced analgesic effects after radical thyroidectomy: a randomized controlled trial

Yang

et al. 2019

BMC Anesthesiol

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“…[7] In another study, time until first analgesic demand was 7 hrs for the 16 mg lornoxicam group and 5.5 hrs for the 100 mg tramadol group. [8] Evaluations according to VRS showed that 16 mg lornoxicam values for the first 30 mins were highly significantly lower compared to the 8 mg lornoxicam group and significantly lower than the 100 mg tramadol group. Later evaluations showed that the tramadol group had lower VRS scores compared to the lornoxicam groups.…”

Section: Discussionmentioning

confidence: 90%

Comparison of lornoxicam and tramadol administrations for postoperative pain in lumbar disk surgery

Yener¹,

Erkal

2019

FNG & Demiroğlu Bilim Tıp Dergisi

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Objectives: This study aims to compare the efficacy and side effects of lornoxicam, a nonsteroidal anti-inflammatory drug , and a weak opioid derivative, tramadol hydrochloride, for postoperative analgesia following lumbar discectomy operation. Materials and methods: Fifty-six American Society of Anesthesiologists (ASA) physical status 1-2 patients were randomly allocated into three groups: Group 1 was administered 8 mg IV lornoxicam, Group 2 16 mg IV lornoxicam, and Group 3 100 mg IV tramadol. In order to evaluate efficacy of the drugs, Verbal Rating Scale (VRS), pain intensity difference (PID), pain relief (PAR), mean blood pressure values, and side effects that developed were documented at 15, 30, and 45 minutes, and 1, 2 ,3 ,4 ,6, 12, and 24 hours into treatment. Results: Demographic data was similar among all groups. In patients who were administered 8 mg lornoxicam, the time until first demand for analgesia was significantly lower (p<0.01). Mean VRS values of these patients were higher compared to other groups (p<0.05). In the postoperative period nausea and vomiting was observed in 35% of the patients in the tramadol group. Conclusion: It was observed that, in the treatment of postoperative pain, 8 mg lornoxicam was insufficient and that 16 mg lornoxicam was as effective as tramadol 100 mg, but had shorter duration of action. Side effects such as nausea, vomiting, sedation and bradycardia were more common in tramadol compared to lornoxicam.

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“…Yücel et al found that time to first analgesic was significantly longer ( P = .045) and Numeric Rating Scale (NRS) scores at 15 minutes, 30 minutes, and 1 hour were lower in the lornoxicam group ( P = .022). 15 Smirnov et al investigated the use of etoricoxib versus placebo and found that while no there was no difference in amount of rescue and time to first rescue, a significant decrease was seen in number of patients requesting medication ( P = .039). 18 The most common reported side effect was nausea and vomiting (34.5%), followed by bleeding (11.8%) and dizziness (8.3%) (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies reported on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for perioperative analgesic control in thyroid surgery. [13][14][15][16]18,42 All included studies were prospective RCTs. The summary of data for these studies is listed in Supplemental Table 2 online.…”

Section: Nsaidmentioning

confidence: 99%

Perioperative Analgesia for Patients Undergoing Thyroidectomy and Parathyroidectomy: An Evidence-Based Review

Nguyen

Stathakios

Quan

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: To perform an evidence-based systematic review evaluating perioperative analgesia, including opioid alternatives, used for patients undergoing thyroidectomy and parathyroidectomy. Methods: A comprehensive literature search from 1997 to January 2018 of Pubmed, Cochrane, and EmBase libraries was performed for studies reporting analgesic administration following thyroid or parathyroid surgery. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were evaluated for level of evidence and given a Jadad score to assess for risk of bias. Outcomes gathered included postoperative pain scores, time to rescue analgesia, rescue analgesic consumption, and adverse events. Results: Thirty-eight randomized controlled trials met inclusion criteria. The GRADE criteria determined the overall evidence to be moderate-high. Studies utilizing NSAIDs reported reduced requirements for rescue analgesics. Acetaminophen studies presented with conflicting data on effectiveness. Gabapentinoid studies demonstrated lower pain scores and an increased time to rescue analgesic. Local anesthetics were effective at decreasing Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) pain scores while also reducing rescue analgesic consumption. Ketamine was shown to increased postoperative nausea and vomiting. NSAIDs and local anesthetic studies had an aggregate grade of evidence A, while all others had grade B evidence. Conclusion: There is significant evidence supporting the use of NSAIDs and local anesthetics in the perioperative period for pain management for thyroid and parathyroid surgeries. Acetaminophen, gabapentinoid and ketamine have some supporting evidence and may serve as adequate alternatives. Further multi-institutional RCTs are warranted to delineate optimal analgesic regimens. Level of Evidence: NA

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Is Lornoxicam Better Than Low-Dose Tramadol for Post-thyroidectomy Pain?

Cited by 10 publications

References 6 publications

Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provides enhanced analgesic effects after radical thyroidectomy: a randomized controlled trial

Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provides enhanced analgesic effects after radical thyroidectomy: a randomized controlled trial

Comparison of lornoxicam and tramadol administrations for postoperative pain in lumbar disk surgery

Perioperative Analgesia for Patients Undergoing Thyroidectomy and Parathyroidectomy: An Evidence-Based Review

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