Sublingual Piroxicam for Postoperative Analgesia: Preoperative Versus Postoperative Administration: A Randomized, Double-Blind Study

Abstract

Nonsteroidal antiinflammatory drugs have been used to obtain preemptive analgesia. We investigated, in this randomized, double-blind study, whether sublingual (s.l.) piroxicam given before was more effective than that given after surgery. Fifty-two patients scheduled for laparoscopic bilateral inguinal hernia repair under general anesthesia were enrolled. Group PRE (25 patients) received 40 mg of piroxicam s.l. 2 h before surgery and a placebo 10 min after surgery. Group POST (27 patients) were treated with a placebo 2 h before surgery and received 40 mg of piroxicam s.l. 10 min after surgery. After an initial dose of 100 mg tramadol IV, patient-controlled analgesia with tramadol was started and recorded. Visual analog scores were assessed in the recovery and at 6, 20, and 30 h postoperatively. Significantly lower visual analog scores were found in group PRE at 6 and 20 h. Significantly smaller cumulative tramadol consumption was observed after 30 h in group PRE. In summary, our findings suggest that preoperative s.l. piroxicam is more effective than the postoperative administration. Because of the low pain scores in both groups, the clinical relevance of these findings is not clear from this study.

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

“…Studies have shown that surgical wound infiltration with local anesthetics is effective to control acute postoperative pain in different procedures, because it decreases pain and opioid consumption 2,13,14 . Wound infiltration with local anesthetics has also been recommended to decrease perioperative opioid consumption 7 . In our study, pain intensity was evaluated by VAS, established method in the literature, since pain intensity described by patients has been referred as one of the most reliable measures to estimate analgesic treatment effectiveness 9 .…”

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

Preoperative preemptive drug administration for acute postoperative pain: A systematic review and meta‐analysis

“…A total of three RCTs yielded three comparisons, in which the oxicams class of NSAIDs were administered preoperatively, were incorporated in the metaanalyses, studying 172 adult patients (85 received oxicams, 87 received placebo; Table 1; Table 2, notes 13,14) (Akca et al, 2004;Gramke et al, 2006;Mowafi et al, 2011). The meta-analysed oxicams were lornoxicam (1 study, medium dose; Mowafi et al, 2011), piroxicam (1 study, high dose; Gramke et al, 2006) and tenoxicam (1 study, medium dose; Akca et al, 2004).…”

“…The meta-analysed oxicams were lornoxicam (1 study, medium dose; Mowafi et al, 2011), piroxicam (1 study, high dose; Gramke et al, 2006) and tenoxicam (1 study, medium dose; Akca et al, 2004).…”

Preemptive analgesia by preoperative administration of nonsteroidal anti-inflammatory drugs

“…The variable patient characteristics and timing of preemptive analgesia in relation to surgical stimuli might require particular treatments for each patient. Thus, for practitioners who aspire to apply the advantage of preemptive analgesia with NSAIDs, following the concept of evidence-based medicine, it is necessary to have results that support the relevant preemptive analgesic effect in clinical investigations [1,[4][5][6].…”