The Effects of Preoperative Inflammation on the Analgesic Efficacy of Intraarticular Piroxicam for Outpatient Knee Arthroscopy

İzdeş, Seval; Orhun, Sibel; Turanli, Sacit; Erkılıç, Ezgi; Kanbak, Orhan

doi:10.1213/01.ane.0000081725.81280.17

Cited by 25 publications

(21 citation statements)

References 19 publications

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“…It is assumed that following local administration of the NSAID, high concentrations of the drug were achieved in the inflamed synovium as proven by the pharmacokinetic study, with potential for a more effective reduction of inflammation and/or pain. This finding is supported by the earlier report, which suggests that NSAIDs delivered via IA injection effectively inhibit the activation of peripheral nociceptors, by reducing the levels of arachidonic acid metabolites such as prostaglandins and thromboxanes in the joint tissue (Izdes et al ., 2003). NSAIDs injected intraarticularly may also reduce the pain by modifying the local inflammatory process (Unlu et al ., 2006).…”

Section: Discussionsupporting

confidence: 85%

Comparison of Piroxicam Pharmacokinetics and Anti-Inflammatory Effect in Rats after Intra-Articular and Intramuscular Administration

Park

Wan

Jang

et al. 2014

Biomolecules & Therapeutics

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This study evaluated the pharmacokinetic profile and therapeutic efficacy of piroxicam (PX), a long acting non-steroidal anti-inflammatory drug for the treatment of arthritis, following intra-articular (IA) injection in comparison to the pharmacokinetic profile and therapeutic efficacy of PX after intramuscular (IM) injection. In the pharmacokinetic study in rats, systemic exposure and pharmacokinetic parameters of PX after a single IA dose were compared with systemic exposure and pharmacokinetic parameters of PX after administration of the same dose IM (0.6 mg/kg). The anti-inflammatory and analgesic effects of IA PX were evaluated simultaneously in a monoiodoacetate-induced osteoarthritis rat model. The plasma PX concentration rapidly rose following IA injection, and it was comparable to the plasma PX concentration following IM injection, suggesting the rapid efflux of the drug molecule from the joint cavity. However, in the efficacy study, the IA PX administration significantly reduced the knee swelling by reducing the level of prostaglandin E2 in the joint, compared to that following administration of IA vehicle and after administration of the IM PX dose. In addition, we found that the anti-inflammatory and anti-nociceptive efficacies of IA PX were synergistically increased upon co-treatment with hyaluronic acid (HA), a potent agent for the treatment of osteoarthritis, at the weight ratio of 1:1 or 1:2, and these effects were more pronounced than those following administration of HA or PX alone. In conclusion, this study demonstrated the efficacy of the IA use of PX alone and/or in combination with HA in osteoarthritis.

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Section: Discussionsupporting

confidence: 85%

Comparison of Piroxicam Pharmacokinetics and Anti-Inflammatory Effect in Rats after Intra-Articular and Intramuscular Administration

Park

Wan

Jang

et al. 2014

Biomolecules & Therapeutics

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“…It was similarly found that lornoxicam resulted in lower pain scores than did bupivacaine in a randomized controlled trial of 40 patients (Fagan et al, 2003). The use of an anti-inflammatory into the joint cavity may play a role in pain control particularly when a significant inflammatory component to the intra-articular pathology is found (Izdes et al, 2003).…”

Section: Knee Arthroscopymentioning

confidence: 97%

“…(HegeScheuing et al, 1995) RCT 59 Morphine (1mg) given either intra-articularly or intravenously at the end of arthroscopy had equivalent analgesic benefit. (Izdes et al, 2003) RCT 90…”

Section: Wwwintechopencommentioning

confidence: 99%

Local Anesthetic Agents in Arthroscopy

Baker¹

2012

Pain Management - Current Issues and Opinions

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“…It undergoes enterohepatic circulation and is primarily used to treat arthritis and other musculoskeletal conditions [10]. Piroxicam exhibits anti-inflammatory [11], analgesic [12], and antipyretic activities in animal models. The mechanism of action of piroxicam, like any other NSAID, is not completely understood but may be related to prostaglandin synthetase inhibition [13].…”

Section: Introductionmentioning

confidence: 99%

Effect of Piroxicam and/or Ascorbic Acid on Postoperative Pain in Orchidectomised Goats

2014

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The study evaluates effects of varied doses of ascorbic acid and piroxicam on behavioural signs of pain in orchidectomised Savannah Brown goats during their postsurgical pain management. The goats were divided into 6 groups of 3 goats each. Orchidectomy was performed on all animals under sedation with xylazine and linear infiltration with lignocaine. After surgery, varied doses of piroxicam (IM) and ascorbic acid (IV) were administered to the goats: Group A = piroxicam, 5 mg/kg + ascorbic acid, 100 mg/kg; Group B = piroxicam, 5 mg/kg + ascorbic acid, 200 mg/kg; Group C = piroxicam, 10 mg/kg + ascorbic acid, 100 mg/kg; Group D = piroxicam, 5 mg/kg; Group E: ascorbic acid, 100 mg/kg together with antibiotics, procaine penicillin, 20,000 IU/kg + streptomycin, 10 mg/kg (IM); and Group F (control) received only the antibiotics. After surgery, pain intensity was determined in each goat by numerical rating scale. Vocalisation, teeth grinding, rapid and shallow breathing, tail wagging, occasionally bleating, neck extension, and dorsal lip curling were recorded at varying degrees across the experimental groups. The goats in the control group showed the highest degree of behavioural signs of pain. It is concluded that treatment with a combination of piroxicam and ascorbic acid ameliorated pain more than either of the agents in orchidectomised Savannah Brown goats.

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The Effects of Preoperative Inflammation on the Analgesic Efficacy of Intraarticular Piroxicam for Outpatient Knee Arthroscopy

Abstract: Intraarticular administration of piroxicam along with bupivacaine improves postoperative analgesia in synovial inflammation before surgery.

Cited by 25 publications

References 19 publications

Comparison of Piroxicam Pharmacokinetics and Anti-Inflammatory Effect in Rats after Intra-Articular and Intramuscular Administration

Comparison of Piroxicam Pharmacokinetics and Anti-Inflammatory Effect in Rats after Intra-Articular and Intramuscular Administration

Local Anesthetic Agents in Arthroscopy

Effect of Piroxicam and/or Ascorbic Acid on Postoperative Pain in Orchidectomised Goats

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