The Local Addition of Tenoxicam Reduces the Incidence of Low Back Pain after Lumbar Epidural Anesthesia

Wang, Yung-Liang; Hsieh, Jing-Ru; Chung, Ham-See; Yu, Chi-Lun; Ho, Alan; Lu, Pao-Ping; Tan, Peter

doi:10.1097/00000542-199812000-00019

Cited by 17 publications

(12 citation statements)

References 14 publications

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“…67 In their second study, the addition of tenoxicam to the lidocaine for skin infiltration not only decreased the incidence of back pain after epidural anesthesia but also shortened the duration of the pain. 68 In their third study, the addition of ketoprofen, a more lipid-soluble antiinflammatory drug, to the lidocaine for skin infiltration also reduced the incidence and decreased the severity of back pain after epidural anesthesia. 69 It is tempting to impart a high evidence score because the studies were randomized, controlled, and double blinded.…”

Section: Prevention Of Back Pain From Neuraxial Injectionmentioning

confidence: 99%

“…Controlled studies evaluating the prevention of back pain after neuraxial anesthesia involved mostly the use of an anti-inflammatory medication or steroid, given epidurally or as part of the intradermal injectate. Wang et al 67,68 and Wang and coworkers 69 performed a series of studies wherein they added a steroid into their epidural injectate or added an anti-inflammatory medication to the local anesthetic for skin infiltration. In their first study, they noted that the addition of 5 mg dexamethasone to the epidural anesthesia resulted in a significantly lower incidence of back pain at 24, 48, and 72 hours after the epidural anesthesia (Table 8).…”

Section: Prevention Of Back Pain From Neuraxial Injectionmentioning

confidence: 99%

“…Although randomized, placebo controlled, and double blinded, the study has limitations ( Table 8). The results of the 3 controlled studies on the addition of an anti-inflammatory drug to the local anesthetic for skin infiltration [68][69][70] led us to conclude that such intervention may decrease the incidence of back pain after an epidural (level 2). The presence of limitations in the 3 studies calls for prospective, randomized-controlled studies on the subject.…”

Section: Prevention Of Back Pain From Neuraxial Injectionmentioning

confidence: 99%

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Back Pain and Neuraxial Anesthesia

Benzon

Asher

Hartrick

2016

Anesthesia &Amp; Analgesia

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The incidence of back pain after neuraxial anesthesia in the adult population is not different from that after general anesthesia. The pain is usually mild, localized in the low back, rarely radiates to the lower extremities, and has a duration of only a few days. The risk factors for development of back pain include the lithotomy position, multiple attempts at block placement, duration of surgery longer than 2.5 hours, body mass index ≥32 kg/m, and a history of back pain. However, there is no permanent worsening of preexisting back pain after neuraxial anesthesia. The back pain has been attributed to tears in the ligaments, fascia, or bone with localized bleeding; immobility of the spine; relaxation of the paraspinal muscles under anesthesia; flattening of the normal lumbar convexity; and stretching and straining of the lumbosacral ligaments and joint capsules. The addition of an anti-inflammatory drug to the local anesthetic used for skin infiltration may decrease the incidence and severity of back pain. The use of spinal or epidural anesthesia in the adult, non-obstetric and obstetric populations should depend on the advantages offered by the technique and not on the occurrence of back pain after the procedure. Additional studies are needed to confirm the efficacy of epidural dexamethasone, or other steroids, or the addition of an anti-inflammatory drug to the local anesthetic infiltration for the prevention of back pain after neuraxial anesthesia. Future studies should involve a physician with expertise in the evaluation of chronic low back pain to help identify the cause of the back pain and institute appropriate treatment(s).

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Section: Prevention Of Back Pain From Neuraxial Injectionmentioning

confidence: 99%

Section: Prevention Of Back Pain From Neuraxial Injectionmentioning

confidence: 99%

Section: Prevention Of Back Pain From Neuraxial Injectionmentioning

confidence: 99%

See 1 more Smart Citation

Back Pain and Neuraxial Anesthesia

Benzon

Asher

Hartrick

2016

Anesthesia &Amp; Analgesia

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“…On the other hand, introducing an epidural needle or catheter and administering a volume of local anesthetic may result in localized musculoligamentous trauma, hematoma, or inflammation, including periostitis, tendonitis, or osteochondritis, which may be followed by secondary paraspinous muscle spasm. Mild or moderate low back pain is a common complaint after epidural analgesia or anesthesia [7,8]. However, the low back pain that developed in our patients was far more severe than that which often develops in patients undergoing epidural analgesia.…”

Section: Discussionmentioning

confidence: 56%

Severe back pain following epidural analgesia in patients with spinocerebellar ataxia: a report of two cases

Iida

Kato

Ogawa

2011

Journal of Clinical Anesthesia

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“…The results of these studies demonstrated that there is evidence for a clinically relevant peripheral analgesic effect of wound infiltration with NSAIDs (29,30).…”

Section: Discussionmentioning

confidence: 93%

Efficacy of wound infiltration with lornoxicam for postoperative analgesiafollowing thyroidectomy: a prospective, randomized, double-blind study

Kılbaş¹,

Mentes²,

Harlak³

et al. 2015

Turk J Med Sci

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Background/aim: Postoperative pain control constitutes a major problem and studies have focused on reducing opioid requirements using regional techniques. We aimed to investigate the efficacy of wound infiltration with lornoxicam on postoperative pain control following thyroidectomy. Materials and methods:In this prospective, randomized-controlled study, 80 patients scheduled for thyroidectomy were randomly assigned to 2 groups. After the thyroidectomy was performed, patients in group I underwent wound infiltration with 4 mg of lornoxicam and patients in group II received the same amount of saline. Rescue analgesia was provided with additional doses of lornoxicam delivered by an on-demand patient-controlled analgesia device. Total analgesic consumption during the postoperative 24 h, and pain intensities assessed using a visual analog scale score at 0, 2, 4, 8, 12 and 24 h postoperatively were recorded.Results: Pain scores during the postoperative 24 h were slightly lower in group I than in group II, but the difference was not significant (P > 0.05). The mean analgesic consumption was 8.87 ± 1.87 mg and 10.33 ± 1.25 mg in groups I and II, respectively (P > 0.05). Conclusion:Wound infiltration with lornoxicam neither improved postoperative pain control nor decreased total analgesic consumption.

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The Local Addition of Tenoxicam Reduces the Incidence of Low Back Pain after Lumbar Epidural Anesthesia

Abstract: In summary, the local addition of tenoxicam reduced the incidence and severity of postepidural backache.

Cited by 17 publications

References 14 publications

Back Pain and Neuraxial Anesthesia

Back Pain and Neuraxial Anesthesia

Severe back pain following epidural analgesia in patients with spinocerebellar ataxia: a report of two cases

Efficacy of wound infiltration with lornoxicam for postoperative analgesiafollowing thyroidectomy: a prospective, randomized, double-blind study

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