ABSTRACT
BACKGROUND: This study was designed to evaluate the effect of intravenous piroxicam on pruritus and pain in patients undergoing abdominal surgery after epidural fentanyl was administered. METHODS: Ninety nine patients, ASA physical status 1 - 2, were randomly allocated to receive either piroxicam 20 mg (n = 50) or saline 2 ml (n = 49) intravenously before surgical incision. An epidural catheter was inserted in all patients before induction of anesthesia. All patients received 5 mg/kg of thiopental sodium and 1.5 mg/kg of vecuronium. Anesthesia was maintained by 50% O2 in N2O with 2 vol% enflurane. Epidural fentanyl 50 microgram was administered intraoperatively and 9.5 12.5 microgram/ml of fentanyl mixed in 100 ml of 0.15% bupivacaine was infused continuously by the Baxter two day infusor for 50 hours postoperatively. Postoperative pruritus and pain were measured by a numeric rating scale (0 - 10) in the piroxicam group and control group. RESULTS: Pruritus and pain scores at 1, 4, 8 and 24 hours in the piroxicam group were significantly lower than those in the control group (P < 0.05). The incidence of pruritus after epidural fentanyl varied from 2 to 6% in the piroxicam group and from 57 to 67% in the control group. Mean scores of pruritus were 0.6, 0.3, 0.2 and 0.1 in the piroxicam group and 5.1, 3.5, 2.8 and 1.8 in the control group. Mean scores of pain were 1.7, 1.2, 0.9 and 0.6 in the piroxicam group and 3.2, 2.4, 1.9 and 1.1 in the control group. CONCLUSIONS: This study demonstrates that intravenous piroxicam 20 mg significantly reduces the incidence and severity of postoperative pruritus and pain in patients who received perioperative epidural fentanyl.