Comparison of tramadol and lornoxicam in intravenous regional anesthesia: a randomized controlled trial / Comparação de tramadol e lornoxicam em anestesia regional por via intravenosa, um estudo randomizado e controlado

BACKGROUND AND OBJECTIVES: Tourniquet pain is one of the major obstacles for intravenous regional anesthesia. We aimed to compare tramadol and lornoxicam used in intravenous regional anesthesia as regards their effects on the quality of anesthesia, tourniquet pain and postoperative pain as well. METHODS: After the ethics committee approval 51 patients of ASA physical status I-II aged 18-65 years were enrolled. The patients were divided into three groups. Group P (n = 17) received 3 mg/kg 0.5% prilocaine; group PT (n = 17) 3 mg/kg 0.5% prilocaine + 2 mL (100 mg) tramadol and group PL (n = 17) 3 mg/kg 0.5% prilocaine + 2 mL (8 mg) lornoxicam for intravenous regional anesthesia. Sensory and motor block onset and recovery times were noted, as well as tourniquet pains and postoperative analgesic consumptions. RESULTS: Sensory block onset times in the groups PT and PL were shorter, whereas the corresponding recovery times were longer than those in the group P. Motor block onset times in the groups PT and PL were shorter than that in the group P, whereas recovery time in the group PL was longer than those in the groups P and PT. Tourniquet pain onset time was shortest in the group P and longest in the group PL. There was no difference regarding tourniquet pain among the groups. Group PL displayed the lowest analgesic consumption postoperatively. CONCLUSION: Adding tramadol and lornoxicam to prilocaine for intravenous regional anesthesia produces favorable effects on sensory and motor blockade. Postoperative analgesic consumption can be decreased by adding tramadol and lornoxicam to prilocaine in intravenous regional anesthesia.

JUSTIFICATIVA E OBJETIVOS: A dor relacionada ao torniquete é um dos maiores obstáculos para a anestesia regional intravenosa (ARIV). Nosso objetivo foi comparar tramadol e lornoxicam usados em ARIV em relação aos seus efeitos sobre a qualidade da anestesia, dor relacionada ao torniquete e dor no pós-operatório. MÉTODOS: Após a aprovação do Comitê de Ética, 51 pacientes com estado físico ASA I-II entre 18-65 anos foram inscritos. Os pacientes foram divididos em três grupos. Grupo P (n = 17) recebeu 3 mg/kg de prilocaína a 0,5%; Grupo PT (n = 17) 3 mg/kg de prilocaína a 0,5% + 2 mL (100 mg) de tramadol e Grupo PL (n = 17) de 3 mg/kg de prilocaína a 0,5% + 2 mL (8 mg) de lornoxicam para ARIV. O início do bloqueio sensorial e motor e os tempos de recuperação foram registrados, bem como a dor relacionada ao torniquete e o consumo de analgésico no pós-operatório. RESULTADOS: Os tempos de início do bloqueio sensorial foram mais curtos nos grupos PT e PL, enquanto que os tempos de recuperação correspondentes foram mais longos do que os do Grupo P. Os tempos de início do bloqueio motor nos grupos PT e PL foram menores do que no Grupo P, enquanto que o tempo de recuperação do grupo PL foi maior do que os dos grupos P e PT. O tempo para início da dor relacionada ao torniquete foi menor no Grupo P e maior no Grupo PL. Não houve diferença em relação à dor relacionada ao torniquete entre os grupos. O Grupo PL apresentou o menor consumo de analgésicos no pós-operatório. CONCLUSÃO: A adição de tramadol e lornoxicam à prilocaína para ARIV produz efeitos favoráveis sobre o bloqueio sensorial e motor. O consumo de analgésicos no pós-operatório pode ser reduzido com a adição de tramadol e lornoxicam à prilocaína em ARIV.

Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis / Comparação da eficácia de tenoxicam administrado por via oral e intra-articular a pacientes com osteoartrite de joelhos

ABSTRACTBACKGROUND AND OBJECTIVES:Tenoxicam is widely used in osteoarthritis treatment and we aimedto compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthri-tis treatment.METHODS: This study was performed between 2011 and 2012 by retrospectively analyzing andcomparing the findings of 60 patients who were clinically and radiologically diagnosed with kneedegenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in thestudy were divided into two groups. The first group (tenoxicam IA, n = 30) included patientfindings of those subjected to intra-articular injection of 20 mg tenoxicam to the knee oncea week for three weeks and the second group (oral tenoxicam, n = 30) included patients whowere administered 20 mg oral tenoxicam once a day for three weeks. All patients were clini-cally evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatmentaccording to specified criteria.RESULTS AND CONCLUSIONS: Twenty two of 60 patients included in the study were male and 38were female. In both groups significant improvements were detected in all of the observedparameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physicalactivity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week,1st month and 3rd month with respect to pre-treatment values. Besides, a better complianceto treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed.Intra-articular tenoxicam administration could be thought as an alternative treatment methodin patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemicgastrointestinal system side effects and those who have difficulties in adapting to treatment.

RESUMOJUSTIFICATIVA E OBJETIVOS: Tenoxicam é amplamente usado no tratamento da osteoartrite (OA)e o nosso objetivo foi comparar a eficácia de tenoxicam administrado por via oral (VO) e intra-articular (IA) no tratamento da OA.MÉTODOS: Este estudo foi conduzido entre 2011 e 2012 por meio de análise retrospectiva ecomparação dos resultados de 60 pacientes que foram clínica e radiologicamente diagnosticadoscom OA degenerativa de joelhos na Policlínica de Tratamento da Dor do Hospital Estadual deBünyan. Os 60 pacientes incluídos no estudo foram alocados em dois grupos. O primeiro grupo(tenoxicam IA, n = 30) incluiu resultados de pacientes submetidos à injeção nos joelhos porvia IA de 20 mg de tenoxicam uma vez por semana durante três semanas e o segundo grupo(tenoxicam VO, n = 30) incluiu pacientes que receberam 20 mg de tenoxicam por VO uma vezpor dia durante três semanas. Todos os pacientes foram avaliados clinicamente na fase basalpré-tratamento e em uma semana, um mês e três meses pós-tratamento, de acordo com oscritérios especificados.RESULTADOS E CONCLUSÕES: Dos 60 pacientes, 22 eram do sexo masculino e 38 do sexo feminino.Em ambos os grupos, melhorias significativas foram detectadas em todos os parâmetros da escalavisual analógica, do índice Western Ontario and MacMaster (Womac --- dor, atividade física erigidez dos joelhos) e do índice de Lequesne nas avaliações feitas em uma semana, um mês etrês meses e comparadas aos valores basais. Além disso, uma melhor adesão ao tratamento etolerabilidade ao sistema gastrointestinal no grupo tenoxicam IA também foram observadas. Aadministração de tenoxicam IA pode ser considerada como um método opcional de tratamentoem pacientes com OA de joelhos que não podem usar tenoxicam por VO, especialmente porcausa dos efeitos colaterais sobre o sistema gastrintestinal, e naqueles com dificuldades de adaptação ao tratamento.

Comparison of different postoperative paın managements in patients submitted to transperitoneal laparoscopic renal and adrenal surgery

ABSTRACTPurpose:We compared the effects of local levobupivacaine infiltration, intravenous paracetamol, intravenous lornoxicam treatments on postoperative analgesia in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.Materials and Methods:Sixty adult patients 26 and 70 years who underwent laparoscopic renal and adrenal surgery were randomized into three groups with 20 patients each: Group 1 received local 20mL of levobupivacaine 0.25% infiltration to the trocar incisions before skin closure. In group 2, 1g paracetamol was given to the patients intravenously 30 minutes before extubation and 5g paracetamol was given intravenoulsy in the 24 postoperative period. In group 3, 8mg lornoxicam i.v. was given 30 minutes before extubation and 8mg lornoxicam i.v. was given in the 24 postoperative period. In the postoperative period, pain scores, cumulative tramadol, and additional pethidine consumption were evaluated.Results:Postoperative pain scores significantly reduced in each group (p < 0.05). Although pain levels of the groups were not significantly different at 1, 2, 4, 8, 12 and 24 hours postoperatively, cumulative tramadol consumptions were higher in group 1 than the others. (Group 1 = 370.6 ± 121.6mg, Group 2: 220.9 ± 92.5mg, Group 3 = 240.7 ± 100.4mg.) (p < 0.005). The average dose of pethidine administered was significantly lower in groups 2 and 3 compared with group 1 (Group 1: 145mg, Group 2: 100mg, Group 3: 100mg) (p = 0.024).Conclusions:Levobupivacaine treated group required significantly more intravenous tramadol when compared with paracetamol and lornoxicam groups in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.

Comparação de lornoxicam e fentanil adicionados à lidocaína em anestesia regional intravenosa / Comparison of lornoxicam and fentanyl when added to lidocaine in intravenous regional anesthesia / Comparación de lornoxicam y fentanilo adicionados a la lidocaína en la anestesia regional intravenosa

JUSTIFICATIVA E OBJETIVO: Comparar os efeitos analgésicos nos períodos intra e pós-operatório de lornoxicam e fentanil adicionados à lidocaína para anestesia regional intravenosa (ARIV) em um grupo de pacientes submetidos à cirurgia de mão. MÉTODOS: Estudo randômico, duplo-cego e controlado. Foram incluídos e randomizados 45 pacientes em três grupos: o Grupo I recebeu 3 mg.kg-1 de lidocaína a 2% (40 mL); o Grupo II recebeu 3 mg.kg-1 de lidocaína (38 mL) + 2 mL de lornoxicam; o Grupo III recebeu 3 mg.kg-1 de lidocaína (38 mL) + 2 mL de fentanil. O desfecho primário avaliado foi o tempo até a primeira necessidade de analgésicos no pós-operatório. RESULTADOS: Lornoxicam adicionado à lidocaína em ARIV aumentou o tempo de recuperação do bloqueio sensorial sem aumentar os efeitos colaterais, e o tempo até a primeira necessidade de analgésicos no pós-operatório em comparação com lidocaína sozinha (p < 0,001, p < 0,001, respectivamente) e fentanil adicionado à lidocaína (p < 0,001, p < 0,001, respectivamente). Além disso, também descobrimos que fentanil diminuiu a dor ocasionada pelo torniquete (p < 0,01) em comparação com lidocaína, mas mostrou efeito analgésico similar ao de lornoxicam (p > 0,05), embora os escores da escala visual analógica (EVA) relacionados à dor ocasionada pelo torniquete tenham sido menores no grupo fentanil. Lornoxicam adicionado à lidocaína em ARIV não foi superior à lidocaína sozinha para diminuir a dor ocasionada pelo torniquete. CONCLUSÃO: A adição de fentanil à lidocaína em ARIV parece ser superior à lidocaína sozinha e ao lornoxicam adicionado à lidocaína para diminuir a dor ocasionada pelo torniquete, apesar de aumentar os efeitos secundários. No entanto, lornoxicam não aumentou os efeitos secundários e proporcionou analgesia nos períodos tanto intraoperatório quanto pós-operatório. Portanto, lornoxicam pode ser mais adequado para o uso clínico.

BACKGROUND AND OBJECTIVES: In this study, our goal was to compare intraoperative and postoperative analgesic effects of lornoxicam and fentanyl when added to lidocaine Intravenous Regional Anesthesia (IVRA) in a group of outpatients who underwent hand surgery. METHODS: This is a double blind randomized study. A total of 45 patients were included, randomized into three groups. Patients in Group I (L) received 3 mg.kg-1 of 2% lidocaine 40 mL; patients in Group II (LL) received 3 mg.kg-1 lidocaine 38 mL + 2 mL lornoxicam; patients in Group III (LF) received 3 mg.kg-1 lidocaine 38 mL + 2 mL fentanyl. Our primary outcome was first analgesic requirement time at postoperative period. RESULTS: Lornoxicam added to lidocaine IVRA increased the sensory block recovery time without increasing side effects and increased first analgesic requirement time at the postoperative period when compared to lidocaine IVRA (p < 0.001, p < 0.001 respectively) and fentanyl added to lidocaine IVRA (p < 0.001, p < 0.001 respectively). In addition, we also found that fentanyl decreased tourniquet pain (p < 0.01) when compared to lidocaine but showed similar analgesic effect with lornoxicam (p > 0.05) although VAS scores related to tourniquet pain were lower in fentanyl group. Lornoxicam added to lidocaine IVRA was not superior to lidocaine IVRA in decreasing tourniquet pain. CONCLUSIONS: Addition of fentanyl to lidocaine IVRA seems to be superior to lidocaine IVRA and lornoxicam added to lidocaine IVRA groups in decreasing tourniquet pain at the expense of increasing side effects. However, lornoxicam did not increase side effects while providing intraoperative and postoperative analgesia. Therefore, lornoxicam could be more appropriate for clinical use.

JUSTIFICATIVA Y OBJETIVO: Comparar los efectos analgésicos en los períodos intra y postoperatorio del lornoxicam y del fentanilo adicionados a la lidocaína para la anestesia regional intravenosa (ARIV), en un grupo de pacientes sometidos a la cirugía de mano. MÉTODOS: Estudio aleatorio, doble ciego y controlado. Fueron incluidos y aleatorizados por el equipo de investigación 45 pacientes en tres grupos: el Grupo I recibió 3 mg.kg-1 de lidocaína al 2% (40 mL); el Grupo II recibió 3 mg.kg-1 de lidocaína (38 mL) + 2 mL de lornoxicam; el Grupo III recibió 3 mg.kg-1 de lidocaína (38 mL) + 2 mL de fentanilo. El resultado primario evaluado fue el tiempo hasta la primera necesidad de analgésicos en el postoperatorio. RESULTADOS: El Lornoxicam adicionado a la lidocaína en ARIV aumentó el tiempo de recuperación del bloqueo sensorial, sin aumentar los efectos colaterales y el tiempo hasta la primera necesidad de analgésicos en el postoperatorio en comparación con la lidocaína sola (p < 0,001, p < 0,001, respectivamente) y el fentanilo adicionado a la lidocaína (p < 0,001, p < 0,001, respectivamente). Además de eso, también descubrimos que el fentanilo redujo el dolor ocasionado por el torniquete (p < 0,01) en comparación con la lidocaína, pero mostró un efecto analgésico parecido con el del lornoxicam (p > 0,05), aunque las puntuaciones de la escala visual analógica (EVA) relacionadas con el efecto ocasionado por el torniquete, hayan sido menores en el grupo fentanilo. El Lornoxicam adicionado a la lidocaína en ARIV no fue superior a la lidocaína sola para reducir el dolor ocasionado por el torniquete. CONCLUSIÓN: Podemos decir que la adición del fentanilo a la lidocaína en ARIV parece ser superior a la lidocaína sola y al lornoxicam adicionado a la lidocaína para disminuir el dolor ocasionado por el torniquete, a pesar de aumentar los efectos secundarios. Sin embargo, el lornoxicam no aumentó los efectos secundarios, proporcionando una analgesia en los períodos tanto intraoperatorio como postoperatorio. Por tanto, el lornoxicam puede ser más adecuado para el uso clínico.

Evaluation of piroxicam-β-cyclodextrin as a preemptive analgesic in functional endoscopic sinus surgery

The preemptive analgesic efficacy and adverse effects of preoperatively administered piroxicam-β-cyclodextrin for post-endoscopic sinus surgery pain was determined in a prospective, double-blind, randomized, clinical study. Seventy-five American Society of Anesthesiologists status I-II patients, aged 18-65 years, were divided into three groups with similar demographic characteristics: group 1 received 20 mg piroxicam-β-cyclodextrin, group 2 received 40 mg piroxicam-β-cyclodextrin and group 3 received placebo orally before induction of general anesthesia. A blinded observer recorded the incidence and severity of pain at admission to the post-anesthesia care unit (PACU), at 15, 30, and 45 min in the PACU, and 1, 2, 4, 6, and 24 h postoperatively. All patients received patient-controlled morphine analgesia during the postoperative period and consumption was recorded for 24 h. During the PACU period, mean visual analogue scale values were significantly lower in groups 1 and 2 compared to group 3 (P < 0.05). During the postoperative period, morphine consumption was 3.03 ± 2.54, 2.7 ± 2.8, and 5.56 ± 3.12 mg for each group, respectively (P < 0.05). As a side effect, bleeding was observed in groups 1 and 3, nausea and vomiting in all groups, and edema only in group 3. However, no significant differences were detected in any of the parameters analyzed, which also included epigastric pain, constipation/diarrhea and headache. Similar hematological test results were obtained for all groups. Preemptive administration of piroxicam-β-cyclodextrin effectively reduced analgesic consumption, and 40 mg of the drug was more effective than 20 mg piroxicam-β-cyclodextrin without side effects during the postoperative period.

Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial / Fentanil peridural versus venoso na analgesia pós-operatória de cirurgia ortopédica: ensaio clínico aleatório

CONTEXT AND OBJECTIVE: Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery. DESIGN AND SETTING: A randomized double-blind study was performed in Hospital São Paulo. METHODS: During the postoperative period, in the presence of pain, 29 patients were divided into two groups: group 1 (n = 14) received 100 µg of fentanyl epidurally and 2 ml of saline intravenously; group 2 (n = 15) received 5 ml of saline epidurally and 100 µg of fentanyl intravenously. The analgesic supplementation consisted of 40 mg of tenoxicam intravenously and, if necessary, 5 ml of 0.25 percent bupivacaine epidurally. Pain intensity was evaluated on a numerical scale and plasma concentrations of fentanyl were measured simultaneously. RESULTS: The percentage of patients who required supplementary analgesia with tenoxicam was lower in group 1 (71.4 percent) than in group 2 (100 percent): 95 percent confidence interval (CI) = 0.001-0.4360 (P = 0.001, Fisher's exact test; relative risk, RR = 0.07). Epidural bupivacaine supplementation was also lower in group 1 (14.3 percent) than in group 2 (53.3 percent): 95 percent CI = 0.06-1.05 (P = 0.03, Fisher's exact test; RR = 0.26). There was no difference in pain intensity on the numerical scale. Mean fentanyl plasma concentrations were similar in the two groups. CONCLUSION: Intravenous and epidural fentanyl appear to have similar efficacy for reducing pain according to the numerical scale, but supplementary analgesia was needed less frequently when epidural fentanyl was used.

CONTEXTO E OBJETIVO: Existem controvérsias sobre o local de ação do fentanil injetado por via peridural. O objetivo foi comparar a eficácia do fentanil peridural e do venoso em cirurgias ortopédicas. TIPO DE ESTUDO E LOCAL: Estudo aleatório, duplo-cego, realizado no Hospital São Paulo. MÉTODO: No pós-operatório, na presença de dor, 29 pacientes foram divididos em dois grupos: grupo 1 (n = 14) recebeu solução de 100 mcg de fentanil por via peridural e 2 ml de solução salina venosa; grupo 2 (n = 15), 5 ml de solução salina peridural e 100 µg de fentanil venoso. A complementação analgésica foi com 40 mg de tenoxicam venoso e, se necessário, 5 ml de bupivacaína 0.25 por cento. A intensidade da dor foi avaliada pela escala numérica e a concentração plasmática do fentanil foi medida simultaneamente. RESULTADOS: A percentagem de pacientes que necessitaram de complementação analgésica com tenoxicam foi menor no grupo 1 (71.4 por cento versus 100.0 por cento grupo 2): intervalo de confiança, IC 95 por cento = 0.001-0.4360 (P = 0.001, teste exato de Fisher; risco relativo, RR = 0.07). A complementação com bupivacaína peridural também foi menor no grupo 1 (14.3 por cento versus 53.3 por cento grupo 2): IC 95 por cento = 0.06-1.05 (P = 0.03, teste exato de Fisher; RR = 0.26). Não houve diferença na intensidade da dor avaliada pela escala numérica. As concentrações plasmáticas do fentanil foram semelhantes nos dois grupos. CONCLUSÃO: A eficácia do fentanil venoso e peridural parece ser semelhante na redução da dor de acordo com a escala numérica, porém a frequência de analgesia suplementar foi menor com o uso do fentanil peridural.

Efficacy and safety of combined piroxicam, dexamethasone, orphenadrine, and cyanocobalamin treatment in mandibular molar surgery

Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin®) when compared with 20 mg piroxicam alone (Feldene®) in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo) Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol). Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group). Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.

comparison of analgesic efficacy of ketorolac and piroxicam for postoperative pain relief after cholecystectomy

A Randomized Control Trials [RCT] single blinded study was designed to evaluate the analgesic efficacy of ketorolac and compare its effectiveness with the analgesic efficacy of piroxicam for postoperative pain management after cholecystectomy at Department of Anaesthesiology and intensive care, PNS Shifa Hospital, Karachi. In this study, fifty patients who had to undergo cholecystectomy were randomized in two groups. The patients were followed for 72 hours post operatively. All the patients were operated through a standard subcostal incision [3 to 4 inches in length]. The patients were American Society of Anaesthesiology status [ASA] of I, II, of both the sexes, aged between 30 to 60 years. A balanced anaesthetic technique was used for all the patients during the conduct of procedure. First dose of both the drugs was given immediately after induction [30 mg Ketorolac I/V and 20 mg Piroxicam I/M]. Postoperatively, group I patients received injection Ketorolac 30mg I/V 8 hourly, group II patients were given injection Piroxicam 20 mg I/M once daily. If pain persistently remained above 5 on visual analogue scale [VAS], injection Pethidine 50 mg I/V p.r.n. was used as rescue analgesia for both the groups.. In group I [ketorolac group] only 5 patients [20%] required rescue analgesia whereas in group II eight patients [32%] required it. The effect of both the drugs on pulse rate, blood pressure, respiratory rate and oxygen saturation were monitored and recorded. The frequency of postoperative complication was recorded. Relevant laboratory data [bleeding time, platelets count, serum urea and electrolytes and liver function tests] was monitored. Both the drugs were found effective in controlling postoperative pain. Both drugs Ketorolac and Piroxicam provided adequate pain relief

Postoperative analgesic effects of intravenous lornoxicam and morphine with pre-emtive ropivacaine skin infiltration and preperitoneal instillation after transabdominal hysterectomy.

To investigate the effectiveness of intravenous lornoxicam and morphine with the preemptive effects of ropivacaine local skin infiltration and peritoneal instillation in reducing postoperative pain after transabdominal hysterectomy, a randomized, double blinded, placebo-controlled study was done in 88 patients undergoing transabdominal hysterectomy under general anesthesia. The patients were allocated into 4 groups to receive: (group A) only intravenous morphine 10 mg; (group B) intravenous morphine 10 mg and lornoxicam 16 mg; (group C) intravenous morphine 10 mg, lornoxicam 16 mg with 0.5 per cent ropivacaine local skin infiltration before skin incision and 1 per cent ropivacaine instillation before peritoneal incision; (group D) intravenous morphine 10 mg, lornoxicam 16 mg with 1 per cent ropivacaine instillation after peritoneal closure and 0.5 per cent ropivacaine local skin infiltration before skin closure. Pain was assessed by patients using visual analog scales (VAS) at 2, 6, 12, 18, 24, 48 hours after surgery. Time to first analgesic requirement and morphine requirement during the first 6 h were significantly lower in the groups using lornoxicam (group B, C, D) as compared with the group using only morphine (group A). However there was no significant difference between group B and group C or group D which means that the additional analgesic effects of using local anesthetic infiltration and instillation either before (pre-emptive) or after the incision could not be seen in this study. Implication: Intravenous 16 mg of lornoxicam with 10 mg of morphine significantly reduced postoperative pain during the first 6 h after abdominal hysterectomy. Additional effects of using local anesthetic wound infiltration to the use of lornoxicam could not be demonstrated.

Bioequivalência de comprimidos de nimesulida do mercado nacional / Bioquivalence of nimesulide tablets of the national market

A nimesulida, é um fármaco sintético, pouco solúvel em água (0,01 mg/mL), classificado como antiinflamatório não esteróide, com atividade analgésica e antipirética. No Brasil são comercializadas várias especialidades farmacêuticas orais, contendo nimesulida, na dosagem de 100 e 200 mg. Em termos de saúde pública tais produtos, prescritos pelo médico como similares intercambiáveis, deveriam apresentar, a mesma eficácia clínica, sendo a bioequivalência um requisito fundamental. Um estudo em que se verifique a qualidade biofarmacotécnica de uma amostragem destes produtos torna-se bastante útil para que se possa avaliar a situação atual...

Tratamento da dor de origem neoplásica de fraca a moderada intensidade com beta-ciclodextrina piroxicam. Estudo clínico controlado / Treatment of pain of neoplasic origin of mild to moderate intensity with beta-ciclodextrin piroxicam. A controled clinical study

A maioria dos pacientes com câncer avançado apresenta dor, sendo seu controle fundamental para se conseguir melhor qualidade de vida. Foram estudados 20 pacientes adultos portadores de neoplasias malígnas de várias localizaçöes, com dor de fraca a moderada entensidade, sem tratamento antineoplásico atual, durante o período de duas semanas. Foram administrados o complexo beta-ciclodexitrina piroxicam ou a dipirona (em associaçäo), em sistema de observaçäo cruzada, com sete dias para cada droga, com o objetivo de comparar seus efeitos nalgésicos. Também foi analisada a toxicidade. Foram observados quatro desaparecimentos completos da dor em ambos os grupos; diminuiçäo importante da dor ocorreu em oito dos 20 pacientes com beta-ciclodexitrina piroxicam. Maior intensidade de analgesia foi observada no grupo com beta-ciclodexitrina piroxicam, quando da análise das observaçöes cruzadas. Conclui-se que a beta-ciclodexitrina piroxicam é droga útil na analgesia de dores de origem oncológica de fraca e moderada intensidades, e com facilidade de aderência do paciente pela dose única diária

Topical piroxicam and conjunctivitis.

The study of comparison of the clinical responses of acute hemorrhagic conjunctivitis to antibiotic eye drops alone and combined with topical piroxicam was analyzed. Seventy-five patients (146 eyes) with viral conjunctivitis were randomly assigned to receive topical antibiotic (35 cases) or antibiotic combined with piroxicam eye drops (40 cases). The patients were examined under slit lamp biomicroscope every other day for the first week, then twice a week until recovery. There was no statistically significant difference between groups in mean age, sex, bilaterality, history of contact, systemic involvement, mean incubation period, mean onset and mean follow-up time. Mean recovery time in the piroxicam group (4.9 days) was less than for the control group (P = 0.003). Foreign body sensation, pain and tearing in the piroxicam group recovered significantly faster than in the control group. Complete recovery of all symptoms and signs in piroxicam treated eyes (61%) was significantly more common than with antibiotic only (29%) in spite of more drug induced burning. Piroxicam eye drops may have beneficial effects for acute hemorrhagic conjunctivitis to relieve discomfort, pain, and accelerate recovery.

Acción del piroxicam en ratones hembras CEPA C57BL/6 con melanoma B16F1 / Action of the piroxicam in the females mices of C57BL/6 with inoculated melanoma B16F1

El melanoma maligno es un cáncer cutáneo grave, cuya frecuencia ha aumentado rápidamente en los últimos años. Debido al éxito limitado de la quimioterapia en el tratamiento del melanoma nos propusimos demostrar la acción del piroxicam, un analgésico no esteroide, sobre el melanoma B16F1, tumor experimental ampliamente utilizado en el estudio de células cancerosas, para lo cual nos planteamos la hipótesis de que el piroxicam administrado a ratones hembras de la cepa C57BL/6 inoculados con melanoma B16F1 ejerce una acción antitumoral. Se utilizaron 33 hembras de la cepa C57BL/6 distribuidos en dos grupos, un grupo tratado durante un mes con una dosis diaria de piroxicam de 8mg/kg y un grupo control el cual recibió una solución de agua destilada más el vehículo de la droga utilizada. Los resultados obtenidos se analizaron mediante la prueba "t" de Student. Se demostró que el Piroxicam no inhibió el desarrollo del melanoma B16F1; por el contrario aumentó el crecimiento diario del tumor primario "in situ" y las dimensiones del tumor primario "in situ" y las dimensiones del tumor primario disecado, debido probablemente al efecto inhibidor de las prostaglandinas sobre la replicación celular del melanoma B16F1. Concluimos con estos resultados que el piroxicam estimula el desarrollo del melanoma B16F1 en ratones de la cepa C57BL/6

Efecto protector de naloxona y piroxicam durante la lesión por isquemia-reperfusión de intestino delgado / Protector effect of naloxone and piroxicam during ischemia-reperfusion injury

El presente trabajo consistió en un modelo experimental con ratas en el cual valoramos el efecto protector de piroxicam, cimetidina y naloxona durante la lesión por isquemia-reperfusión de intestino delgado. Las dosis de naloxona fueron mayores a las que empleamos en trabajos previos. En los animales tratados con piroxicam y naloxona se encontró un efecto protector que mejoró el índice de supervivencia en estos animales, lo cual correlaciona con la ausencia de necrosis y de infiltrado leucocitario en el estudio histopatológico. Sin embargo, las dosis mayores de naloxona empleadas en este trabajo no mejoraron el efecto protector. La cimetidina no mostró ningún efecto protector. Se analizan los posibles mecanismos de acción de estos fármacos durante la lesión por isquemia-reperfusión

El manejo del dolor postoperatorio en cirugia anal mediante el empleo de un inhibidor de las prostoglandinas: un estudio comparativo con 109 pacientes / Management of postoperatory pain in anal surgery by meaning of an inhibitor of prostaglandins: a comparative study with 109 patients

Para tratar de controlar el dolor pos operatorio en cirugía anorectal, se realiza un trabajo prospectivo utilizando piroxicam, que es un inhibidor de las prostaglandinas. Ciento nueve pacientes son divididos en dos grupos: A, constituido por 62 pacientes, a 45 de los cuales se administró piroxicam a dosis de 20 miligramos dos veces al día en las 48 horas inmediatamente anteriores a la intervención y 20 miligramos una vez al día en los 4 días posteriores a la intervención, y 17 en pacientes en quienes se administró piroxicam a dosis de 20 miligramos, dos veces al día durante los 4 días siguientes a la intervención; en ambos subgrupos, la administración fue exclusivamente por vía oral; y B, constituido por 47 pacientes a quienes no se les administró piroxicam, y cuyo dolor post operatorio fue manejado empleando 6 miligramos de clorhidrato de morfina por vía intramuscular, a solicitud del paciente. Los dos grupos fueron comparables en cuanto a edad, sexo, patología anal, técnica quirúrgica y anestesia empleadas. La valoración del medicamento investigado, piroxicam, se realizó sobre el número de dosis de morfina recibidas por el paciente entre el momento de recuperar su sensibilidad dolorosa y las primeras 24 del post operatorio inmediato, cuando se realizó la primera evacuación, y luego la necesidad de calmante, inyectado o tomado por boca, después de la primera evacuación. De los pacientes a quienes se dió piroxicam preoperatoriamente, 15,5 por ciento recibió solamente una dosis post operatoria de morfina, mientras que el 53 por ciento de quienes no lo recibieron, necesitaron una o más dosis de morfina (p<0,05). Después de la primera evacuación, 27 por ciento de los pacientes a quienes se administró piroxicam necesitó algún tipo de analgesia, oral o inyectable, mientras que el 49 por ciento de aquellos sin piroxicam recibió analgesia en ese mismo período (p<0,05). Se concluye que la administración preoperatoria de piroxicam disminuye la necesidad de morfina en el postoperatorio inmediato y la utilización de analgésicos, orales o inyectables, después de la primera evacuación intestinal. Reacción de intolerancia al medicamento se presentó en un solo paciente

Evoluación doble-ciega de la seguridad y eficacia del etodolac comparado con el pitoxicam en el tratamiento de la artritis gotosa aguda / Double blind evaluation of the seguridad and eficacy of etodolac as compared with elpiroxicam in the treatment of the acute gont y arthritis

Con el objeto de evaluar la eficacia y seguridad del etodolac se llevó a cabo um estudio doble-ciego comparativo Etodolac-Piroxican em 60 pacientes com Artirtis Gotosa aguda. Ambos medicamentos fueron utiles para el control de la inflamación y del dolor. Se observaron menos efectos colaterales con el Etodolac

A comparative study of flurbiprofen and piroxicam in osteoarthritis.

In this single-blind, multiple-dose study the efficacy and tolerability of flurbiprofen was compared with that of piroxicam in 60 adult patients suffering from osteoarthritis of the knee. The patients were randomly allocated to receive either flurbiprofen 100 mg twice daily or piroxicam 20 mg once daily for a period of four weeks. Clinical assessments w.r.t. pain, tenderness, stiffness, swelling and general activity of patient were carried out prior to initiation of trial therapy and thereafter at weekly intervals for four weeks. The findings were graded. Though significant improvements as compared to baseline data occurred in both the treatment groups, flurbiprofen was found to be superior to piroxicam in improving pain on movement and at rest (p < 0.05). The incidence of side effects was less in the group receiving flurbiprofen (6% compared to 47% observed with piroxicam).

Piroxicam intramuscular en el control del dolor posoperatorio / Intramuscular piroxicam for the control of postoperative pain

Se estudiaron 57 pacientes adultos (47 varones, 10 mujeres), sometidos a diversas intervenciones quirúrgicas de abdomen, traumatológicas y ortopédicas, para evaluar la eficacia y tolerancia de piroxicam por vía intramuscular en el tratamiento del dolor posoperatorio. En cada caso se realizó un análisis basado en la autoevaluación de la intensidad del dolor por el propio enfermo, así como por el investigador. Con estos criterios, se encontraron diferencias estadísticamente significativas en la intensidad del dolor experimentado antes de la aplicación de piroxicam, en comparación con la intensidad de este síntoma en las primeras horas después de la primera dosis y en dosis subsecuentes. Cincuenta y cuatro pacientes (94.7 por ciento) tuvieron resultados excelentes o buenos en el control del dolor, y tres mostraron una respuesta moderada. Sólo un paciente se quejó de efectos secundarios. Los resultados obtenidos respaldan el uso piroxicam intramuscular como fármaco de elección para el control del dolor posoperatorio de diversas intervenciones quirúrgicas.