Comparative study of different doses and routes of administration of lornoxicam for peri-operative analgesia in patients undergoing intravenous regional anesthesia for minor upper arm surgery

The use of perioperative NSAIDs has become popular in operation ranging from minor outpatient to major inpatient surgery. A systemic review suggested that NSAIDs have the most to offer as adjuncts to intravenous regional anesthesia. Lornoxicam has demonstrated clinical efficacy in relieving pain, through different routes of administrations, oral, IM, IV, and local infiltration. In this study comparison of different doses and routes of administration of Lornoxicam for peri-operative analgesia in patients undergoing intravenous regional anesthesia for minor upper arm surgery was done. 60 patients ASA 1 and 2 undergoing minor upper limb surgeries were studied Patients were randomly divided into six groups; Group I: Total volume of 40ml of pre-prepared Local intravenous solution mixed with 8mg of Lornoxicam. Group 2: Total volume of 40ml of pre-prepared Local intravenous solution mixed with 16mg of Lornoxicam. Group 3: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 8mg intramuscular. Group 4: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 16mg intramuscular. Group 5: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 8mg intravenously. Group 6: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 16mg intravenously. Better qualities of block, less tourniquet pain, and better quality of postoperative analgesia were found in groups 1, 2 that had lornoxicam combined with lidocaine compared with other groups used lornoxicam intravenously or intramuscular [p<0.05]. Moreover, using lornoxicam 16mg proved to be better than lornoxicam 8mg when combined with total intravenous solution [p<0.05]. Lornoxicam used in the local intravenous solution gave better quality of intraoperative condition and postoperative analgesia without increase in the incidence of side effects compared with lornoxicam used intramuscularly or intravenously. Also lornoxicam 16mg provide better intraoperative analgesia compared to lornoxicam 8mg when both were used locally with local intravenous regional analgesia

Hyperbaric bupivacaine and fentanyl for elective cesarean section: effect of a height and weight adjusting dose

There are large varieties of dosage regimens which are in use for spinal anesthesia for Cesarean section [3]. All aiming for limiting the dose of Bupivacaine to reduce incidence of maternal hypotension and vasopressor requirements, decreasing nausea and vomiting, reducing time to discharge from post anesthesia unit, and improving maternal satisfaction [4]. This study was designed to assess the validity of adjusting the dosage of intrathecal hyperbaric bupivacaine according to the patient's height and weight would provide adequate surgical anesthesia for elective cesarean section while decreasing the incidence of maternal hypotension and the use of vasopressor to treat hypotension and consequently fetal outcome. Patients were randomly assigned to be involved into two groups. Group 1: The fixed dose group, patients received fentanyl 20 microgram [0.4ml] added to hyperbaric bupivacaine 0.5% 2.4ml. Group 2: The adjusting dosage group, patients receive fentanyl 20 microgram [0.4ml] added to a volume of hyperbaric bupivacaine 0.5% that is determined by referencing to the dosage regimen detailed Table. All the cardiovascular data measured plus the incidence of nausea and vomiting were statistically significantly lower in the adjusted group compared to the fixed one [p<0.05]. Time to loss of cold [T4] and to pinprick sensation to T64 on both sides were significantly slower in the adjusted group [p<0.05]. There were no significant differences as regard the visual analogue scale, number of patients needed supplementary analgesia, or the fetal outcome between the two groups at different time intervals [p>0.05]. Adjusting the intrathecal hyperbaric Bupivacaine dose to patient's height and weight combined with 20 microgram Fenatnyl provide adequate anesthesia with less maternal side effects for patients undergoing elective cesarean section