ABSTRACT
Lornoxicam (xefocam) as an agent of perioperative antinociceptive defense was studied and compared with other nonsteroidal anti-inflammatory drugs (NSAIDs) (ketorolac, ketoprofen). A comparative study was performed in 140 cancer surgical patients who were mainly middle-aged and elderly (51 +/- 10.9 years) and who had various concomitant diseases (ASA II-III). Extensive oncological operations under multicomponent general anesthesia were performed in these patients on the abdomen (n=60), small pelvis (n=46), and head and neck (n=34). All NSAIDs were used on the principle of preemptive analgesia, by intramuscularly injecting the therapeutic dose of an analgesic 40-60 min before surgery and by further continuing this basic therapy in combination with an opioid after surgery. Thirty patients received lornoxicam (xefocam, 16 mg/day), 30 had ketorolac (ketanov, 60-90 mg/day), 30, ketoprofen/ketonal (200 mg/day), and 20 patients, ketoprofen/artrozilene (320 mg/day). A control group comprised 30 patients who did not receive NSAIDs. In the patients of all the groups, the anesthesia scheme included one more antinociceptive agent--the kininogenesis inhibitor contrical (the total dose was 50,000-60,000 ATrU) (beginning from the stage of induction) and its administration (30,000 ATrU/day) was continued within 2 days after surgery. The studies performed have established that lornoxicam (xefocam) used in therapeutic doses shows a 50% reduction (versus 30% when ketorolac or ketoprofen is used) in a need for the potent opioid bepronorfine after extensive operations for cancer is one of the most effective NSAIDs. It has been noted that a short-term course of perioperative therapy with NDAIDs does not cause complications or side effects if individual contraindications to and limitations on their use are followed.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Neoplasms/surgery , Pain, Postoperative/prevention & control , Piroxicam/analogs & derivatives , Adult , Aged , Analgesia , Humans , Male , Middle Aged , Pain, Postoperative/drug therapy , Piroxicam/therapeutic use , Preoperative CareABSTRACT
The traditional general anesthetics and opioid seem to be insufficient for complete protection of the patient from operative trauma in major surgery. The prospective study has been done in 2 groups of patients undergoing abdominal oncological operations with multimodal general anesthesia based on midazolam, propofol, phentanyl and calipsol in microdose in preventive and postoperative analgesia by ketoprofen in the 1st group (35 cases) and the same general anesthesia in combination with prolonged epidural anesthesia with ropivacaine. Both complete anesthesia and postoperative analgesia have been achieved in each group of the patients, but in the 2nd group the doses of generally introduced analgesics with central action--phentanyl and calypsol--were threefold and twofold less, respectively, and restoration of gastric and intestinal peristalsis was more rapid (1.5 day) vs control group (3.5 days). The importance of using all the mentioned components of anesthesia and analgesia before, during and after operation to prevent the defects of antinociceptive protection and subsequent development of postoperative pain syndrome has been pointed out.
