Comparing efficacy of preemptively used lornoxicam and tramadol for postoperative pain in patients underwent laparoscopic cholecystectomy

Amaç: Postoperatif ağrı, akut ağrının en sık nedenlerinden biridir. Postoperatif ağrı tedavisinin klasik şekli parenteral opioid uygulamasıdır. Bu randomize çift-kör çalışmada preemptif uygulanan lornoksikam ve tramadolün analjeziklerin etkinliklerinin karşılaştırılması amaçlandı.Hastalar ve Yöntem: Toplam 76 hasta randomize olarak dört gruba ayrıldı. Tüm hastalar operasyondan 4 saat öncesi tablet aldılar. Grup PL preemptif olarak 4 mg lornoksikam, Grup PT 50mg tramadol alırken, Grup L ve T ise plasebo tablet aldılar. Operasyon sonunda Grup PL’ye 8 mg/saat infüzyon ve 1 mg bolus lornoksikam; Grup L’ye 1.6mg yükleme, 8 mg/saat infüzyon ve 1 mg bolus lornoksikam; Grup PT’ye 5 mg/saat infüzyon ve 10 mg bolus tramadol; Grup T’ye 20 mg yükleme, 5 mg/saat infüzyon ve 10 mg bolus tramadol hasta kontrollü (PCA) ile 24 saat boyunca uygulandı. Ağrı şiddeti 0,1., 2., 3., 6., 10., 24. saatlerde kaydedildi ve 24 saat sonunda genel ağrı iyileşmesi değerlendirildi.Bulgular: Gruplar arasında demografik bulgular, operasyon süresi, kalp hızı ve ortalama kan basınç değerleri bakımından anlamlı fark gözlenmedi. Grup PL ve PT de Grup L ve T ye göre daha düşük ağrı şiddeti ve daha hızlı ağrı iyileşmesi görüldü. Grup PL ve PT’de daha az total analjezik tüketimi ve daha yüksek ağrı tedavisi memnuniyeti bulundu. Tüm gruplar birbirleriyle karşılaştırıldığında, 24 saatlik ağrı tedavisi en iyi Grup PL’de bulundu. Ağrı şiddeti tüm zamanlarda Grup T’de en yüksek, Grup PL’de ise en düşük bulundu. Sonuç: Analjezi etkisi lornoksikam grubunda daha önce başlarken, ilaç ihtiyacı tramadol gruplarında daha fazla idi. Cerrahi girişim sonunda PCA kullanımı ile benzer ağrı iyileşmesi görüldü. Bu çalışma postoperatif ağrı tedavisinde analjeziklerin preemptif uygulanmasının daha fazla analjezi sağlayabileceğini düşündürmektedir.

Laparoskopik kolesistektomi uygulanan hastalarda, ameliyat öncesi uygulanan lornoksikam ve tramadol’un postoperatif ağrı üzerine olan etkilerinin karşılaştırılması

Objectives: The management of postoperative pain is an important problem in Anesthesiology. This randomized double-blind study compared the analgesic efficacy of preemptively used lornoxicam and tramadol in patients underwent laparoscopic cholecystectomy.Methods: A total of 76 patients were randomly divided into four groups. All patients received tablets 4 hours before the operation. Preemptively Group PL received 4 mg lornoxicam, Group PT received 50 mg tramadol and Group L and T received placebo. After the operation Group PL received 0.8 mg/h infusion and 1 mg bolus lornoxicam; Group L 1.6 mg loading, 0.8 mg/h infusion and 1 mg bolus lornoxicam; Group PT 5 mg/h infusion and 10 mg bolus tramadol; Group T 20 mg loading, 5 mg/h infusion and 10 mg bolus tramadol for 24 hours. Pain intensity and pain relief at 0, 1st, 2nd, 3rd, 6th,10th, 24th hours and overall assessment of pain relief was done at 24th hour.Results: Demographic features, operation time, heart rate and mean arterial blood pressure values were not different between four groups. Both Group PL and PT had lower pain intensity and higher pain relief values than Group L and T. Group PL and PT had lower total drug consumption and higher pain relief. Overall assessment of pain relief was highest in Group PL. Pain intensity was highest in Group T and lowest in Group PL at all time points.Conclusion: Onset of analgesia with lornoxicam was faster and greater patient-controlled analgesia (PCA) demand was observed with tramadol. Postoperative pain relief was similar with lornoxicam and tramadol administrated by PCA. This study suggests that preemptive administration of lornoksikam and tramadol may result in more postoperative pain relief.

PDF

___

1. Schug SA, Merry AF, Acland RH. Treatment principles for the use of opioids in pain of nonmalignant origin. Drugs 1991;42:228-39.
2. Ready LB. Patient-controlled analgesia: Does it provide more than comfort? Can J Anaesthest 1990;37:719-21.
3. Oden R. Acute Postoperative Pain: Incidence, severity and the etiology of inadequate treatment. Anaesthesiol Clin N Am 1989;7:1-15.
4. Nuutinen LS, Laitinen JO, Salomaki TE. A risk-benefit appraisal of injectable NSAIDs in the management of postoperative pain. Drug Safety 1993;9:380-93.
5. Moote C. Efficacy of nonsteroidal anti-inlammatory drugs in the management of postoperative pain. Drugs 1992;44 (suppl 5): 14-30.
6. Kehlet H, Dahl JB. Are periperative nonsteroidal anti-inflammatory drugs ulcerogenic in short term? Drugs 1992;44 (suppl 5):38-41.
7. Houmes R-JM, Voets MA, Verkaaik A, Erdmann W, Lachmann B. Efficacy and safety of tramadol versus morphine for moderate and severe postoperative pain with special regard to respiratory depression. Anesth Analg 1992;74:510-4.
8. Canepa G, Di Somma C, Ghia M et al. Postoperative analgesia with tramadol: A controlled study compared with an analgesic combination. Int J Clin Pharm 1993;13:43-51.
9. Vickers MD, O’flaherty D, Szekely SM, Read M, Yoshizumi J. Tramadol: Pain relief by an opioid without depression of respiration. Anaesthesia 1992;47:291-6.
10. Pruss TP; Stroißnig H, Radhofer-Weltte S, et al. Overview of the pharmacological properties, pharmacokinetics and animal safety assessment of lornoxicam. Postgrad M J 1990; 66 (suppl 4): 18-21.
11.Staunstrup H., Ouesen J., Larsen UT et al. Efficacy and tolerability of lornoxicam versus tramadol in postoperative pain. J Clin Pharmacol 1999;38:1-8.
12. Richmond CE, Bromley LM, Woolf CJ: Preoperative morphine pre-empts postperative pain. Lancet 1993;342:73-5.
13. Karslı B, Yılmaz M, Kayacan N, İçel E. Postoperatif analjezide preemptif tramadol ve meperidin. Turkiye Klinikleri J Med Sci 2000;18:31-4.
14. Yeğin A, Arslan A, Karslı B, Trakya A. Torakotomilerde uygulanan intraplevral, interkostal ve preemptif analjezinin postoperatif analjeziye etkileri. Turkiye Klinikleri J Med Sci 2003;23:141-5.
15. Rosanow DE, van Krieken F, Stolke D, Kursten FW. Intravenous administration of lornoxicam, a new NSAID and pethidine for postoperative pain. Clin Drug Invest 1996;11:11-9.
16. Olkkola KT, Brunetto AV, Matilla MJ. Pharmacokinetics of Oxicam nonsteroidal anti-inflammatory agents: Clin Pharmacokinet 1994; 26: 107-20.
17. Norholt SE, Sindet-Pedersen S, Larsen U, et al. Pain control after dental surgery: A double blind, randomised trial of lornoxicam versus morphine. Pain 1996; 67:335-43.
18. Ilias W, Jansen M. Pain Control after Hysterectomy: An observer-blind, randomised trial of lornoxicam versus tramadol. Br J Clin Pract 1996; 50: 197-202.
19. Berry H, Bird HA, Black C, et al. A Double blind, multicenter, placebo controlled trial of lornoxicam in patiens with osteoarthritis of the hip and knee. Ann Rheum Dis 1992;51:238-41.
20. Caruso I, Montrone F, Boari L, et al. Lornoxicam versus diclofenac in rheumatoid arthritis: A double blind multicenter study. Adv Therapy 1994 ; 11: 132-8.
21. Bernstein RM, Calin HJ, Calin A, Ollier S. A Comparison of the efficacy and tolerability of lornoxicam and indomethacin in ankylosing spondylitis. Eur J Rheumatol Inflamm 1992;12:6-13.
22. Hogan QH. No preemptive analgesia. Anesthesiology 2002;96:526-7.
23. Kissin I. Preemptive analgesia. Anesthesiology 2000;93:1138-43.
24. Karamehmet Y, Tercan E, Doğru K et al. Comparison of patient-controlled analgesia with and without a background infusion after appenditectomy in children. Paediatric Anaesthesia 2003;13:427-31.
25. Wang ZY, Wang CQ, Yang JJ, et al. Which has the least immunity depression during postoperative analgesia- morphine, tramadol, or tramadol with lornoxicam? Clin Chim Acta 2006;369:40-5.
26. Karaca M, Koçoğlu H, Göçmen A. Comparison of lornoxicam with tramadol in patient controlled analgesia after gyneocological surgery. Eur J Gynecol Oncol 2006;27:78-80.
27. Kemal SO, Şahin Ş, Apan A. Comparison of tramadol, tramadol-metamizol and tramadol- lornoxicam administered by intavenous PCA in management of postoperative pain. Ağrı 2007;19:24-31.
28. Ölmez G, Kaya S, Aflay U, Şahin H. Comparison of lornoxicam versus tramadol analgesia for transrectal prostate biopsy: a randomized prospective study. Int Urol Nephrol 2008;40:341-4.
29. Karaman Y, Kebabçı E, Gürkan A. The preemptive analgesic effect of lornoxicam in patients undergoing major abdominal surgery: a randomized controlled study. Int J Surg 2008;6:193-6.
30. Rosenow DE, Albrechtsen M, Stolke D. A comparison of patient-controlled analgesia with lornoxicam versus morphine in patients undergoing lumbar disk surgery. Anesth Analg 1998;86:1045-50.