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The postoperative analgesic effect of lornoxicam administered with PCA device
84
Posters
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Postoperative Pain Management
149. The postoperative analgesic effect of lornoxicam administered with PCA device Authors: Akba M, Bigat Z, Bulut F, Kayacan N, Karsli B [email protected] Department of Anesthesiology, , Akdeniz Universitesi Tip Fakultesi( Akdeniz University Medical Faculty), Anesteziyoloji ve Reanimasyon AD, Dumlupinar bulvari, Kampus Antalya, Turkey Introduction: Lornoxicam (chlortenoxicam), is a new nonsteroidal anti-inflamatory drug (NSAID) of oxicam class with it’s analgesic effects, anti-inflammatory and antipyretic properties. The major advantage of NSAIDs when it is compared with opioid analgesics, is that they are relatively well tolerated with less side effects when used in selected patients for short-term postoperative analgesia. Lornoxicam is suitable for postoperative analgesia because of its quick elemination and 4-6 hours of plasma half-life time. The aim of this study was to see the effect of lornoxicam administered by PCA for postoperative pain control in patients who underwent lower abdominal surgery. Methods: After approval local ethic committee 50 ASA I-II patients were enrolled this prospective randomized, double blind study. The patients were randomly assigned into two groups of group S (spinal anesthesia group n:22) and group G (general anesthesia group n:28). In the postoperative period, patients received 40 mg lornoxicam with 100cc saline solution within 24 hours after surgery. Injectable solution of 0.4 mg/ml lornoxicam was self administered through an IV indwelling catheter used with a patient controlled analgesia (PCA) device. The device was preset to deliver a maximal dose of 1 mg lornoxicam with a loading dose of 4 mg, lockout time of 30 min, bolus dose of 0.5 mg. Treatment was continued for 24 hours. In both groups blood pressure and heart rate were measured periodically during 24 hours. After surgery, patients requesting analgesia were asked to score the intensity of their pain on a 10 point visual analog score (VAS). The patients were checked for pain at 1, 3, 6, 12 and 24 th hours. Independent sample t test was used for statistical analyse. P⬍0.05 accepted as meaningful. Results: There were no statistically significant differences between VAS’s of the two groups (pⱕ0,005). 46.4 % of the patients have needed additional analgesia at 3 th hour after operation in the first group which was 54.5 % in the second group. At 6 th hour additional analgesia requirement was 3.5 % in group G which was 13.6 % in group S. In either group no patients needed additional analgesia at 12 th and 24 th hours. In the first hour postoperatively, the need for analgesia occurred only in the group G.
168. Comparison of effects of thoracic epidural or paravertebral patient controlled analgesia on pulmonary function following open lung surgery Novak Jankovicˇ V, Sˇtupnik T, Paver Erzˇen V, Oberauner L [email protected] Clinical Department of Anesthesiology and Intensive Therapy, University Medical Centre, Zalosˇka 7, 1000 Ljubljana, Slovenia Background: Open lung surgery causes severe post-thoracotomy pain, associated with stress response and pathophysiological abnormalities. Although many anaesthesiologists regard thoracic epidural analgesia (TEA) as the golden standard, paravertebral analgesia (PVA) has been shown to be as effective as TEA. We performed a prospective completely randomized study to compare the influence of TEA or PVA on the postoperative pulmonary function in patients undergoing open lung surgery. Methods: 40 patients (ASA II-III) scheduled for open lung sergery were randomly assigned to two groups in a completely randomized study design. In the TEA group epidural cathether was placed between T6-T7; in the PVA group the cathether was placed at the T6-T7 level ipsilateral to the thoracotomy. Both groups received a singe preoperative bolus dose of 4 mg of morphine and 5mL of 0.5% bupivacaine through the catheter. Infusion of analgesic mixture (10 mg of morphine, 50mg of bupivacaine and 0.15 mg of clonidine in 100 mL of saline) was given postoperatively using patient controlled analgesia pump (rate: 1mL/h, bolus dose: 3mL, lockout period: 30 min). FVC, FEV1, PEF (peak expiratory flow), MIP (maximal inspiratory pressure), and MEP (maximal exspiratory pressure) were measured before surgery and daily for the first three postoperative days. Results: Major loss of pulmonary function on the first postoperative day with a slow gradual increase during the next two days was observed. Multiple linear regression (SAS PROC GLM) with ANOVA was performed. After controlling for the statistically significant effects of preoperative values (FEV1, FVC, PEF, MIP, MEP), age, sex and extent of lung resection (lobectomy, pneumonectomy, lesser resections), no significant fixed treatment effects of postoperative analgesia (table 1) were found.
Table 1. Fixed treatment effects (TEA- PVA) of postoperative analgesia and values of the corresponding F-statistic 1st postoperative day
Conclusion: At the end of this study we concluded that Lornoxicam with PCA can be used safely for postoperative analgesia for first 24 hours time after lower abdominal surgery. FEV1 (ml) FVC (ml) PEF (l/min) MIP (cm H20) MEP (cm H20)
3rd postoperative day
TEAPVA
F
p
TEAPVA
F
p
38.2 77.6 ⫺8.1 2.6 2.6
1.22 2.62 0.14 0.53 0.71
0.2779 0.1146 0.6958 0.4267 0.3696
⫺5.3 ⫺17.7 7.6 ⫺1.4 ⫺0.9
3.06 5.74 0.86 0.03 0.00
0.0893 0.0022 0.3586 0.8586 1.0000
Conclusion: PVA was found to be as effective as TEA at preservation of pulmonary function following open lung surgery. We therefore recommend PVA as the preferred method of postoperative analgesia as it is tecnically easier to perform and associated with less complications than TEA (1).
Reference: 1. Richardson J.et al. Br J Anaesth 1999; 83(3):387-92
Posters
•
Postoperative Pain Management
149. The postoperative analgesic effect of lornoxicam administered with PCA device Authors: Akba M, Bigat Z, Bulut F, Kayacan N, Karsli B [email protected] Department of Anesthesiology, , Akdeniz Universitesi Tip Fakultesi( Akdeniz University Medical Faculty), Anesteziyoloji ve Reanimasyon AD, Dumlupinar bulvari, Kampus Antalya, Turkey Introduction: Lornoxicam (chlortenoxicam), is a new nonsteroidal anti-inflamatory drug (NSAID) of oxicam class with it’s analgesic effects, anti-inflammatory and antipyretic properties. The major advantage of NSAIDs when it is compared with opioid analgesics, is that they are relatively well tolerated with less side effects when used in selected patients for short-term postoperative analgesia. Lornoxicam is suitable for postoperative analgesia because of its quick elemination and 4-6 hours of plasma half-life time. The aim of this study was to see the effect of lornoxicam administered by PCA for postoperative pain control in patients who underwent lower abdominal surgery. Methods: After approval local ethic committee 50 ASA I-II patients were enrolled this prospective randomized, double blind study. The patients were randomly assigned into two groups of group S (spinal anesthesia group n:22) and group G (general anesthesia group n:28). In the postoperative period, patients received 40 mg lornoxicam with 100cc saline solution within 24 hours after surgery. Injectable solution of 0.4 mg/ml lornoxicam was self administered through an IV indwelling catheter used with a patient controlled analgesia (PCA) device. The device was preset to deliver a maximal dose of 1 mg lornoxicam with a loading dose of 4 mg, lockout time of 30 min, bolus dose of 0.5 mg. Treatment was continued for 24 hours. In both groups blood pressure and heart rate were measured periodically during 24 hours. After surgery, patients requesting analgesia were asked to score the intensity of their pain on a 10 point visual analog score (VAS). The patients were checked for pain at 1, 3, 6, 12 and 24 th hours. Independent sample t test was used for statistical analyse. P⬍0.05 accepted as meaningful. Results: There were no statistically significant differences between VAS’s of the two groups (pⱕ0,005). 46.4 % of the patients have needed additional analgesia at 3 th hour after operation in the first group which was 54.5 % in the second group. At 6 th hour additional analgesia requirement was 3.5 % in group G which was 13.6 % in group S. In either group no patients needed additional analgesia at 12 th and 24 th hours. In the first hour postoperatively, the need for analgesia occurred only in the group G.
168. Comparison of effects of thoracic epidural or paravertebral patient controlled analgesia on pulmonary function following open lung surgery Novak Jankovicˇ V, Sˇtupnik T, Paver Erzˇen V, Oberauner L [email protected] Clinical Department of Anesthesiology and Intensive Therapy, University Medical Centre, Zalosˇka 7, 1000 Ljubljana, Slovenia Background: Open lung surgery causes severe post-thoracotomy pain, associated with stress response and pathophysiological abnormalities. Although many anaesthesiologists regard thoracic epidural analgesia (TEA) as the golden standard, paravertebral analgesia (PVA) has been shown to be as effective as TEA. We performed a prospective completely randomized study to compare the influence of TEA or PVA on the postoperative pulmonary function in patients undergoing open lung surgery. Methods: 40 patients (ASA II-III) scheduled for open lung sergery were randomly assigned to two groups in a completely randomized study design. In the TEA group epidural cathether was placed between T6-T7; in the PVA group the cathether was placed at the T6-T7 level ipsilateral to the thoracotomy. Both groups received a singe preoperative bolus dose of 4 mg of morphine and 5mL of 0.5% bupivacaine through the catheter. Infusion of analgesic mixture (10 mg of morphine, 50mg of bupivacaine and 0.15 mg of clonidine in 100 mL of saline) was given postoperatively using patient controlled analgesia pump (rate: 1mL/h, bolus dose: 3mL, lockout period: 30 min). FVC, FEV1, PEF (peak expiratory flow), MIP (maximal inspiratory pressure), and MEP (maximal exspiratory pressure) were measured before surgery and daily for the first three postoperative days. Results: Major loss of pulmonary function on the first postoperative day with a slow gradual increase during the next two days was observed. Multiple linear regression (SAS PROC GLM) with ANOVA was performed. After controlling for the statistically significant effects of preoperative values (FEV1, FVC, PEF, MIP, MEP), age, sex and extent of lung resection (lobectomy, pneumonectomy, lesser resections), no significant fixed treatment effects of postoperative analgesia (table 1) were found.
Table 1. Fixed treatment effects (TEA- PVA) of postoperative analgesia and values of the corresponding F-statistic 1st postoperative day
Conclusion: At the end of this study we concluded that Lornoxicam with PCA can be used safely for postoperative analgesia for first 24 hours time after lower abdominal surgery. FEV1 (ml) FVC (ml) PEF (l/min) MIP (cm H20) MEP (cm H20)
3rd postoperative day
TEAPVA
F
p
TEAPVA
F
p
38.2 77.6 ⫺8.1 2.6 2.6
1.22 2.62 0.14 0.53 0.71
0.2779 0.1146 0.6958 0.4267 0.3696
⫺5.3 ⫺17.7 7.6 ⫺1.4 ⫺0.9
3.06 5.74 0.86 0.03 0.00
0.0893 0.0022 0.3586 0.8586 1.0000
Conclusion: PVA was found to be as effective as TEA at preservation of pulmonary function following open lung surgery. We therefore recommend PVA as the preferred method of postoperative analgesia as it is tecnically easier to perform and associated with less complications than TEA (1).
Reference: 1. Richardson J.et al. Br J Anaesth 1999; 83(3):387-92