Effects of preoperative lornoxicam versus tramadol on postoperative pain and adverse effects in adult tonsillectomy patients.

OBJECTIVES This study assessed the efficacy and adverse effects of preoperatively administered lornoxicam versus tramadol in adults, for post-tonsillectomy pain. METHODS This prospective, double blind, randomized, clinical research was performed in the Ear, Nose and Throat Surgery Room in the Department of Anesthesia and Reanimation, Gazi University Faculty of Medicine. Forty American Society of Anesthesiologists (ASA) status I-II patients of both gender, aged 18-55 years, were included. RESULTS Tonsillectomy patients were divided into two groups: Those in Group L received 8 mg lornoxicam and in Group T received 50 mg tramadol intravenously just before induction of general anesthesia. Induction and maintenance of anesthesia (propofol, atracurium, nitrous oxide and sevoflurane) were standardized. Heart rate and systolic and diastolic arterial pressure data were monitored during the anesthesia. Intra-operative bleeding was scored by the same operator using a 5-point scale at the end of the surgery. Postoperative pain on swallowing was scored by a blinded anesthesiologist using Verbal Rating Scale (VRS) on arrival in the Post Anesthesia Care Unit (T(0)), at 30 min (T(1)), 1h (T(2)), 2h (T(3)), 3h (T(4)), 4h (T(5)), 5h (T(6)), and 6h (T(7)) thereafter. During the first postoperative 6 hours, when VRS >/=2, 1mg.kg(-1) im meperidine was used as a rescue analgesic. Adverse effects in the postoperative 6h period were noted. T(1) and T(2) pain scores in Group T were higher than in Group L (p=0.049, p=0.007, respectively). The number of patients requiring rescue analgesics during the first 6 hours in Group L was lower than in Group T. Nausea-vomiting, bleeding and postoperative hemorrhage values were similar between Group L and Group T. CONCLUSION Preoperative 8 mg lornoxicam was more effective than 50 mg tramadol with respect to early postoperative tonsillectomy pain in adult patients, and side effects were similar.

[1]  M. White,et al.  An evaluation of pain and postoperative nausea and vomiting following the introduction of guidelines for tonsillectomy , 2005, Paediatric anaesthesia.

[2]  A. Hiller,et al.  Propacetamol and diclofenac alone and in combination for analgesia after elective tonsillectomy , 2004, Acta anaesthesiologica Scandinavica.

[3]  P. Collison,et al.  Harmonic Scalpel versus Conventional Tonsillectomy: A Double-Blind Clinical Trial , 2004, Ear, nose, & throat journal.

[4]  Deborah P. Birkmire-Peters,et al.  Radiofrequency Ablation versus Electrocautery in Tonsillectomy , 2004, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[5]  J. Lopez-Escamez,et al.  American Society of Anesthesiology classification may predict severe post-tonsillectomy haemorrhage in children. , 2003, The Journal of otolaryngology.

[6]  L. Hughes,et al.  Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a meta-analysis. , 2003, Archives of otolaryngology--head & neck surgery.

[7]  M. Tramèr,et al.  Nonsteroidal Antiinflammatory Drugs and the Risk of Operative Site Bleeding After Tonsillectomy: A Quantitative Systematic Review , 2003, Anesthesia and analgesia.

[8]  R. Likar,et al.  [Preemptive randomized, double-blind study with lornoxicam in gynecological surgery]. , 2003, Schmerz.

[9]  H. Kokki.  Nonsteroidal Anti-Inflammatory Drugs for Postoperative Pain A Focus on Children , 2003 .

[10]  A. Turan,et al.  Analgesic Effects of Rofecoxib in Ear-Nose-Throat Surgery , 2002, Anesthesia and analgesia.

[11]  Z. Elar,et al.  Preemptive diclofenac reduces morphine use after remifentanil‐based anaesthesia for tonsillectomy , 2002, Paediatric anaesthesia.

[12]  J. Divatia,et al.  Efficacy of intravenous ketoprofen for pre-emptive analgesia. , 2002, Journal of postgraduate medicine.

[13]  H. Kokki,et al.  The effect of ketoprofen on recovery after tonsillectomy in children: a 3-week follow-up study. , 2002, International journal of pediatric otorhinolaryngology.

[14]  S. Pocock,et al.  Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery. , 2002, British journal of anaesthesia.

[15]  H. Kokki,et al.  Recovery After Tonsillectomy in Adults: A Three‐Week Follow‐up Study , 2002, The Laryngoscope.

[16]  S. Brull,et al.  Preemptive analgesia II: recent advances and current trends , 2001, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[17]  S. Brull,et al.  Preemptive analgesia I: physiological pathways and pharmacological modalities , 2001, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[18]  N. Bhattacharyya.  Evaluation of Post-tonsillectomy Bleeding in the Adult Population , 2001, Ear, nose, & throat journal.

[19]  M. Courtney,et al.  Tramadol vs. diclofenac for posttonsillectomy analgesia. , 2001, Archives of otolaryngology--head & neck surgery.

[20]  D. O'hanlon,et al.  Timing of pre-emptive tenoxican is important for postoperative analgesia , 2001, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[21]  I. Kissin.  Preemptive Analgesia , 2000, Anesthesiology.

[22]  M. Akçabay,et al.  Relief of posttonsillectomy pain with low-dose tramadol given at induction of anesthesia in children. , 2000, International journal of pediatric otorhinolaryngology.

[23]  C. Perry,et al.  Tramadol , 2000, Drugs.

[24]  J. Akervall,et al.  Pain Treatment after Tonsillectomy: Advantages of Analgesics Regularly Given Compared with Analgesics on Demand , 2000, Acta oto-laryngologica.

[25]  J. Ovesen,et al.  Efficacy and Tolerability of Lornoxicam versus Tramadol in Postoperative Pain , 1999, Journal of clinical pharmacology.

[26]  N. Davies,et al.  Clinical Pharmacokinetics of Lornoxicam , 1998, Clinical pharmacokinetics.

[27]  J. Lerman,et al.  Vomiting After Adenotonsillectomy in Children: A Comparison of Ondansetron, Dimenhydrinate, and Placebo , 1998, Anesthesia and analgesia.

[28]  N. Morton,et al.  Ondansetron reduces nausea and vomiting after paediatric adenotonsillectomy , 1997, Paediatric anaesthesia.

[29]  W. Ilias,et al.  PAIN CONTROL AFTER HYSTERECTOMY: AN OBSERVER‐BLIND, RANDOMISED TRIAL OF LORNOXICAM VERSUS TRAMADOL , 1996, The British journal of clinical practice.

[30]  D. Stolke,et al.  Intravenous Administration of Lornoxicam, a New NSAID, and Pethidine for Postoperative Pain , 1996 .

[31]  S. Furst,et al.  Prophylactic Antiemetic Treatment with Ondansetron in Children Undergoing Tonsillectomy , 1994, Anesthesiology.

[32]  C. Patterson,et al.  Diclofenac sodium for post‐tonsillectomy pain in children , 1988, Anaesthesia.

[33]  M. Bone,et al.  A comparison of rectal diclofenac with intramuscular papaveretum or placebo for pain relief following tonsillectomy , 1988, Anaesthesia.