Analgesia in day case breast biopsy — The value of pre-emptive tenoxicam

  • Sallyann T. Colbert
  • Deirdre M. O’Hanlon
  • Conor McDonnell
  • Fred H. Given
  • Padraic W. Keane
Reports of Investigation

Abstract

Purpose

Inadequate analgesia is a major problem following ambulatory surgery. In this prospective randomised study, the use of pre-operative intravenous tenoxicam (a non steroidal anti-inflammatory agent) was compared with post-incision tenoxicam for the relief of post-operative pain in 77 patients undergoing day case breast biopsy.

Methods

All patients received a standard general anaesthetic which included infiltration of the wound with bupivacaine after skin closure. Intravenous tenoxicam (20 mg) was administered as a single bolus either 30 min before surgery (37 patients) or after incision (40 patients). Pain scores ( 100 mm visual analog scale) were obtained at 30, 60, 120 and 240 min after surgery analgesic requirements recorded.

Results

Both groups of patients were similar with respect to age, weight, operative time and length of the incision. Patients receiving the tenoxicam 30 min before surgery had lower pain scores at 30 min (22 ± 3) vs 46 ± 3;P < 0.0001), 60 min (9 ± 2 vs 28 ± 3);P < 0.0001), 120 min (6 ± 2 vs 16 ± 3);P = 0.0002) and 240 min (3 ± 1) vs 7 ± 2);P = 0.02) post-operatively. They had a longer time to first analgesia (55.1 ± 4.6 vs 29.6 ± 2.6) min;P = 0.0004), required less meperidine (5.4 ± 2.6 vs 18.8 ± 3.9) mg;P = 0.007) and were more likely not to require any further analgesia during the first four hours post-operatively.

Conclusion

Pre-operatively administered tenoxicam provides superior post-operative analgesia than tenoxicam administered after surgical incision in patients undergoing breast biopsy.

Résumé

Objectif

Lanalgésie inadéquate est un problème majeur en chirurgie ambulatoire. Dans cette étude aléatoire et prospective, on a comparé chez 77 patientes subissant une biopsie du sein sur une base ambulatoire l’effet du ténoxicam (un anti-inflammatoire non stéroïdien) administré par voie intraveineuse avant l’opération à cette même médication administrée après l’incision.

Méthodes

Toutes les patientes ont reçu une anesthésie générale standard, incluant une infiltration de la plaie avec de la bupivacaïne après fermeture de la peau. Le tenoxicam I.V. (20 mg) a été administré en bolus 30 min avant la chirurgie (37 patientes) ou après l’incision (40 patientes). Le score de la douleur, en utilisant une échelle visuelle analogue de 100 mm, a été obtenu à 30, 60, 120 et 240 min après la chirurgie et les besoins en analgésiques ont été compilés.

Résultats

Les deux groupes de patientes étaient semblables quant à l’âge, au poids, à la durée de la chirurgie et à la longueur de l’incision. Les patientes qui ont reçu le ténoxicam 30 min avant l’opération ont présenté un score de douleur inférieur lors de toutes les évaluations: lors de 30 min, 22 ± 3 vs 46 ± 3 (P< 0,000l), à 60 min, 9 ± 2 vs 28 ± 3 (P< 0,000l), à 120 min, 6 ± 2 vs 16 ± 3 (P=0,0002), à 240 min, 3 ± 1 vs 7 ± 2 (P=0,02). Ces patientes ont aussi présenté le plus long intervalle avant la l ère demande d’analgésiques (55,1 ± 4,6 vs 29,6 ± 2,6 min), (P=0,0004), ont nécessité moins de mépéridine (5,4 ± 2,6 vs 18,8 ± 3,9 mg), (P=0,007) et étaient plus susceptibles de ne requérir aucune autre analgésie durant les quatre premières heures post opératoires.

Conclusion

Le ténoxicam administré en période pré opératoire produit une analgésie post opératoire supérieure à celle obtenue par son administration après l’incision chez des patientes subissant une biopsie du sein.

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Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  • Sallyann T. Colbert
    • 1
  • Deirdre M. O’Hanlon
    • 2
  • Conor McDonnell
    • 1
  • Fred H. Given
    • 2
  • Padraic W. Keane
    • 1
  1. 1.Department of AnaesthesiaUniversity College HospitalGalwayIreland
  2. 2.Department of SurgeryUniversity College HospitalGalwayIreland
  3. 3.Department of AnaesthesiaSt. James HospitalDublin 8Ireland

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