Abstract
Purpose: In this prospective randomized study, a comparison was made between the efficacy of 20 mg tenoxicam, administered either, 30 min preoperatively or at induction of anesthesia, for the relief of postoperative pain in patients undergoing ambulatory breast biopsy.
Methods. Seventy-three patients were recruited and all received a standard anesthetic consisting of induction with 2 mg·kg−1 propofol followed by 5 µg·kg−1 alfentanyl. No premedication was administered and at the end of the procedure the wounds were infiltrated with 10 ml of bupivacaine (0.5 %). Patients were randomized to receive 20 mg tenoxicam intraveneously either 30 min before surgery or at induction of anesthesia.
Results: Demographic criteria were similar in both groups. There were differences in pain scores at 30, 60, 120 and 240 min postoperatively (VAS at 30 min 3.2±1.2vs 5.5±1.8;P<0.001: VAS at 60 min 1.8±1.2vs 3.7±1.9;P<0.001: VAS at 120 min 0.9±0.9vs 1.7±1.0;P=0. 003: VAS at 240 min 0.5±0.5vs 1.1±0.8;P<0.001: Expressed as mean±SD). There was a difference in the number of patients requiring additional analgesia, in the first four hours postoperatively (12 (33%)vs 27 (73%);P=0.001) and a difference in the time to additional analgesia in these patients (87.5±32.5vs 55.0±26.8 min;P=0.002).
Conclusion: Early administration of pre-emptive tenoxicam 30 min before induction of anesthesia improves postoperative analgesia in patients undergoing ambulatory breast biopsy.
Résumé
Objectif: Notre étude porte sur la comparaison de l’efficacité de 20 mg de ténoxicam, administrés 30 min avant l’opération ou à l’induction de l’anesthésie pour le soulagement de la douleur postopératoire de patientes qui subissent une biopsie du sein en chirurgie ambulatoire.
Méthode: Nous avons recruté 73 patientes qui ont toutes reçu un régime anesthésique normal constitué d’une induction avec 2 mg·kg−1 de propofol suivi de 5µg·kg−1 d’alfentanil. Aucune prémédication n’a été administrée et, à la fin de l’intervention, 10 ml de bupivacaïne (0,5 %) ont été infiltrés dans la plaie chirurgicale. Les patientes, réparties de façon aléatoire, ont reçu 20 mg de ténoxicam intraveineux, soit 30 min avant l’opération, soit à l’induction de l’anesthésie.
Résultats: Les informations personnelles étaient similaires dans les deux groupes. Les scores de douleur ont été différents pour les mesures réalisées 30, 60, 120 et 240 min après l’opération (selon l’EVA à 30 min 3,2±1,2vs 5,5±1,8;P<0,001: EVA à 60 min 1,8±1,2vs 3,7±1,9;P<0,001: EVA à 120 min 0,9±0,9vs 1,7±1.0;P=0,003: EVA à 240 min 0,5±0,5vs 1,1±0,8;P<0,001: moyenne±écart type). Un nombre différent de patientes a demandé de l’analgésie supplémentaire, pendant les quatre premières heures postopératoires (12 (33 %)vs 27 (73 %);P=0,001). Le temps écoulé avant cette demande d’analgésie diffère également (87,5±32,5vs 55,0±26,8 min;P=0,002).
Conclusion: L’administration précoce de ténoxicam préventif, 30 min avant l’induction de l’anesthésie, améliore l’analgésie postopératoire chez des patientes qui subissent une biopsie du sein en clinique externe.
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References
Ballantyne JC, Carr DB, deFerranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 1998; 86: 598–612.
Carr DB, Goudas LC Acute pain. Lancet 1999; 353: 2051–8.
Carr DB. Preempting the memory of pain (Editorial). JAMA 1998; 279: 1114–5.
Sinatra RS. Acute pain management and acute pain services.In: Cousins MJ, Bridenbaugh PO (Eds.). Neural Blockade in Clinical Anesthesia and Management of Pain, 2nd ed. Philidelphia: Lippincott-Raven, 1998.
Brown DL, Carpenter RL. Perioperative analgesia: a review of risks and benefits. J Cardiothorac Vasc Anesth 1990; 4: 368–83.
Lutz LJ, Lamer TJ. Management of postoperative pain: review of current techniques and methods. Mayo Clin Proc 1990; 65: 584–96.
Colbert ST, O’Hanlon DM, Mc Donnell C, Given FH, Keane PW. Analgesia in day case breast biopsy - the value of pre-emptive tenoxicam. Can J Anaesth 1998; 45: 217–22.
Carr DB, Jacox A, Chapman RC, et al. Acute pain management: operative or medical procedures and trauma. Department of Health and Human Services, Publication no 92-0032, Agency for Health Care Policy and Research, Public Health Service. Rockville, MD: US Department of Health and Human Services, 1992.
McQuay HJ, Moore RA. An Evidence-Based Resource for Pain Relief. Oxford: Oxford University Press, 1998.
McCormack K. Non-steroidal anti-inflammatory drugs and spinal nociceptive processing. Pain 1994; 59: 9–44.
Allison MC, Howatson AG, Torrence CJ, Lee FD, Russell RI. Gastrointestinal damage associated with the use of non-steroidal antiinflammatory drugs. N Engl J Med 1992; 327: 749–54.
Clive DM, Stoff JS. Renal syndromes associated with nonsteroidal antiinflammatory drugs. N Engl J Med 1984; 310: 563–72.
Vane JR, Bakhle YS, Botting RM. Cyclooxygenases 1 and 2. Ann Rev Pharmacol Toxicol 1998; 38: 97–120.
Nilsen OG. Clinical pharmacokincties of tenoxicam. Clin Pharmacokinet 1994; 26: 16–43.
Jeunet F, Enz W, Guentert T. Tenoxicam used as a parenteral formulation for acute pain in rheumatic conditions. Scand J Rheumatol Suppl 1989; 80: 59–61.
Gonzales JP, Todd PA. Tenoxicam. A preliminary review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy. Drugs 1987; 34: 289–3.
Besson JM. The neurobiology of pain. Lancet 1999; 353: 1610–5.
Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet 1999; 353: 1959–64.
Pasqualucci A. Experimental and clinical studies about the preemptive analgesia with local anesthetics. Possible reasons of the failure. Minerva Anestesiol 1998; 64: 445–57.
Katz J. Pre-emptive analgesia: evidence, current status and future directions. Eur J Anaesthesiol 1995; 12(Suppl 10): 8–13.
Niv D, Devor M. Transition from acute to chronic pain.In: Aronoff GM (Ed.). Evaluation and Treatment of Chronic Pain, 2nd ed. Baltimore: Williams & Wilkins, 1998.
Gottschalk A, Smith DS, Jobes DR, et al. Preemptive epidural analgesia and recovery from radical prostatectomy: a randomized controlled trial. JAMA 1998; 279: 1076–82.
Horton CW Jr,Reichl LE, Szebehely VG. Long-time Prediction in Dynamics. New York: John Wiley & Sons, 1983.
Katz J. Phantom limb pain. The Lancet 1997; 350: 1338.
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O’Hanlon, D.M., Thambipillai, T., Colbert, S.T. et al. Timing of pre-emptive tenoxican is important for postoperative analgesia. Can J Anaesth 48, 162–166 (2001). https://doi.org/10.1007/BF03019729
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DOI: https://doi.org/10.1007/BF03019729