title: Intravenous tenoxicam reduces dose and side effects of PCA morphine in patients after thoracic endoscopic sympathectomy.
abstract: BACKGROUND
  Among surgical modalities for treatment of palmar hyperhidrosis, endoscopic sympathectomy is the most popular choice in recent years. After surgery, the major complaint was anterior chest pain. This study was conducted to evaluate the analgesic efficacy and side effects of tenoxicam (a thienothiazine derivative) in combination with patient-controlled analgesia (PCA) using morphine in patients who received thoracic endoscopic sympathectomy.
  
  
  METHODS
  Forty-one ASA class I patients who underwent endoscopic sympathectomy (T2 and T3 ganglia) were randomly divided into two groups. Operation was conducted under general anesthesia with single lumen endotracheal intubation. No narcotic was given during the operation except for fentanyl (3 micrograms/kg) during induction. After surgery, patients in group I received PCA morphine only and patients in group II received PCA morphine plus tenoxicam (20 mg, i.v.) immediately for pain relief. In addition, rescue analgesia with intramuscular meperidine (1 mg/kg) was available to each patient every 4 h prn. The intensity of pain was assessed with VAS pain score every 4 h for 24 h. The frequency of demand and doses of delivered PCA morphine were recorded.
  
  
  RESULTS
  Results showed no statistically significant difference between groups in respect of age, body height, body weight and pain scores. However, based upon similar qualitative pain relief, patients in group II revealed less demand for analgesic, less doses of morphine requirement and less side effects.
  
  
  CONCLUSIONS
  Tenoxicam may be an effective adjuvant to PCA morphine for postoperative pain control. This combination reduces the total consumption of PCA morphine with less side effects.
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan, R.O.C.
authors.forename: W J
authors.initials: WJ
authors.lastname: Liaw
authors.forename: Y J
authors.initials: YJ
authors.lastname: Day
authors.forename: J J
authors.initials: JJ
authors.lastname: Wang
authors.forename: S T
authors.initials: ST
authors.lastname: Ho
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010149:Postoperative Pain / Q000188:drug therapy*; D010894:Piroxicam / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013562:Sympathectomy; D013906:Thoracoscopy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010894:Piroxicam; D009020:Morphine; C032801:tenoxicam