title: Preoperative application of piroxicam gel compared to a local anaesthetic field block for postoperative analgesia.
abstract: The non-steroidal anti-inflammatory drugs inhibit prostaglandin synthesis and hence have an analgesic action. Following topical administration, the drug is concentrated in the tissues and so can have a local analgesic effect. This study investigated the effect of the preoperative application of topical piroxicam on postoperative analgesic requirement compared to a placebo group and a conventional local anaesthetic field block. Forty-two patients presenting for in-patient inguinal hernia repair were randomly allocated on a double-blind basis to have either piroxicam gel 15gm applied preoperatively, or an inguinal field block with 20 ml of 0.375% bupivacaine following induction of anaesthesia, or no treatment. Postoperative Visual Analogue Scores for pain on moving in group P, I or C on admission at 1h, 2h, and 4 h following surgery were: 2 vs 1 vs 6.5; 3 vs 3 vs 5; 3 v 2 vs 4.5; 3 vs 2 vs 5.0, respectively (P < 0.005). Median(range) time to first analgesia was 25.4(15-70) min in group I, 30.3(10-49) min in group P; this was not significantly different from group C21.5(7-70) min. Over the first 24 hours the postoperative morphine requirement was significantly less in the two treatment groups 30(20)mg in group I and 34(17) mg in group P and 71(15) in group C, P < 0.0001. There were no apparent NSAID-induced side-effects, or effects on wound healing. The preoperative administration of piroxicam (15gm) topically compared favourably with a preoperative local anaesthetic field block with respect to VAS scores, time to first analgesia and total morphine consumption. And both treatment groups provided significantly superior analgesia than the control group.
authors.affiliation: Department of Anaesthetics, Craigavon Area Hospital, Portadown, N. Ireland.
authors.forename: J J
authors.initials: JJ
authors.lastname: O'Hanlon
authors.forename: G
authors.initials: G
authors.lastname: McCleane
authors.forename: T
authors.initials: T
authors.lastname: Muldoon
mesh_terms: D000287:Administration, Topical; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D004311:Double-Blind Method; D005782:Gels; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D010894:Piroxicam / Q000008:administration & dosage*; D011229:Preanesthetic Medication
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005782:Gels; D010894:Piroxicam; D002045:Bupivacaine