title: Analgesia in day case breast biopsy--the value of pre-emptive tenoxicam.
abstract: OBJECTIVE
  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 bupivacalne 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.
  
  
  CONCLUSIONS
  Pre-operatively administered tenoxicam provides superior post-operative analgesia than tenoxicam administered after surgical incision in patients undergoing breast biopsy.
authors.affiliation: Department of Anaesthesia and Surgery, University College Hospital, Galway, Ireland.
authors.forename: S T
authors.initials: ST
authors.lastname: Colbert
authors.forename: D M
authors.initials: DM
authors.lastname: O'Hanlon
authors.forename: C
authors.initials: C
authors.lastname: McDonnell
authors.forename: F H
authors.initials: FH
authors.lastname: Given
authors.forename: P W
authors.initials: PW
authors.lastname: Keane
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001706:Biopsy / Q000009:adverse effects*; D001940:Breast / Q000473:pathology / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010894:Piroxicam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010894:Piroxicam; C032801:tenoxicam