title: The analgesic efficacy of intravenous tenoxicam as an adjunct to patient-controlled analgesia in total abdominal hysterectomy.
abstract: Nonsteroidal antiinflammatory drugs may reduce postoperative opioid consumption. We evaluated the analgesic efficacy of preoperatively administered tenoxicam in patients undergoing total abdominal hysterectomy. Patients were randomly assigned to receive IV either normal saline 4 mL (Group NS), tenoxicam 20 mg (Group T20), or tenoxicam 40 mg (Group T40) before the induction of anesthesia in a double-blinded fashion. Patient-controlled analgesia with fentanyl was used to assess postoperative opioid requirements. Pain was evaluated by visual analog scale at 2, 4, 6, 8, and 24 h postoperatively. Intraoperative bleeding as assessed by the surgeon, incidence of nausea, and gastrointestinal symptoms were recorded. No statistically significant difference was identified between groups in fentanyl consumption or pain scores. The incidence of nausea was similar in all groups. Two patients in Group T20 and two in Group T40 exhibited mild gastrointestinal symptoms. Intraoperative oozing was noted in two patients in Group T40. We conclude that patients undergoing total abdominal hysterectomy and receiving fentanyl via patient-controlled analgesia postoperatively do not benefit from tenoxicam pretreatment. On the contrary, the drug may be associated with an increased incidence of side effects.
  
  
  CONCLUSIONS
  The preoperative administration of 20 or 40 mg IV tenoxicam does not reduce fentanyl consumption via Patient-Controlled Analgesia, compared with placebo, after total abdominal hysterectomy. Additionally, tenoxicam may increase intraoperative bleeding and gastrointestinal side effects.
authors.affiliation: Department of Anesthesia, St. Savas Hospital. Department of Critical Care, Evangelismos Hospital, Athens, Greece. fotinidanou@yahoo.com
authors.forename: F
authors.initials: F
authors.lastname: Danou
authors.forename: A
authors.initials: A
authors.lastname: Paraskeva
authors.forename: T
authors.initials: T
authors.lastname: Vassilakopoulos
authors.forename: A
authors.initials: A
authors.lastname: Fassoulaki
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010149:Postoperative Pain / Q000188:drug therapy*; D010894:Piroxicam / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011247:Pregnancy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010894:Piroxicam; C032801:tenoxicam