title: Differential analgesic effect of tenoxicam on the wound pain and uterine cramping pain after cesarean section.
abstract: BACKGROUND
  Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to enhance opioid analgesia in the acute pain service. The question, however, of whether NSAIDs produce a similar extent of potentiation among different types of pain, has not been thoroughly investigated.
  
  
  METHODS
  A randomized, placebo-controlled, double-blind study was performed to characterize the analgesic effect of tenoxicam, a long-acting NSAID, on resting wound pain, evoked wound pain, and uterine cramping pain after cesarean section. Saline (n = 48) or 20 mg tenoxicam (n = 45) was intravenously injected immediately after clamping the umbilical cord. All patients were instructed to obtain maximal postoperative analgesia by intravenous patient-controlled morphine. RESULTS Tenoxicam profoundly reduced the intensity of uterine cramping pain (3.6 [2.0-5.6] versus 5.5 [3.4-6.6]; p < 0.01) but had no additional effect on wound pain at rest, with movement, changing position, sitting, and walking. Intraoperative injection of 20 mg tenoxicam decreased the demand ratio for patient-controlled analgesia (PCA) and 24-hour morphine consumption by approximately 30%.
  
  
  CONCLUSIONS
  The data show that tenoxicam potentiates opioid analgesic effect on the somatic and visceral types of pain to different extents, and they suggest that intraoperative injection of 20 mg tenoxicam is sufficient to enhance intravenous PCA morphine on uterine cramping pain for the first 24 hours after cesarean section.
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
authors.forename: Hsing-Wen
authors.initials: HW
authors.lastname: Hsu
authors.forename: Ya-Jung
authors.initials: YJ
authors.lastname: Cheng
authors.forename: Li-Kuei
authors.initials: LK
authors.lastname: Chen
authors.forename: Yong-Ping
authors.initials: YP
authors.lastname: Wang
authors.forename: Chen-Jung
authors.initials: CJ
authors.lastname: Lin
authors.forename: Chien-Nan
authors.initials: CN
authors.lastname: Lee
authors.forename: Wei-Zen
authors.initials: WZ
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D002585:Cesarean Section / Q000009:adverse effects*; D004311:Double-Blind Method; D004357:Drug Synergism; D005260:Female; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010894:Piroxicam / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011247:Pregnancy; D014590:Uterine Contraction / Q000187:drug effects*
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010894:Piroxicam; D009020:Morphine; C032801:tenoxicam