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AMBULATORY ANESTHESIA

Sublingual Piroxicam for Postoperative Analgesia: Preoperative Versus Postoperative Administration: A Randomized, Double-Blind Study

University Hospital Maastricht, Department of Anesthesiology and Pain Treatment, Maastricht, The Netherlands; Hopital de Zone Morges, Service d’ Anesthesiologie, Morges, Switzerland; Universitair Ziekenhuis Antwerpen, Dienst Anesthesiologie, Edegem, Belgium; Klinieken Noord Antwerpen, Dienst Anesthesiologie, Brasschaat, Belgium

Address correspondence and reprint requests to M.A.E. Marcus, MD, PhD, University Hospital Maastricht, Department of Anesthesiology, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Address e-mail to mmar{at}sane.azm.nl.

Nonsteroidal antiinflammatory drugs have been used to obtain preemptive analgesia. We investigated, in this randomized, double-blind study, whether sublingual (s.l.) piroxicam given before was more effective than that given after surgery. Fifty-two patients scheduled for laparoscopic bilateral inguinal hernia repair under general anesthesia were enrolled. Group PRE (25 patients) received 40 mg of piroxicam s.l. 2 h before surgery and a placebo 10 min after surgery. Group POST (27 patients) were treated with a placebo 2 h before surgery and received 40 mg of piroxicam s.l. 10 min after surgery. After an initial dose of 100 mg tramadol IV, patient-controlled analgesia with tramadol was started and recorded. Visual analog scores were assessed in the recovery and at 6, 20, and 30 h postoperatively. Significantly lower visual analog scores were found in group PRE at 6 and 20 h. Significantly smaller cumulative tramadol consumption was observed after 30 h in group PRE. In summary, our findings suggest that preoperative s.l. piroxicam is more effective than the postoperative administration. Because of the low pain scores in both groups, the clinical relevance of these findings is not clear from this study.

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