Comparison of lornoxicam with tramadol in patient­ controlled analgesia after gynecological surgery

Background: The aim of this study was to compare the effects of lornoxicam and tramadol in patient-controlled analgesia (PCA) after gynecological surgery.

Methods: Forty-four patients were randomly allocated to one of two groups after elective gynecological surgery. Patients in group I (n = 22) received IV tramadol, and group II patients (n = 2) received IV lornoxicam with a PCA pump. A visual analogue scale (VAS) (0 = no pain, 10 = worst pain), hemodynamic parameters and side-effects were assessed before starting the infusion (baseline), at the 15th and 30th min, 1st, 2nd, 3rd, 4th, 6th, 8th, 12th, 18th, 24th, 36th and 48th hour thereafter, and results were compared.

Results: Adequate analgesia was achieved in both groups. VAS values in the tramadol group were lower than those of lornoxiacam at the 15th and 30th minute, 1st, 2nd, 4th, 6th, 8th and 12th hour measurements (p < 0.05). Eight patients (36.3%) in group I and six patients (27.2%) in group II suffered from nausea (p > 0.05).

Conclusions: Tramadol and lornoxicam may be used for pain control after gynecological surgery via PCA. However, we conclude that tramadol has better analgesic efficacy than lornoxicam during the first 12 hours postoperatively.

Postoperative analgesia; Patient-controlled analgesia; Tramadol; Lornoxicam

[1] Spence A.A.: "Pain after surgery". J. Bone Joint Surg. Br., 1991, 73, 189.

[2] Ready L.B.: "Acute perioperative pain". In: Miller R.D. (ed.) Anesthesia, 5'" edition, Philadelphia, Churchill Livingstone, 2000, 2323.

[3] Kehlet H.: "Postoperative pain relief: what is the issue?". Br. J Anaesth., 1994, 72, 375.

[4] Silvasti M., Svartling N., Pitkanen M., Rosenberg P.H.: "Comparison of intravenous patient-controlled analgesia with tramadol versus morphine after microvascular breast reconstruction". Eur. J. Anaesthesiol., 2000, 17, 448.

[5] Pang W., Huang S., Tung C.C., Huang M.H.: "Patient-controlled analgesia with tramadol versus tramadol plus lysine acetyl salicylate". Anesth. Analg., 2000, 91, 1226.

[6] Hopkins D., Shipton E.A., Potgieter D., Van derMerwe C.A., Boon J., De Wet C. et al.: "Comparison of tramadol and morphine via subcutaneous PCA following major orthopaedic surgery". Can J. Anaesth., 1998, 45, 435.

[7] Hynninen M.S., Cheng D.C., Hoss出n I., Carroll J., Aumbhagavan S.S., Yue R. et al.: "Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery". Can J Anaesth., 2000, 47, 1182.

[8] De Albrechtsen M., Stolke D.: "A comparison of patient-controlled analgesia with lornoxicam versus morphine in patients undergoing lumbar disk surgery". Anesth. Analg., 1998, 86, 1045.

[9] Norholt S.E., Sindel-Pedersen S., Larsen U., Bang U., Ingerslev J., Nielsen O. et al.: "Pain control after dental surgery: a doubleblind, randomised trial of lornoxicam versus morphine". Pain, 1996, 67, 335.

[10] Rosenow D.E., van Krieken F., Stolke D., Kursten F.W.: "Intravenous administration of lornoxicam, a new NSAID, and pethidine for postoperative pain". Clin. Drug. Invest., 1996, 11, 11.

[11] Ilias W., Jansen M.: "Pain control after hysterectomy: an observerblind, randomised trial of lornoxicam versus tramadol". Br. J. Clin Pract., 1996, 50, 197.

[12] Aygun S., Kocoglu H., Goksu S., Karaca M., Oner U.: "Postoperative patient-controlled analgesia with intravenous tramadol, intravenous fentanyl, epidural tramadol and epidural ropivacaine+fentanyl combination". Eur. J. Gynaecol. Oneal., 2004, 25, 498.

[13] Bloch M.B., Dyer R.A., Heijke S.A., James M.F.:'Tramadol infusion for postthoracotomy pain relief: a placebo-controlled comparison with epidural morphine". Anesth. Analg., 2002, 94, 523.

[14] Pang W.W., Mok M.S., Lin C.H., Yang T.F., Huang M.H.: "Comparison of patient-controlled analgesia (PCA) with tramadol or morphine". Can. J. Anaesth., 1999, 46, 1030.

[15] Daglar B., Kocoglu H., Celkan M.A., Goksu S., Kazaz H., Kayiran C.: "Comparison of the effects of lornoxicam versus diclofenac in pain management after cardiac surgery: A single-blind, randomized, active-controlled study". Curr. Therapeu. Res., 2005, 66, 107.

[16] Griffin M.: "Con: nonsteroidal anti-inflammatory drugs should not be routinely administered for postoperative analgesia after cardiac surgery". J. Cardiothorac. Vase. Anesth., 2000, 14, 735.