Intra-articular tenoxicam improves postoperative analgesia in knee arthroscopy

Purpose: Non Steroidal Anti-inflammatory drugs have a well documented benefit in the relief of postoperative pain. This study was designed to compare the analgesic effect of intra-articular tenoxicam 20 mg with intravenous tenoxicam on postoperative pain in 88 patients undergoing day case knee arthroscopy. Methods: A prospective, double blind, randomized trial was performed. All patients received a standard general anesthetic. Patients in group A received 20 mg tenoxicam made up to 40 ml with normal saline intra-articularly (ia) and 2 ml normal saline iv. Patients in group B received 40 mi normal saline intra-articularly and 2 ml, 20 mg of tenoxicam, iv. Results: Both groups of patients were similar with respect to age, weight, sex and tourniquet inflation time. Patients receiving ia tenoxicam had lower pain scores (at rest and upon movement) at 30, 60, 120 and 180 min postoperatively (0.8 +/- 0.2 vs 2.5 +/- 0.2 at rest and 1.24 +/- 0.2 vs 3.4 +/- 0.2 at movement at 60 min; P < 0.0001), Fewer patients required additional analgesia in the first four hours postoperatively (33% vs 84%; P < 0.00001) and the time to first analgesia (23.7 +/- 11.2 vs 9.4 +/- 0.6;P < 0.02) was longer in those receiving ia tenoxicam. Conclusion: Intra-articular tenoxicam provides superior postoperative analgesia and reduces postoperative analgesic requirements compared with iv tenoxicam in patients undergoing day case knee arthroscopy.