Improved postoperative analgesia with preoperative piroxicam

Purpose: Piroxicam like other Non-Steroidal Anti-Inflammatory drugs can be used to provide postoperative analgesia. With a half-life of 50 hr given preoperatively its' analgesic effect should continue postoperatively. This study compared the effects of 20 mg piroxicam given at different limes in the perioperative period on postoperative analgesic requirement. Method: Following ethical committee approval and written informed consent, 60 ASA I and II patients presenting for inpatient gynaecological laparoscopic surgery were given either 20 mg piroxicam or a placebo or two hours preoperatively, immediately before induction of anaesthesia or one hour postoperatively in a randomised double bind manner. Results: Postoperative Visual Analogue Pain Scores were lower on admission to the recovery ward in patients given piroxicam preoperatively (Group 1), than in the other two treatment groups (groups 2 and 3). Pain scores were 2.72 vs 4.25 vs 6.67 respectively (P < 0.001). Pain scores did not differ at any other times. Time to first analgesic request was greater in the group 1 than in the other two treatment groups; 141 (61) min vs 115 (147) in Group 2 and 30 (36) min in Group 3. Nine patients in Group 1 requested further analgesia compared with 15 in Group 2 and 16 in Group 3. There were no piroxicam-induced side-effects. Conclusion: Piroxicam given two hours preoperatively reduced pain scores, time to first analgesia and postoperative analgesic requirements compared with administration prior to induction or one hour postoperatively.