Diclofenac Sodium and Tenoxicam for Postoperative Analgesia

Abstract

It's been well recognized that the combination of opioid agonist and non-steroid anti-inflammatory drugs (NSAIDs) may provide better analgesia and less adverse effects. This study compares diclofenac sodium (75mg) with two different doses of tenoxicam (20 and 40 mg) in combination with patient-controlled analgesia (PCA) morphine for patients undergoing abdominal total hysterectomy (ATH). Total 78 patients (n=30 in diclofenac group and n=24 in each tenoxicam group) were enrolled into this randomized, double-blind study. All patients received loading doses of assigned NSAID and morphine to relief visual analogue scores (VAS, 0-10) to less than 3 at post-operative recovery room (RR). PCA morphine was applied thereafter. Patients were evaluated before discharging from RR and every 8AM, 14PM and 20PM for 48 hours. VAS (resting and moving), side effects (dizziness, nausea/vomiting, and itching), and vital signs were recorded and analyzed. There were no differences among these groups in age, body weight, opioid dosage for surgical anesthesia, side effect incidence, and vital signs. Patients receiving tenoxicam 20 mg consumed more PCA morphine (655±252 mg/kg) than patients receiving diclofenac sodium (526±137 mg/kg) or tenoxicam 40 mg (484±161 mg/kg). Patients receiving tenoxicam 20 mg suffered more pain [VAS, area under curve (AUC)/service hour, move, 2.97+0.71] when compared to diclofenac group (2.31+0.57) and tenoxicam 40 mg group (2.26+0.63). We conclude that in patients receiving PCA morphine for post-ATH pain control, 40 mg tenoxicam, as well as 75 mg diclofenac sodium, provides better analgesia than 20 mg tenoxicam.