The local addition of tenoxicam reduces the incidence of low back pain after lumbar epidural anesthesia

Background: Postepidural backache is a common postoperative complaint after lumbar epidural anesthesia. Useful interventions to decrease the incidence of postepidural backache would be helpful. Methods: We performed a prospective, randomized, double-blind study to comp are the effect of local addition of tenoxicam on the incidence of postepidu ral backache after nonobstetric surgery. One thousand unpremedicated ASA ph ysical status I or LI patients scheduled for hemorrhoidectomy were assigned randomly to tenoxicam or control groups. Patients in the control group rec eived 25 mi lidocaine, 2%, with epinephrine 1:200,000 epidurally and 4 mi L idocaine, 1%, for local skin infiltration. Patients in the tenoxicam group received 25 mi lidocaine, 2%, with epinephrine 1:200,000 epidurally and 4 m i lidocaine, 1%, with tenoxicam (2 mg) 1:2,000 for local skin infiltration, Patients were interviewed at 24, 48, and 72 h postoperatively using a stan dard visual analog scale for evaluation of postepidural backache. A patient was considered to have postepidural backache when the postoperative visual analog scale score was higher than the preoperative score. Results: The incidence of postepidural backache in patients in the control group for the 3 days were 22.8%, 17.4%, and 9.2%, all of which were signifi cantly more frequent than observed in the patients in the tenoxicam group ( 6.8%, 4.0%, and 1.2%, P < 0.01), There was a significant association betwee n backache and multiple attempts at epidural needle insertion. Conclusions: In summary, the Local addition of tenoxicam reduced the incide nce and severity of postepidural backache.