ANALGESIA IN DAY-CASE BREAST BIOPSY - THE VALUE OF PREEMPTIVE TENOXICAM

Purpose: Inadequate analgesia is a major problem following ambulatory surgery, In this prospective randomised study, the use of pre-operativ e intravenous tenoxicam (a non steroidal anti-inflammatory agent) was compared with post-incision tenoxicam for the relief oi post-operative pain in 77 patients undergoing day case breast biopsy, Methods: All p atients received a standard general anaesthetic which included infiltr ation of the wound with bupivacaine after skin closure, Intravenous te noxicam (20 mg) was administered as a single bolus either 30 min befor e surgery (37 patients) or after incision (40 patients), Pain scores ( 100 mm visual analog scale) were obtained at 30, 60, 120 and 240 min a fter surgery analgesic requirements recorded. Results: Both groups of patients were similar with respect to age, weight, operative time and length of the incision. Patients receiving the tenoxicam 30 min before surgery had lower pain stores at 30 min (22 +/- 3) vs 46 +/- 3; P < 0 .0001), 60 min (9 +/- 2 vs 28 +/- 3); P < 0.0001), 120 min (6 +/- 2 vs 16 +/- 3); P = 0.0002) and 240 min (3 +/- 1) vs 7 +/- 2); P = 0.02) p ost-operatively, They had a longer lime to first analgesia (55.1 +/- 4 .6 vs 29.6 +/- 2.6) min; P = 0.0004), required less meperidine (5.4 +/ - 2.6 vs 18.8 +/- 3.9) mg; P = 0.007) and were more likely not to requ ire any further analgesia during the first four hours post-operatively . Conclusion: Pre-operatively administered tenoxicam provides superior post-opera-live analgesia than tenoxicam administered after surgical incision in patients undergoing breast biopsy.