Tenoxicam IV in major gynaecological surgery - Pharmacokinetic, pain relief and haematological effects

This study compared postoperative analgesic dispensation and measures relat ing to haemostasis following inrtavenous administration, in a randomized do uble-blinded manner; of either placebo or tenoxicam 20 mg to 30 women prese nting for major gynaecological oncology surgery under a standardized, combi ned epidural/general anaesthetic technique, Pharmacokinetic disposition of tenoxicam in this patient cohort was also described. There was no objective or subjective alteration in haemostatic function or increase in blood loss , nor any deviation from the normal range of values. Postoperative analgesi a during the first 48 hours was delivered to achieve a VAS endpoint of less than five on leg-raising, by a combination of a nurse-controlled low-dose background epidural infusion and patient-administered epidural bolus, Great er VAS variability was observed during the first four postoperative hours ( P=0.08), The tenoxicam group self-administered significantly fewer epidural bolus doses to maintain satisfactory analgesia compared with the placebo g roup during the first 24 hours (P=0.004) and 48 hours (P=0.01) postoperativ ely. Similar differences between the groups in the total dose of the epidur al bupivacaine/fentanyl mixture delivered were described (4h: P=0.148; 24h: P=0.033; 48h: P=0.001) (Figure 2). Despite surgery, transfusion and the us e of a renal protective fluid administration strategy, tenoxicam dispositio n was not greatly different from that widely described for healthy voluntee rs. There were no significant side-effects and no adverse events attributab le to tenoxicam. In this small study we have shown that tenoxicam administe red preoperatively reduced the epidural analgesic requirements during the f irst 48 hours following major gynaecological surgery. There was no clinical or pathological evidence of haematological impairment following a single I V administration of tenoxicam 20 mg.