Postoperative analgesia is not different after local vs systemic administration of meloxicam in patients undergoing inguinal hernia repair

Purpose: To distinguish between local and systemic drug effects, we compare d pain scores, analgesic consumption and plasma concentrations after local vs iv administration of meloxicam 7.5 mg in patients with inguinal hernia r epair. Methods: In a double-blind, randomized study 56 patients received either lo cal or iv meloxicam 7.5 mg. Postoperative pain was assessed with a visual a nalogue scale (VAS) at rest, on mobilization, and on coughing, the need for supplementary analgesics (fentanyl iv and/or acetaminophen-codeine tablets ) was recorded, and blood samples were drawn during 24 hr after meloxicam a dministration. Results: No significant differences were found between groups with respect to pain scores, or in the consumption of supplementary analgesics. Followin g local application of meloxicam, the peak plasma concentration (C-max) of 0.5 +/- 0.2 mg.L-1 achieved after 1.8 +/- 0.5 hr was much lower than the C- max of 2.5 +/- 0.9 mg.L-1 achieved immediately after iv administration (P < 0.05). Mean meloxicam plasma concentration after infiltration was signific antly lower than after iv doses for the first three hours after administrat ion (P < 0.05). Conclusion: We showed no differences in pain scores and analgesic consumpti on between local and iv administration of meloxicam 7.5 mg during the first 24 hr after herniorrhaphy, while plasma concentration of meloxicam was low er after local administration. These results indicate a lack of difference in pain relief after concentrating meloxicam at the hernia wound or after a chieving high blood levels rapidly (v). Local administration of meloxicam m ay confer an advantage over systemic administration by eliciting lower inci dences of systemic adverse effects.