Postoperative Analgesic Effects of Intravenous Lorno
xicam and Morphine with Pre-emtive Ropivacaine Skin
Infiltration and Pre peritoneal Instillation after Transabdo
minal Hysterectomy
SHUSEE VISALYAPUTRA, M.D.*, VIMOLLUCK SANANSILP, M.D.*,
NUCHSAROACH PECHPAISIT, M.D.*, ROUNGSIN CHOAV ARART ANA, M.D.**,
SURAJIT SRITISARN, M.D.*, WANNA UNGPINITPONG, M.D.*'
LADDA PERMPOLPRASERT, B.Sc.*, PARICHARD APIDECHAKUL, B.Sc.*
Affiliation : * Department of anesthesiology,
** Department of obstetric and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700,
Thailand.
AbstractTo investigate the effectiveness of intravenous lomoxicam and morphine with the preemptive
effects of ropivacaine local skin infiltration and peritoneal instillation in reducing postoperative pain
after transabdominal hysterectomy, a randomized, double blinded, placebo-controlled study was done
in 88 patients undergoing transabdominal hysterectomy under general anesthesia. The patients were
allocated into 4 groups to receive: (group A) only intravenous morphine 10 mg; (group B) intra
venous morphine 10 mg and lomoxicam 16 mg; (group C) intravenous morphine 10 mg, lomoxicam
16 mg with 0.5 per cent ropivacaine local skin infiltration before skin incision and 1 per cent ropi
vacaine instillation before peritoneal incision; (group D) intravenous morphine 10 mg, lomoxicam
16 mg with 1 per cent ropivacaine instillation after peritoneal closure and 0.5 per cent ropivacaine
local skin infiltration before skin closure. Pain was assessed by patients using visual analog scales
(VAS) at 2, 6, 12, 18, 24, 48 hours after surgery. Time to first analgesic requirement and morphine
requirement during the first 6 h were significantly lower in the groups using lomoxicam (group B,
C, D) as compared with the group using only morphine (group A). However there was no signifi
cant difference between group B and group C or group D which means that the additional analgesic
effects of using local anesthetic infiltration and instillation either before (pre-emptive) or after the
incision could not be seen in this study. Implication: Intravenous 16 mg of lomoxicam with 10 mg of
morphine significantly reduced postoperative pain during the first 6 h after abdominal hysterectomy.
Additional effects of using local anesthetic wound infiltration to the use of lomoxicam could not be
demonstrated.
Keywords : NSAIDs, Lomoxicam, Local Infiltration, Local Anesthetics, Ropivacaine, Hysterectomy
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