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Effect on Pain Relief and Inflammatory Response Following Addition of Tenoxicam to Intravenous Patient-Controlled Morphine Analgesia: A Double-Blind, Randomized, Controlled Study in Patients Undergoing Spine Fusion Surgery

Authors

  • Wen-Kuei Chang MD,

    1. Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Hsin-Lun Wu MD,

    1. Department of Anesthesiology, Hsin-Chu Mackay Memorial Hospital, Hsin-Chu City, Taiwan
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  • Chang-Sue Yang MD, MHA,

    1. Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
    3. Department of Ophthalmology, Taipei Medical University, Taipei, Taiwan
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  • Kuang-Yi Chang MD, PhD,

    1. Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Chien-Lin Liu MD,

    1. Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Kwok-Hon Chan MD,

    1. Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Chun-Sung Sung MD, PhD

    Corresponding author
    1. School of Medicine, National Yang-Ming University, Taipei, Taiwan
    • Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Disclosure: This study was supported by the Anesthesiology Research and Development Foundation (grant ARDF9701), Taiwan, Republic of China. The authors report no conflicts of interest.

Reprint requests to: Chun-Sung Sung, MD, PhD, Department of Anesthesiology, Taipei Veterans General Hospital, no. 201, Sec. 2, Shihpai Road, Beitou, Taipei 11217, Taiwan. Tel: +886-2-28757549; Fax: +886-2-28751597; E-mail: cssung@vghtpe.gov.tw.

Abstract

Objective

This study tested the hypothesis that adding tenoxicam (T) to intravenous patient-controlled analgesia (IV-PCA) with morphine (M) would improve postoperative pain relief and wound inflammatory responses compared with M alone after spine surgery.

Design

Randomized, prospective, double-blind, controlled study.

Subjects

Ninety-four patients eligible for elective spine surgery.

Setting

Teaching hospital.

Methods

Patients were randomized to one of three groups: the M group (PCA regimen with M), the TM group (PCA regimen with T and M), or the T+TM group (20 mg T administered 30 minutes before wound closure in addition to the TM regimen). The primary end point was the numeric rating scale score for pain intensity, and secondary end points pertaining to postoperative pain management included M consumption, PCA demand/delivery, use of rescue analgesics, adverse events, and levels of inflammatory mediators in wound drainages.

Results

PCA demand was reduced in both the TM and T+TM groups compared with the M group (both P ≤ 0.001). The incidence of skin itching was significantly reduced in the T+TM group compared with the other groups (both P ≤ 0.05). PGE2 and interleukin-6 levels in wound drainages were reduced in the TM and T+TM groups compared with the M group (both P ≤ 0.001).

Conclusions

The combination of T and M for IV-PCA was not more efficacious than IV-PCA with M alone in reducing postoperative pain after spine surgery but reduced PCA demand and suppressed local inflammation at the surgical site. Administration of T before wound closure may ameliorate IV-PCA M-induced skin itching.

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