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Payen D., Faivre V., Lukaszewicz A. C., Villa F., Goldberg P.
Department of Anesthesiology, Fatih University, Istanbul, Turkey
Aim. Low back pain after lumbar epidural anesthesia remains an important clinical problem. Possible causes of the back pain associated with epidural anaesthesia are localized trauma, aseptic periosteitis, tendonitis, inflammation of the ligaments, and osteochondritis. Lornoxicam is a new nonsteroidal anti-inflammatory drug (NSAID) that has been shown to be effective and well tolerated in the treatment of postoperative pain. The use of locally administered lornoxicam for the relief of low back pain following lumbar epidural anesthesia has not yet been studied. Thus, the aim of the present study was to investigate the efficacy of lornoxicam in the management of pain after lumbar epidural anesthesia.
Methods. A total of 60 patients were randomized to receive either treatment with lornoxicam or to receive a control treatment. The Lornoxicam group received 12 ml of 0.5% epidural bupivacaine and 4 ml 1% lidocaine, along with 2 mg lornoxicam for local infiltration. The control group received 12 ml of 0.5% epidural and 4 mL 1% lidocaine alone for local infiltration. Following the initial preoperative evaluation, a blinded investigator assessed pain intensity at 24, 48 and 72 hours postoperatively using a Verbal Rating Scale (VRS).
Results. The overall frequency of low back pain after epidural anesthesia was significantly higher in control-group patients compared to Lornoxicam-group patients during the 3 days studied (26.6% and 6.6%, respectively, P<0.05).
Conclusions. Our study demonstrated that local administration of Lornoxicam before epidural anesthesia for pilonidal sinus surgery decreased the frequency and severity of low back pain following lumbar epidural anesthesia with lidocaine. In conclusion, local administration of lornoxicam during epidural anesthesia may present a useful option for the relief of post-epidural low back pain. (Minerva Anestesiol 2009;75:494-7)