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October 22, 2008
8:00 AM - 9:30 AM
Room Room 225A
Could Lornoxicam Prevent Fentanyl-Induced Increase in Postoperative Morphine Requirement?
Xuerong Yu, M.D., Yuguang Huang, M.D., Xia Ju, M.D., Hailan Wang, M.D.
Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
Background Opioids are widely used in the postoperative period owing to their profound analgesic effect. However, some recent experimental and clinical data point to the development of two phenomena following acute exposure to opioids: acute opioid tolerance and hyperalgesia. The occurrence of these effects might lead to an increase in opioid requirement in the postoperative period. NSAIDs is believed to prevent opioid induced hyperalgesia and/or acute opioid tolerance which could cause an increase in postoperative opioid requirement. In this randomized, double-blinded, placebo-controlled study, we investigated if co-administration of lornoxicam and fentanyl could prevent the increase of postoperative morphine requirement induced by fentanyl. Methods We conducted a randomized, placebo-controlled, doubled-blinded study to evaluate the effect of intravenous (i.v.) lornoxicam intraoperatively on postoperative pain and cumulative morphine consumption for 48h after transabdominal hysterectomy or myomectomy. 60 patients were randomly devided into 4 groups: group C received normal saline intraoperatively, group F received 3 boluses of fentanyl at 15-min intervals intraoperatively (totally 3μg/kg), group L received lornoxicam 8 mg 5 min before the skin incision, group FL received lornoxicam 8 mg 5 min before the skin incision and then 3 boluses of fentanyl at 15-min intervals intraoperatively (totally 3μg/kg). Anaesthesia was standardized with spinal anaesthesia. Morphine was administered via a patient controlled analgesia(PCA) device after the operations. Cumulative postoperative morphine consumption, pain scores and adverse effects were recorded. All statistical analyses were performed using SPSS 11.0. Variables were presented as mean±SD and were evaluated with a non-parametric analysis of variance (ANOVA). Patient characteristic data and the rates of adverse effects were compared by using a χ2-test. A significance level of 0.05 was used. Results Patient characteristics data and duration of surgery were similar in the groups. Cumulative morphine consumption in group F was significantly more than that in group C at 3, 6, 12 h postoperatively (p<0.05). The postoperative cumulative morphine consumption was similar in group C, L and FL.[table1]No differences in postoperative pain score and side effects were observed among the groups. Conclusions These data suggested that intraoperative fentanyl was associated with the increase of postoperative morphine consumption. And this effect could be prevented by administrating lornoxicam before fentanyl.

Anesthesiology 2008; 109 A1623
Table 1. Postoperative cumulative morphine consumption
Group (n=10)1h (mg)3h (mg)6h (mg)12h (mg)24h (mg)48h (mg)
*Compared with group C, p<0.05