Analgesic effects of lornoxicam after total abdominal hysterectomy


  • Ozgur Sapolya, MD
  • Beyhan Karamanlhoglu, MD
  • Dilek Memis, MD



analgesics opioid, tramadol, lornoxicam, postoperative pain, hysterectomy


The authors investigated, in a randomized, placebocontrolled, double-blinded study, the efficacy and safety of lornoxicam on pain after abdominal hysterectomy and on tramadol consumption in patients. Fifty patients were randomized to receive either oral placebo or lornoxicam 8 mg one hour before surgery. Anesthesia was induced with propofol and maintained with sevoflurane in 50 percent N2O/O2 with a fresh gas flow of 2 L/min (50percent N2O in O) and fentanyl (2 fig/kg). All patients received patient-controlled analgesia with tramadol with loading dose of 50 mg; incremental dose of 20 mg; lock out interval of 10 minute; and four-hour limit 300 mg. The incremental dose was increased to 30 mg if analgesia was inadequate after one hour. Patients were studied at one, two, four, eight, 12, and 24 hours for visual analogue (VAS) pain scores, heart rate, mean arterial pressure, periferic oxygen saturation, sedation, tramadol consumption, and length of hospitalization. VAS scores at one hour were significantly lower in the lornoxicam group (p < 0.001). The tramadol consumption at one, two, four, eight, and 12 hours was significantly lower in the lornoxicam group when compared with the placebo group (p < 0.001, p = 0.008, p = 0.029, p = 0.034, p = 0.042, respectively). Sedation scores were similar at all the measured times in the groups. Length of hospitalization was significantly shorter in lornoxicam group (4.8 ± 0.4 day) than placebo group (5.2 ± 0.5 day) (p = 0.005). There was difference in the incidence of nausea between the groups (p = 0.047). The number of patients and the doses ofantiemetics given during the first 24 hours after surgery in lornoxicam group were less than those in placebo group (p = 0.003, p = 0.034, respectively).
In conclusion, a single oral dose of lornoxicam given preoperatively enhanced the analgesic effect of tramadol, decreasing tramadol consumption and side effects, and shortened the length of hospitalization.

Author Biographies

Ozgur Sapolya, MD

Assistant Director, Department of Anaesthesiology, Trakya University Medical Faculty, Edirne, Turkey.

Beyhan Karamanlhoglu, MD

Professor, Department of Anaesthesiology, Trakya University Medical Faculty, Edirne, Turkey.

Dilek Memis, MD

Associate Professor, Department of Anaesthesiology, Trakya University Medical Faculty, Edirne, Turkey.


Dickenson A: Neurophysiology of opioid poorly responsive pain. Cancer Surv. 1994; 21: 5-16.

Fishman S, Borsook D: Opioids in pain management. In Benzon H, Raja S, Molloy RE, Strichartz G (eds.): Essentials of Pain Medicine and Regional Anesthesia. New York: Churchill Livingstone, 1999: 51-54.

Hitzenberger G, Radhofer-Welte S, Takacs F, et al.: Pharmacokinetics of lornoxicam in man. Postgrad Med J. 1990; 66 (Suppl 4): S22-S27.

Olkkola KT, Brunetto AV, Mattila MJ: Pharmacokinetics of oxicam nonsteroidal anti-inflammatory agents. Clin Pharmacokinet. 1994; 26: 107-120.

Norholt SE, Sindet-Pedersen S, Larsen U, et al.: Pain control after dental surgery: A double-blind, randomised trial of lornoxicam versus morphine. Pain. 1996; 67: 335-343.

Radhofer-Welte S, Rabasseda X: Lornoxicam, a new potent NSAID with an improved tolerability profile. Drugs Today (Barc). 2000, 36: 55-76.

Ramsay MA, Savege TM, Simpson BR, et al.: Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974; 2: 656-659.

Schnitzer T: The new analgesic combination tramadol/acetaminophen. Eur J Anaesthsiol. 2003; 20 (Suppl 28): 13-18.

McCormack K: The spinal actions of nonsteroidal anti-inflammatory drugs and the dissociation between their anti-inflammatory and analgesic effects. Drugs. 1994; 47 (Suppl 5): 28-47.

McCormack K: Non-steroidal anti-inflammatory drugs and spinal nociceptive processing. Pain. 1994; 59: 9-43.

Trampitsch E, Pipam W, Moertl M, et al.: Preemptive randomized, double-blind study with lornoxicam in gynecological surgery. Schmerz. 2003; 17: 4-10.

Ilias W, Jansen M: Pain control after hysterectomy: An observer-blind, randomised trial of lornoxicam versus tramadol. Br J Clin Pract. 1996; 50: 197-202.

Karaman S, Gunusen I, Uyar M, et al.: The effect of preoperative lornoxicam and ketoprofen application on the morphine consumption of post-operative patient-controlled analgesia. J Int Med Res. 2006; 34: 168-175.

Mitchell RWD, Smith G: The control of acute postoperative pain. Br J Anaesth. 1989; 63: 147-158.

Fosnocht DE, Chapman CR, Swanson ER, et al.: Correlation of change in visual analog scale with pain relief in the ED. Am J Emerg Med. 2005; 23: 55-59.




How to Cite

Sapolya, MD, O., B. Karamanlhoglu, MD, and D. Memis, MD. “Analgesic Effects of Lornoxicam After Total Abdominal Hysterectomy”. Journal of Opioid Management, vol. 3, no. 3, May 2007, pp. 155-9, doi:10.5055/jom.2007.0053.