Sandeep Kumar Kar, Deepanwita Das and Amit Kumar Mondal
Background: Septoplasty operation is a commonly performed procedure, usually done on short stay basis. Postoperative pain and bleeding are two major concerns that influence delayed discharge or readmission. Lornoxicam, nonselective anti-inflammatory drugs belongs to oxicam group with balanced cycloxygenase inhibitor and is well tolerated by the patients. It is theoretically potential to reduce postoperative pain and perioperative bleeding. The role of preemptive analgesia in prevention of postoperative pain is controversial. Lornoxicam has proven role in the management of postoperative pain. However, comprehensive evidence is lacking regarding its preemptive use for postoperative pain relief.
Materials and Methods: After getting ethical committee approval and written informed consents from 88 adult patients of either sex, ASA physical status I and II scheduled for septoplasty under local anaesthesia and monitored anaesthesia care, were allocated in this prospective randomised double blinded placebo controlled study to receive either intravenous single dose lornoxicam 16 mg diluted into 100 ml normal saline (Group A) or Normal Saline (Group B) over 10 minutes 30 min before surgical incision. Dexmedetomedine was infused 1 microgram/kg over 10 min as initial loading dose and 0.2-0.7 microgram/kg/hr as maintainance of anaesthesia. Severity of postoperative pain was assessed with Visual Analogue Scale (VAS) Score 0-100 mm at immediate postoperative period, 30 min and every 1 hr till 4 hrs postoperatively and then 4 hrly upto 12 hrs and 6 hrly till 24 hrs. Oral paracetamol 1 gm was used as rescue analgesic on demand. Patients’ refractory to paracetamol treated with 10 microgram iv fentanyl increments. Patients were followed up for satisfaction and complications till 24 hrs.
Results: Patients of group A reported significantly lower pain score (p<0.05) and significantly less in patients of group A as compared to group B required rescue analgesia within first 6 hrs postoperatively. Time to first rescue analgesic request was also significantly prolonged in group A.
Conclusion: Preemptive single dose lornoxicam appears to be effective in management of acute postoperative pain following septoplasty.
