Postoperative Analgesic Effects of Intravenous Lornoxicam and Morphine with Pre-emtive Ropivacaine Skin Infiltration and Preperitoneal Instillation after Transabdominal Hysterectomy

VIMOLLUCK SANANSILP, M.D.*, ROUNGSIN CHOA V ARART ANA, M.D.**, WANNA UNGPINITPONG, M.D.*' PARICHARD APIDECHAKUL, B.Sc.* To investigate the effectiveness of intravenous lomoxicam and morphine with the preemptive effects of ropivacaine local skin infiltration and peritoneal instillation in reducing postoperative pain after transabdominal hysterectomy, a randomized, double blinded, placebo-controlled study was done in 88 patients undergoing transabdominal hysterectomy under general anesthesia. The patients were allocated into 4 groups to receive: (group A) only intravenous morphine 10 mg; (group B) intra- venous morphine 10 mg and lomoxicam 16 mg; (group C) intravenous morphine 10 mg, lomoxicam 16 mg with 0.5 per cent ropivacaine local skin infiltration before skin incision and 1 per cent ropi- vacaine instillation before peritoneal incision; (group D) intravenous morphine 10 mg, lomoxicam 16 mg with 1 per cent ropivacaine instillation after peritoneal closure and 0.5 per cent ropivacaine local skin infiltration before skin closure. Pain was assessed by patients using visual analog scales (VAS) at 2, 6, 12, 18, 24, 48 hours after surgery. Time to first analgesic requirement and morphine requirement during the first 6 h were significantly lower in the groups using lomoxicam (group B, C, D) as compared with the group using only morphine (group A). However there was no signifi- cant difference between group B and group C or group D which means that the additional analgesic effects of using local anesthetic infiltration and instillation either before (pre-emptive) or after the incision could not be seen in this study. Implication: Intravenous 16 mg of lomoxicam with 10 mg of morphine significantly reduced postoperative pain during the first 6 h after abdominal hysterectomy. Additional effects of using local anesthetic wound infiltration to the use of lomoxicam could not be demonstrated. Key word : NSAIDs, Lomoxicam, Local Infiltration, Local Anesthetics, Ropivacaine, Hysterectomy