[Comparative evaluation of preventive analgesia with xefocam, ropivacaine, and transdermal drug delivery system of durogesic in patients after craniotomy]

The goal of this study was to comparatively evaluate the efficacy of pre-emptive analgesia in patients after supra- and infratentorial craniotomy. Three hundred and sixty-two postcraniotomy patients aged 16 to 72 years were recruited in the study. The patients were divided into 5 groups. The first two groups received traditional analgesia on demand with metamizole sodium and ketoprofen (Group 1) or xefocam (Group 2). Groups 3-5 had different preemptive analgesia modes. Scheduled dosing of xefocam (8 mg i.v. 30 min prior to surgery and then 8 mg every 8 hours within 48 hours) was used in Group 3. Group 4 underwent scalp nerve block and skin infiltration with ropivacaine. Group 5 had a scheduled dosing of fentanyl (12-18 hours before surgery, Durogesic was applied to the patient's skin in a dose 25 microg per hour for 3 days). Postoperative pain was assessed using the visual analogue scale (VAS) at 6, 18, 30, 42, and 54 hours after surgery. The patients who received pre-emptive analgesia showed significantly lower VAS scores than those who had traditional analgesia (p < 0.05).

[Analysis of the effects of different medicines on hypercoagulability state variations of femoral shaft fracture and after its operation]

OBJECTIVE

To explore the role of Tong Mai Tang & Lornoxicam on the serum concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin (IL-6) , D-dipolymer( D-Di), Platelet count (PLC) in treatment of femoral shaft fracture among period surgery time.

METHODS

We selected 120 cases of traumatic femoral shaft fracture patients according to the inclusion criteria and exclusion criteria, which were randomized dividend into four groups (I, II, III, IV respectively) of the same size based on the random number table method of 30 patients each. Therapeutic methods of four groups following as: Group I, Tpanax Notoginseng Pills PO; Group II, Tpanax Notoginseng Pills PO, Lornoxicam For Injection, 8 mg IM; Group III, Tpanax Notoginseng Pills PO, Tong Mai Decoctions 200 mL PO; Group IV, Tpanax Notoginseng Pills PO, Lornoxicam For Injection 8 mg IM, Tong Mai Decoctions 200 mL PO. The above medications were administered to the four groups after admission to hospital the next day. Peripheral blood samples were taken for immune determination of pro-inflammatory cytokines of TNF-alpha, IL-6, D-Di, PLC in blood serum on the 2nd and 6th day before operation and on the 8th and 13th day after operation in the morning. And all patients received liver and kidney function examination 2nd and 13th day after admission. Analysis of variance and least significant difference-test were done with the help of SPSS 17.0 statistic software.

RESULTS

The difference among four groups in TNF-alpha and IL-6 were significant (P < 0.05). And there were also significant statistic difference between group II/III/IV and group I group (P < 0.05). But the difference between group II and group III was insignificant (P > 0.05). However, the group contrast result between group IV and group II/III had statistics difference (P < 0.05). The difference in D-Di PLC at 6th day and 8th day were significant (P < 0.05). The group comparisons in group I/II/IV were also significant. There were non-statistics significance in group II compared 6th day/8th day with 2nd day (P > 0.05). The comparison between the 13th day with the first three time sections had statistics significance. And there were statistics significance at the 13th day between group IV and group II (P < 0.05).

CONCLUSION

The serum concentrations of TNF-alpha, IL-6, D-Di and PLC level were significantly increased in peroperative period, These results seem to indicate that the Tong Mai Decoctions & Lornoxicam may play an important role in inhibiting the release of TNF-alpha, IL-6, D-Di and PLC into the blood stream and decreasing the incunabula complication at early traumatic stage. The Tong Mai Decoctions & Lornoxicam was the worth promoting screened China and the West union medication combination.

Comparison the analgesic effects of single dose administration of tramadol or piroxicam on postoperative pain after cesarean delivery

A multimodal approach to postcesarean pain management may enhance analgesia and reduce side effects after surgery. We investigated postoperative pain in a double-blinded, randomized, single-dose comparison of the monoaminergic and mu-opioid agonist tramadol, 100 mg (Group T) and piroxicam 20 mg (Group P) given IM alone--single dose in 150 patients who had elective cesarean delivery. All patients were assessed at 0, 6, 12 and 24 hours post operation for pain degree (by Visual Analogue Score: VAS 1-10), nausea and vomiting. Pain degree was classified as: Painless: 0, Mild: 1-4, Moderate: 5-8, Severe: 9-10. There was no significant difference between the efficacy of tramadol and piroxicam injections (P > 0.05). Pain intensity decreased markedly over time in both groups. Mean +/- SEM pain degrees were as follows: P = 7.7 +/- 0.5, T = 8.2 +/- 0.8 after 0 hours; P=5.4 +/- 0.6, T = 6.1 +/- 0.5 after 6 hours; P=3.3 +/- 0.4, T = 3.4 +/- 0.7 after 12 hours; P = 1.1 +/- 0.4, T = 1.3 +/- 0.5 after 24 hours of surgery. Side effects were similarly minimal with all treatments. It might be concluded that i.m. injections of 20 mg piroxicam (single dose therapy) could relieve postoperative pain after cesarean section as well as tramadol and it could reduce opioid analgesic requirements with less adverse side effects during the first postoperative 24 h.

Tolerance induced by non-opioid analgesic microinjections into rat's periaqueductal gray and nucleus raphe

Several lines of investigations have shown that the microinjection of non-opioid analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) in the midbrain periaqueductal gray matter (PAG) induces antinociception with some effects of tolerance. Our recent findings also have shown the same effects of tolerance in intraperitoneal (i.p.) injections of analgin (metamizol), ketorolac, and xefocam. Moreover, just recently, we have shown that microinjection of three NSAIDs analgin, ketorolac and xefocam into the central nucleus of amygdala produces tolerance to these drugs and cross-tolerance to morphine. The present study was designed to examine whether together with analgin, microinjection of another type of NSAIDs clodifen, ketorolac and xefocam into the PAG and the nucleus raphe magnus (NRM) leads to the development of tolerance in male rats. The experiments were carried out on experimental and control (with saline) white male rats by the models of tail-flick (TF, to the stimulation of focusing light beam) and hot plate (HP, paw withdrawal) tests. For microinjections of NSAIDs stainless steel guide cannula was implanted into the PAG and NRM by the stereotaxic atlas. Latency increase of these reflexes indicated the degree of antinociception. Analysis of variance with post-hoc Dunnet Multiple Comparison Test were used for statistical evaluations. Our study showed that microinjection of NSAIDs into the PAG produced antinociception as revealed by a latency increase in TF and HP compared to the baseline control with saline microinjected into the same nucleus. However, when these drugs microinjection subsequent testing also took place in the following days the antinociceptive effects progressively diminished so that on the 4th and especially the 5th experimental days the TF and HP latencies were similar to the averaged control baseline for rats that received repeated (5 days) injections of only saline. On the 5th day, one hour after of NSAIDs testing, experimental groups of rats received i.p. injections of mu-opioid antagonist naloxone and we did not reveal significant alterations in TP and HP latencies in non-opioid tolerant rats as well as in control animals. Microinjections of NSAIDs into the NRM also produced antinociception as revealed by a latency increase in TF and HP compared to the baseline control of as in intact rats so with saline microinjected ones into the same nucleus. Subsequent NSAIDs microinjections caused progressively less antinociception, so by day 4 there was no effect, similar to saline microinjections (baseline control) for both the TF and the HP tests, except analgin. The later did not show complete tolerance even on the 5th experimental day. Special control experiments showed that post-treatment with naloxone in RVM diminished NSAID-induced antinociception on the first and second experimental days and impeded the development of tolerance to the antinociceptive effect of NSAIDs. Obtained results underscore the strong convergence of antinociceptive mechanisms of opioids and non-opioids, particularly NSAIDs in the PAG-RVM downstream circuit in the acute effect of and the development of tolerance to both types of analgesics. On the other hand, our data confirm the results of other authors that NSAIDs are in close relation with endogenous opioids and the tolerance to these non-opioid drugs probably depends on opioid tolerance.

Topical treatment of actinic keratoses with piroxicam 1% gel: a preliminary open-label study utilizing a new clinical score

BACKGROUND

The cyclo-oxygenase enzymes 1 and 2 (COX-1 and COX-2) are both involved in skin tumorigenesis, causing inhibition of apoptosis, angiogenesis, invasiveness, recruitment of growth factors, immunosuppression, and production of carcinogens. Piroxicam is a nonselective nonsteroidal anti-inflammatory drug that blocks the activity of COX-1 and COX-2.

OBJECTIVE

To evaluate the efficacy and tolerability of piroxicam 1% gel in the treatment of actinic keratoses.

METHODS

Piroxicam 1% gel was applied twice daily for 12 weeks to 31 actinic keratoses. The lesions were evaluated clinically and by means of dermoscopy at an initial baseline visit, at intermediate visits, and after 90 days. Changes were evaluated using a new scoring system (AKESA), based on the clinical presence of erythema, scale, and atrophy on a target lesion. In our experience, the use of piroxicam 1% gel for 90 days induced complete regression in 48% of evaluated actinic keratoses, corresponding to keratotic and verrucous clinical variants. In these lesions, the AKESA score was markedly reduced after treatment. Adverse effects were pruritus, mild erythema, dry skin, and, rarely, rash. Our preliminary trial shows that piroxicam exerts anti-tumorigenic effects and may play a useful role in the chemoprevention of skin cancers.

[Effect of lornoxicam on inflammatory markers in patients with non-ST-segment elevation acute coronary syndrome]

AIM

To evaluate the clinical efficacy, safety, and effects of the nonsteroidal anti-inflammatory drug lornoxicam on inflammatory markers in non-ST-segment elevation acute coronary syndrome (NSTEACS).

SUBJECTS AND METHODS

Eighty-five patients with NSTESCS were enrolled in a prospective randomized study. They were divided into 2 groups: 1) patients received lornoxicam (8 or 12 mg/daily) for 15 days in addition to standard treatment and 2) controls. Cardiovascular outcomes and the levels of C-reactive protein (CRP), IL-6, and IL-10 were determined.

RESULTS

The lornoxicam group exhibited a significant reduction in CRP and a decrease in IL-6. There was also a significant increase in IL-10 levels in this group. A 6-month follow-up indicated a significant reduction in the number of cardiovascular events (nonfatal myocardial infarction, unstable angina, coronary death).

CONCLUSION

Lornoxicam reduces the risk of poor cardiovascular outcomes in patients with NSTEACS and the levels of inflammatory markers.

[Efficacy and tolerability of short courses of nonsteroid anti-inflammatory drugs in the treatment of dorsalgia: results of the comparative study]

Efficacy of different nonsteroid anti-inflammatory drugs (voltaren (diclofenac), movalis (meloxicam), nimesil (nimesulide) and xefocam (lornoxicam) in stopping the pain syndrome and normalization of motor activity was assessed in 140 patients with dorsalgia using the Visual Analogous Scale and the modified Waddel scale. Moreover, we suggest a method for calculating a treatment efficacy coefficient. The most effective drug in the treatment of back pain was xefocam (lornoxicam). Nimesil (nimesulide) was somewhat less effective. Other drugs did not reveal any significant effect. Xefocam was well-tolerated: adverse effects were rare compared to other drugs used in the study.

[Corrective effect of cyclooxygenase inhibitor on functional status of mononuclear cells expressing Toll-like receptors]

AIM

To study the influence of the COX inhibitor--lornoxicam (LX)--on Toll-like receptor (TLR)-mediated production of proinflammatory and anti-inflammatory cytokines by peripheral blood mononuclear cells (PBMC) from healthy subjects and patients with acute pancreatitis (AP) in vitro.

MATERIALS AND METHODS

Cytokine production by PBMC of healthy donors was stimulated by TLR1/2 ligand peptidoglycan (PG) and TLR4 ligand lypopolysaccharide (LPS) in presence of LX. Levels of cyotokines (IL-1beta, IL-6, IL-8, IL-10, IL-12, and TNFalpha) were measured by ELISA. Group of patients with acute pancreatitis of toxic etiology included 11 subjects: patients from main group received combined therapy supplemented with NSAID from the oxicam class--LX; patients who received only standard basic treatment formed comparison group.

RESULTS

It was found that in vitro LX inhibits production of both proinflammatory and anti-inflammatory cytokines by PBMC of healthy subjects mediated by ligands of TLR1/2 and TLR4. Maximal inhibitory effect of LX was observed when cytokine production was induced through TLR1/2. Patients with AP demonstrated increased production of TNFalpha induced by TLR1/2 and TLR4 ligands.

CONCLUSION

LX inhibits TLR-mediated production of both proinflammatory (IL-1, IL-6, IL-8, IL-12, TNFalpha) and anti-inflammatory (IL-10) cytokinesby PBMC of healthy subjects in vitro. Treatment with LX in patients with AP results in diminished effector function of TLR1/2 and TLR4 already during 1st day of the illness and normalization of these indices by 6th day.

Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

CONTEXT AND OBJECTIVE

Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery.

DESIGN AND SETTING

A randomized double-blind study was performed in Hospital São Paulo.

METHODS

During the postoperative period, in the presence of pain, 29 patients were divided into two groups: group 1 (n = 14) received 100 microg of fentanyl epidurally and 2 ml of saline intravenously; group 2 (n = 15) received 5 ml of saline epidurally and 100 microg of fentanyl intravenously. The analgesic supplementation consisted of 40 mg of tenoxicam intravenously and, if necessary, 5 ml of 0.25% bupivacaine epidurally. Pain intensity was evaluated on a numerical scale and plasma concentrations of fentanyl were measured simultaneously.

RESULTS

The percentage of patients who required supplementary analgesia with tenoxicam was lower in group 1 (71.4%) than in group 2 (100%): 95% confidence interval (CI) = 0.001-0.4360 (P = 0.001, Fisher's exact test; relative risk, RR = 0.07). Epidural bupivacaine supplementation was also lower in group 1 (14.3%) than in group 2 (53.3%): 95% CI = 0.06-1.05 (P = 0.03, Fisher's exact test; RR = 0.26). There was no difference in pain intensity on the numerical scale. Mean fentanyl plasma concentrations were similar in the two groups.

CONCLUSION

Intravenous and epidural fentanyl appear to have similar efficacy for reducing pain according to the numerical scale, but supplementary analgesia was needed less frequently when epidural fentanyl was used.

CLINICAL TRIAL REGISTRATION NUMBER

NCT00635986.

Microemulsion system with improved loading of piroxicam: a study of microstructure

Formulation of a new oil-in-water (o/w) microemulsion composed of castor oil/Tween 80/ethanol/phosphate buffer for enhancing the loading capacity of an anti-inflammatory drug piroxicam has been accomplished. The pseudo-ternary phase diagram has been delineated at constant surfactant/cosurfactant ratio (1:2). The internal structure of so created four-component system was elucidated by means of an analysis of isotropic area magnitudes in the phase diagram. Conductivity (sigma), kinematic viscosity (keta), and surface tension (gamma) studies with the variation in Phiw (weight fraction of aqueous phase) show the occurrence of structural changes from water-in-oil (w/o) microemulsion to oil-in-water (o/w). Along with the solubility and partition studies of piroxicam in microemulsion components, the changes in the microstructure of the microemulsion after incorporation of drug have been evaluated using pH, sigma, gamma, keta, and density studies. Piroxicam, a poorly water-soluble drug displayed high solubility (1.0%) in an optimum microemulsion formulation using ethanol (55.0%), Tween 80 (26.5%), castor oil (7.5%), and phosphate buffer (11.0%). The results have shown that the microemulsion remained stable after the incorporation of piroxicam. Fluorescence spectra analysis taking pyrene as fluorescent probe was performed, and the results showed that pyrene was completely solubilized in the oil phases of the bicontinuous microemulsions. The fluorescence spectrum of the model drug piroxicam was used to probe the intramicellar region of nonionic microemulsion. The results showed that the piroxicam was localized in the interfacial film of microemulsion systems more deeply in the palisade layer with ethanol as the cosurfactant.

Single dose oral lornoxicam for acute postoperative pain in adults

BACKGROUND

Lornoxicam is one of the oxicam class of non-steroidal anti-inflammatory drugs (NSAIDs), producing analgesic and antipyretic effects in part through the non-selective inhibition of cyclo-oxygenase-1 and -2. It is prescribed for osteoarthritis, rheumatoid arthritis, acute lumbar-sciatica conditions and for postoperative pain management. Lornoxicam is available in 31 countries in Europe, the Middle East, Far East and South America, and is becoming more widely available.

OBJECTIVES

To assess the efficacy, the time to onset of analgesia, the time to use of rescue medication and any associated adverse events of single dose oral lornoxicam in acute postoperative pain.

SEARCH STRATEGY

We searched CENTRAL, MEDLINE, EMBASE and PubMed to June 2009.

SELECTION CRITERIA

Single oral dose, randomised, double-blind, placebo-controlled trials of lornoxicam for relief of established moderate to severe postoperative pain in adults.

DATA COLLECTION AND ANALYSIS

Studies were assessed for methodological quality and the data extracted by two review authors independently. Summed total pain relief over 6 hours (TOTPAR 6) was used to calculate the number of participants achieving at least 50% pain relief. These derived results were used to calculate, with 95% confidence intervals (CIs), the relative benefit compared to placebo, and the number needed to treat (NNT) for one participant to experience at least 50% pain relief over 6 hours. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals was collected.

MAIN RESULTS

Three studies, with 628 participants, met the inclusion criteria; 434 participants were treated with various doses (2 mg to 32 mg) of lornoxicam, 118 with placebo, and 76 with other active therapies. All the participants had pain following third molar extraction, and study duration was 8 to 24 hours. The NNT for at least 50% pain relief over 6 hours after a single dose of lornoxicam 8 mg was 2.9 (2.3 to 4.0). There were insufficient data to analyse other doses or use of rescue medication. No serious adverse events or withdrawals were reported by any of the studies.

AUTHORS' CONCLUSIONS

Oral lornoxicam is effective at treating moderate to severe acute postoperative pain, based on limited data. Adverse events did not differ significantly from placebo.

Effect of locally administered lornoxicam in the management of low back pain after lumbar epidural anesthesia: a double-blind, randomized, controlled study

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.

Single dose oral tenoxicam for acute postoperative pain in adults

BACKGROUND

Tenoxicam is a non-steroidal anti-inflammatory drug (NSAID) licensed for use in rheumatic disease and other musculoskeletal disorders in the UK, and is widely available in other countries worldwide. This review sought to evaluate the efficacy and safety of oral tenoxicam in acute postoperative pain, using clinical studies of patients with established pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties.

OBJECTIVES

To assess the efficacy of single dose oral tenoxicam in acute postoperative pain, and any associated adverse events.

SEARCH STRATEGY

We searched The Cochrane Library (Issue 1, 2009), MEDLINE (March 2009); EMBASE via Ovid (March 2009); the Oxford Pain Relief Database.

SELECTION CRITERIA

Randomised, double-blind, placebo-controlled clinical trials of oral tenoxicam for relief of acute postoperative pain in adults.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data. The area under the "pain relief versus time" curve was used to derive the proportion of participants with tenoxicam experiencing least 50% pain relief over 4 to 6 hours, using validated equations. The number needed to treat to benefit (NNT) was calculated using 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals was also collected.

MAIN RESULTS

Not one of sixteen studies identified by the searches and examined in detail studied oral tenoxicam in patients with established postoperative pain and therefore no results are available.

AUTHORS' CONCLUSIONS

In the absence of evidence of efficacy for oral tenoxicam in acute postoperative pain, its use in this indication is not justified at present. Because trials clearly demonstrating analgesic efficacy in the most basic of acute pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes which are effective, there is no urgent research agenda for this particular drug.

A clinical comparison of topical piroxicam and EMLA cream for pain relief and inflammation in laser hair removal

The aim of this study was to compare the efficacy of topical piroxicam and EMLA cream on pain control and subsequent inflammation in neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064 nm laser hair removal in female volunteers. Fifty female volunteers were enrolled in this prospective, randomized, double-blind, clinical study over a 6-month period. Patients were randomly assigned to receive topical piroxicam as group Piroxicam or EMLA cream as group EMLA. Topical analgesics were applied to the treatment sites for 60 min. The pain scores [on a visual analog scale (VAS)] and side effects were recorded before the hair removal, during the hair removal, at the end of the hair removal, and 1 h, 2 h and 24 h after the hair removal. Patients' characteristics and the treatment settings of the Nd:YAG 1,064 nm laser were similar in the two groups. The pain scores (VAS) were similar, and satisfaction was high in both groups after the hair removal. The number of blanching and erythema episodes were significantly higher in group E than in group P (P < 0.001). Inflammatory side effects were less frequent in group P than in group E after the procedure (P < 0.001). This study showed that topical piroxicam and EMLA provided adequate and similar pain relief after Nd:YAG 1,064 nm laser hair removal in female volunteers. Topical piroxicam was associated with fewer inflammatory side effects than was EMLA cream, because of its anti-inflammatory effect after the procedure.

[Comparison of analgesics using two devices for the patient-controlled analgesia]

INTRODUCTION

A pilot unicenter blind placebo-controlled study comparing different analgesics was conducted in parallel groups, by concurrently using two patient-controlled analgesia (PCA) apparatuses in one patient, was conducted Subjects and methods. The study included patients after laparotomy. Group I patients (n=22) were proposed 2 PCA apparati, one of which contained trimeperidine solution and the other did placebo. Group 2 patients (n=17) were proposed 2 PCA apparatuses, one of which contained trimeperidine solution and the other did lornoxycam. PCA was adjusted in the same manner in both apparati. The patients were asked to determine which analgesic is best in providing 24-hour analgesia.

RESULTS

There were no differences in the intensity of pain between the groups. The latter did not differ in the number of adverse reactions. Comparison showed no significant differences in the use of trimeperidine between Groups 1 and 2 patients. Among Group 1 patients, 61% considered trimeperidine as the best analgesic and 22% did placebo; 17% called none. Group 2 patients chose trimeperidine in 41% of cases and lornoxycam in 41%, none was called in 18%.

CONCLUSION

Comparative assessment of analgesics, by employing 2 PCA apparatuses in one patient, allows evaluation of the efficacy of analgesics added to the conventional methods.

[Effect of preemptive intrathecal lornoxicam on foot swelling of formalin test in rats]

OBJECTIVE

To investigate the anti-inflammatory effect of preemptive intrathecal Lornoxicam on foot swelling of formalin test in rats.

METHODS

Eighteen healthy male adult Sprague-Dawley (SD) rats (about 250 g) were randomized into 3 groups: intrathecal solvent group (group S, solvent 20 microL), intramuscular Lornoxicam group (group IM, Lornoxicam 300 microg/20 microL) and intrathecal Lornoxicam group (group IT, Lornoxicam 300 microg/20 microL). After measuring the basic volumes of the left hind paws, rats were injected with corresponding solution intrathecally or intramuscularly, and followed by an intra-plantar administration of 100 microL of 5% formalin 10 minutes later. The volumes of left hind paws were measured again at 10 min, 30 min, 1 h, 2 h, 3 h, 4 h, 24 h after formalin injection.

RESULTS

There was no statistical difference of weights or basic volumes among three groups. At 10 min after formalin injection, the left hind paw volume of group IT [(1.53 +/- 0.06) mL] were smaller than that of group S [(1.67 +/- 0.09) mL], P=0.039, but there was no statistically difference between group IT and group IM [(1.65 +/- 0.06) mL]. At 30 min after formalin injection, the left hind paw volume of group S [(1.88 +/- 0.88) mL] was larger than that of group IM [(1.77 +/- 0.05) mL, P<0.05] and group IT [(1.61 +/- 0.06) mL, P<0.01]. The feet swelling degree of group IT was less than that of group IM, P<0.05. At 1 h, 2 h and 3 h after formalin injection, the left hind paw volume of group S was similar to that of group IM, and the volume of group IT was smaller than the other two groups. At 4 h and 24 h after formalin injection, there were no statistic differences of the left hind paw volume among the three groups.

CONCLUSION

At 10 min to 3 h after formalin injection, swelling of rat feet induced by formalin was alleviated by preemptive intrathecal Lornoxicam.

Influence of surfactants of Rofam type on properties of piroxicam tablets

Possibilities of application of non-ionic surfactants of Rofam type as solubilizers for piroxicam poorly dissolved in water were assessed. Homologous series of Rofams containing oxyethylene segments from 3 to 18 were used in the study. Tablet formulation was made by wet granulation technique using these surfactants in order to improve drug dissolution properties. Influence of both quantity and type of Rofam on morphological parameters of granules and tablets was investigated. All the examined parameters met the pharmacopeal norms. Paddle method was used to evaluate piroxicam pharmaceutical availability. The presence of non-ionic surfactants in composition of tablet mass improved dissolution rate of piroxicam.

[Comparison of antalgic effects of patient-controlled intravenous lornoxicam and sufentanil in patients after oral maxillofacial surgery]

OBJECTIVE

To compare the analgesic efficiency and adverse effects of postoperative patient-controlled intravenous analgesia (PCIA) with lornoxicam and sufentanil in patients undergoing oral maxillofacial surgery.

METHODS

200 ASA (American Society of Anesthesiologists) I-II patients who undertook oral maxillofacial operation were divided into two groups: lornoxicam group (group L) and sufentanil group (group S), with 100 patients in each group. The effectiveness was assessed with visual analogue scale (VAS), Prince-Henry score (PHS) and Ramsay sedation Score (RSS) at different time points: 4, 8, 12, 24 and 48 h after the beginning of analgesia. The analgesic efficacy of analgesia and the adverse effects during analgesia period were observed.

RESULTS

Statistical analysis revealed no significant difference in VAS, PHS and RSS at 4, 8, 12, 24, 48 h and the overall satisfaction on analgesia therapy. The percentage of nausea, vomiting and dizziness was significantly lower in group L than that in group S (1% vs 9%, 0 vs 4%, 0 vs 3%, P<0.05).

CONCLUSION

Lornoxicam could provide an identical efficacy as sufentanil in the postoperative PCIA in patients undergoing oral maxillofacial surgery. In addition, lornoxicam caused less adverse effects.

Pharmacodynamics of Piroxicam from Self-Emulsifying Lipospheres Formulated with Homolipids Extracted fromCapra hircus

A self-emulsifying system is a mixture of oil and surfactant that forms oil-in-water emulsion when exposed to aqueous fluid. It enhances the in vitro dissolution and improves the in vivo absorption of lipophilic drugs that have poor aqueous solubility. In this study, a poorly water soluble drug, piroxicam, was incorporated into self-emulsifying lipospheres consisting of a mixture of a homolipid from Capra hircus and Tween 65. Various solid self-emulsifying lipospheres were formulated having different ratios of the homolipid and Tween 65 to contain piroxicam. The self-emulsifying lipospheres were evaluated using the following parameters: particle size, absolute drug content, and dissolution profile. The pharmacodynamics of the drug from the lipospheres were also evaluated using antinociceptive activity on albino mice. Based on our results the self-emulsifying lipospheres containing 4:11 ratio of the homolipid and Tween 65 had the best performance in terms of antiinflammatory effect, particle size, and dissolution. They possibly could be employed in the formulation of self-emulsifying lipospheres for various administration.

Piroxicam nanoparticles for ocular delivery: Physicochemical characterization and implementation in endotoxin-induced uveitis

To investigate the anti-inflammatory impacts of piroxicam nanosuspension, in the current investigation, piroxicam:Eudragit RS100 nanoformulations were used to control inflammatory symptoms in the rabbits with endotoxin-induced uveitis (EIU). The nanoparticles of piroxicam:Eudragit RS100 was formulated using the solvent evaporation/extraction technique. The morphological and physicochemical characteristics of nanoparticles were studied using particle size analysis, X-ray crystallography, differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM). Drug release profiles were examined by fitting the data to the most common kinetic models. Selected nanosuspensions were used to assess the anti-inflammatory impacts of piroxicam nanoparticles in the rabbits with EIU. The major symptoms of EIU (i.e. inflammation and leukocytes numbers in the aqueous humor) were examined. All the prepared piroxicam formulations using Eudragit RS100 resulted in a nano-range size particles and displayed spherical smooth morphology with positively charged surface, however, the formulated particles of drug alone using same methodology failed to manifest such characteristics. The Eudragit RS100 containing nanoparticles displayed lower crystallinity than piroxicam with no chemical interactions between the drug and polymer molecules. Kinetically, the release profiles of piroxicam from nanoparticles appeared to fit best with the Weibull model and diffusion was the superior phenomenon. The in vivo examinations revealed that the inflammation can be inhibited by the drug:polymer nanosuspension more significantly than the microsuspension of drug alone in the rabbits with EIU. Upon these findings, we propose that the piroxicam:Eudragit RS100 nanosuspensions may be considered as an improved ocular delivery system for locally inhibition of inflammation.

Piroxicam: restriction of indications: labelling change. Only half-measures

Piroxicam has too many cutaneous and gastrointestinal adverse effects and yet, it remains on the market.

[The effect of three different lornoxicam administrations on postoperative analgesia]

In this study we evaluated the postoperative analgesic efficacy of lornoxicam PO, IM and IV administration preoperatively. Fourty patients, aged between 18-65 years, ASA I-II class, were randomized to four groups. Lornoxicam 8 mg was administired PO, IM, IV (Group PO, Group IM, Group IV) 1 hour before the operation. Analgesia was not performed in control group (Group C). First analgesic requirement time, analgesic consumption and the VAS and VRS pain scores were recorded postoperatively. When VAS 3 patient controlled analgesia with lornoxicam was begun. We found that first analgesic requirement time was shorter, postoperative 2nd hour VAS and VRS scores and drug consumptions were higher in Grup C cases according to the other groups. There was no significant difference in first analgesic requirement time and analgesic consumption. Preoperative administration of 8 mg lornoxicam delayed the first analgesic requirement time and decreased total analgesic requirement. There was no difference on analgesic effect between PO, IM, and IV administrations.

Preparation and Characterization of Solid Dispersions of Piroxicam with Hydrophilic Carriers

The objective of this study was to improve the dissolution rate of a poor water soluble drug, piroxicam, by solid dispersion technique. Solid dispersions were prepared by three different methods depending on the type of carrier. The dissolution rate of piroxicam was markedly increased in solid dispersion of myrj 52, Eudragit E100 and mannitol. Solubility studies revealed a marked increase in the solubility of piroxicam with an increase in myrj 52 and Eudragit E100 concentrations. Data from the X-ray diffraction and FT-IR spectroscopy showed that piroxicam was amorphous in the solid dispersions prepared with dextrin and Eudragit E100.

Prediction of oral clearance fromin vitrometabolic data using recombinant CYPs: Comparison among well-stirred, parallel-tube, distributed and dispersion models

Intrinsic clearances (CLint-HLM-total) for the metabolism of NE-100, metoprolol, clarithromycin (CAM), lornoxicam and tenoxicam were predicted from in vitro data with recombinant cytochorme P450s (CYPs) using relative activity factor (RAF) and then compared with CLint-HLM observed in human liver microsomes (HLM). The predicted CLint-HLM-total correlated well with the observed CLint-HLM in HLM. When oral clearances (CLoral) of low-clearance drugs such as metoprolol, CAM, lornoxicam and tenoxicam were predicted from the in vitro data using four physiological models (well-stirred, parallel tube, distributed and dispersion models), the predicted CLoral corresponded well with the observed CLoralin vivo and were similar among the four models. For a high-clearance drug, the predicted CLoral of NE-100 in extensive CYP2D6 metabolizers (EMs) was substantially different between individual models, although the predicted CLoral in a poor metabolizer of CYP2D6 (PMs) was similar. The CLoral ratio of NE-100 between the EMs and the PMs predicted from the dispersion model, which leads to a reliable prediction for the high-clearance drug, was 48.4, but the ratio decreased depending on the increase of the NE-100 plasma concentration. The results suggest that the CLoral decrease in the EMs is caused by saturation of NE-100 metabolism mediated by CYP2D6 and is based on increases in plasma NE-100 concentrations dependent on the dose of NE-100. The study suggests that the RAF and the in vitro-in vivo scaling approaches are useful for predicting CLoral from in vitro data with recombinant CYPs without using HLM and hepatocytes.

Lornoxicam in extracorporeal shock-wave lithotripsy; comparison with tenoxicam and placebo in terms of analgesic consumption

OBJECTIVE

To assess the analgesic efficacy of lornoxicam and compare it with that of tenoxicam in patients undergoing extracorporeal shock-wave lithotripsy (ESWL) for renal stones.

MATERIAL AND METHODS

The study was carried out in a randomized, double-blind fashion and involved 60 patients (American Society of Anesthesiologists physical status I-II) undergoing ESWL who were divided into three groups. Patients in the placebo group (n = 20) received saline and those in the lornoxicam group (n = 20) received lornoxicam 8 mg intravenously 60 min before the procedure. In the tenoxicam group, patients (n = 20) received tenoxicam 20 mg intravenously at the same time point. All patients were started on patient-controlled i.v. meperidine analgesia during the procedure. The effectiveness was assessed by using a visual analog scale (VAS) and by calculating the total analgesic consumption of meperidine during the procedure. Arterial blood pressure, oxygen saturation, and respiratory rate were recorded throughout the procedure; nausea and vomiting, agitation, and respiratory depression were assessed.

RESULTS

Compared with patients in the placebo group, patients in the lornoxicam and tenoxicam groups received smaller doses of meperidine at all time points (p < 0.05). After 30, 45, and 60 min of ESWL, patients in the lornoxicam group required significantly smaller doses of meperidine than those in the tenoxicam group (p < 0.05). Patients in the placebo group showed higher VAS scores than those in the lornoxicam and tenoxicam groups at 15, 30 and 60 min. The VAS score in the lornoxicam group was lower than that in the tenoxicam group at 15, 30, and 45 min, but the difference between the groups was statistically significant only at 45 min (1 and 3, respectively; p < 0.05).

CONCLUSION

In patients undergoing ESWL the i.v. administration of a single dose of 8 mg lornoxicam provides significantly better pain control compared with tenoxicam 20 mg and placebo, without increasing adverse side-effects.

[Does pre-emptive analgesia really pre-empt?]

The paper discusses the theoretical background and practical rationale for a concept of pre-emptive analgesia. It gives the results of studying the efficacy of lornoxicam that outstrips the infliction of a surgical injury in different anesthesia modes (combined total and intravenous combined multicomponent anesthesia with epidural block). A hundred thirty-seven patients who had undergone laparoscopic cholecystectomies (Group 1) and expanded interventions for colorectal cancer (Group 2) were examined. The examination provided no evidence for the efficiency of pre-emptive analgesia with lornoxicam during perioperative anesthesia in patients undergone moderately and highly traumatic abdominal interventions.

In vitro phonophoresis: effect of ultrasound intensity and mode at high frequency on NSAIDs transport across cellulose and rabbit skin membranes

The objective of this study was to evaluate the effect of intensity, mode, and duration of ultrasound application on the transport of three nonsteroidal anti-inflammatory drugs (NSAIDs) across cellulose membrane and rabbit-skin. Ibuprofen, piroxicam and diclofenac sodium were used as the model drugs. Studies were performed in vitro using a modified Franz diffusion assembly adapted to a therapeutic ultrasound transducer. Ultrasound had a significant and positive effect on the transport of the model NSAIDs across cellulose and rabbit skin membranes. Increasing ultrasound intensity from 0.5 to 3.0 W/cm2 led to a proportional increase in drug transport. Continuous ultrasound mode was more effective in enhancing drug transport than the pulsed mode. Diclofenac sodium had the least flux and permeability coefficient. This was attributed to its comparatively lower pKa value that renders the drug more ionizable in the buffer solution, consequently reducing its selective penetration through the membranes. This study demonstrated the therapeutic potential of ultrasound in transdermal delivery of NSAIDs and the synergistic effect of temperature and ultrasound operational parameters on drug transport.

[Protective effect of lornoxicam on development of myocardial infarction in rats under conditions of ischemia and ischemia-reperfusion]

Activation of inflammation and enzyme cyclooxygenase with formation of proinflammatory prostaglandins is a key element of development of myocardial infarction in patients with acute coronary syndrome. Basing on literature data and own experience we suggested that single intravenous injection of 230 mg/kg of nonselective inhibitor of type 1 and 2 cyclooxygenase lornaxicam in the phase of initialization of inflammation 20 min after onset of ischemia would lead to reduction of myocardial infarction volume in rats in irreversible ischemia and ischemia with subsequent reperfusion. The conducted study allowed to reveal that administration of lornoxicam in recommended for human use dose lowered mortality of animals and increased number of capillaries per one cardiomyocyte in case of irreversible coronary artery occlusion. In ischemia-reperfusion as in irreversible myocardial ischemia lornoxicam reduced volume of necrosis and degree of thinning of left ventricular wall in the region of infarction, and lowered volume of connective tissue in periinfarction zone of the myocardium in remote period.

Immediate release of poorly soluble drugs from starch-based pellets prepared via extrusion/spheronisation

The aim of this study was to evaluate modified starch (high-amylose, crystalline and resistant starch) as the main excipient for immediate-release pellets containing poorly soluble drugs (hydrochlorothiazide and piroxicam) and prepared via extrusion/spheronisation. The bioavailability of pellets (containing 50 mg hydrochlorothiazide) was determined after oral administration to 6 dogs. A 2(4)-factorial design with central point was used to evaluate the influence of hydrochlorothiazide (10% and 50%, w/w), HPMC (binder, 4% and 7%, w/w), sorbitol (0% and 10%, w/w) and water (granulation liquid, low and high level) on pellet yield, size (Feret mean diameter) and sphericity (aspect ratio and two-dimensional shape factor, eR). Optimal granulation liquid content depended on drug and sorbitol level in the formulation. All factors except sorbitol content, as well as the interactions between drug concentration and binder level and between drug and water level, were significant (P<0.05) for pellet yield, while a significant curvature (P<0.05) suggested non-linearity of the response plots. The model was not significant for pellet shape, while hydrochlorothiazide and water level as well as their interaction were significant (P<0.05) for pellet size. Pellet friability, disintegration, residual water content and in-vitro drug release were determined. Pellets containing 2.5% (w/w) piroxicam were also evaluated. For both model drugs, pellets with a high yield (>90%), acceptable sphericity (AR<1.2) and low friability (<0.01%) were obtained. Due to pellet disintegration, fast dissolution of both hydrochlorothiazide and piroxicam was achieved: >80% drug released in 30 min. The bioavailability (AUC0-->24 h, Cmax and tmax) of hydrochlorothiazide pellets in dogs was not significantly different from fast-disintegrating immediate-release hydrochlorothiazide tablets (P>0.05).

[Comparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain]

Comparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain. The aim of the present study was to compare of the postoperative analgesic effects of tramadol, combinations of tramadol-metamizol and tramadol-lornoxicam administered by intravenous Patient Control Analgesia (PCA) in lower abdominal surgery. Sixty adult, female patients who undergoing lower abdominal surgery, were included in this study. Patients were randomized to three groups. The solutions were prepared containing 500 mg tramadol in 50 ml saline (10 mg/ml tramadol) for Group I, 250 mg tramadol+3000 mg metamizol in 50 ml saline (5 mg/ml tramadol+60 mg/ml metamizol) for Group II and 250 mg tramadol+20 mg lornoxicam in 50 ml saline (5mg/ml tramadol + 0.4 mg/ml lornoxicam) for Group III. Loading dose 10 ml was administrated within 30 min 30 to 40 min before the end of the surgery. PCA was started at the first complaint of pain. Pain was evaluated by VAS in every 15 minute intervals at the first hour and later at 2nd, 4th, 8th, 12th, 18th and 24th hours postoperatively. Vital parameters, side-effects, sedation scores and total analgesic consumptions were also recorded concurrently. Total tramadol and anti-emetic consumption, the incidence of postoperative nausea and vomiting (PONV) were significantly higher in group I than the other groups (p<0.05). In conclusion; Tramadol-metamizol and tramadol-lornoxicam combinations administered by intravenous PCA provide efficient postoperative analgesia with less side effects.

Comparison of effects of preoperatively administered lornoxicam and tenoxicam on morphine consumption after laparoscopic cholecystectomy

BACKGROUND AND OBJECTIVE

The efficacy, tolerability and the morphine-sparing effects of lornoxicam were compared with those of tenoxicam when used preoperatively in patients undergoing laparoscopic cholecystectomy.

METHODS

In this prospective, double-blind study, 60 ASA I-II patients undergoing laparoscopic cholecystectomy were randomized equally to receive intravenous tenoxicam 40 mg (Group T) or lornoxicam 16 mg (Group L), preemptively. Three patients withdrew from the study, so 57 patients were included in the analysis. In the postoperative period, the first morphine demand times, pain scores, side-effects and cumulative morphine consumptions were evaluated during the first 24 h.

RESULTS

The patient characteristics data and the duration of surgery were similar between two groups, except for body weights (P = 0.002). The first morphine demand time was significantly longer in Group L (P = 0.037), but the pain levels did not differ. The mean pain scores were higher in Group T in the 15 min (P = 0.036), 1 h (P = 0.020), 2 h (P = 0.001) and 4 h (P = 0.0042) after extubation. A statistically significant difference between two groups was found in calculated cumulative morphine consumptions per kilogram in the 15 min (P = 0.037), 30 min (P = 0.016), and 1 h (P = 0.004) and 2 h (P = 0.013) between two groups. There was no difference in the severity of nausea but 13 patients in Group T and five patients in Group L had vomiting (P = 0.018). Patient satisfaction was similar in the two groups.

CONCLUSIONS

Preoperatively administered lornoxicam 16 mg significantly prolonged the first morphine demand time, reduced postoperative morphine consumption during the first 4 h and caused significantly fewer adverse effects when compared with tenoxicam after laparoscopic cholecystectomy.

Double-Blind, Placebo-Controlled, Randomized Clinical Trial of Sublingual or Intramuscular Piroxicam in the Treatment of Renal Colic

AIMS

To investigate the therapeutic effect of the fast-dissolving dosage form (FDDF) of sublingual piroxicam on renal colic compared with the intramuscular (IM) injection form of the same agent in a randomized, double-blind, placebo-controlled clinical trial.

METHODS

80 patients were assigned to one of two treatment groups: Group 1 received 40 mg piroxicam FDDF sublingual tablets and IM injection of 2 ml distilled water. Group 2 received an IM injection of 40 mg piroxicam and two sublingual tablets of placebo. At baseline and 30 min after the medication, vital signs were recorded and the pain intensity was evaluated by the patient using a numeric rating scale.

RESULTS

The overall efficacy of the treatment was 90%. There was no significant difference with respect to the required rescue treatment (p = 0.328), pain relapse within 24 h (p = 0.434) and the decrease in vital signs and numeric rating scale in both groups (p > 0.05).

CONCLUSION

The piroxicam FDDF tablet was found to be as effective as the IM injection form of the same agent in the treatment of renal colic. The FDDF is a good alternative to the parenteral form because of its earlier onset of action and ease of self-administration which increases patient compliance.

Polyelectrolyte complexes of Eudragit l30 d-55 and gelatin: antinociceptive activity of entrapped piroxicam

The electrostatic interaction between oppositely charged polyelectrolytes leads to the formation of polyelectrolyte complexes, which are of considerable interest because of their potential applications as both drug carriers or surface modifying agents. In this study, in vitro and in vivo studies were carried out on polyelectolyte complexes formulated with Eudragit L30 D-55 and gelatin. The complexes of Eudragit L30 D-55 and gelatin were formulated by nonstoichiometric method. The polyelectrolyte complexes formulated were then granulated and evaluated by percentage yield, particle size, and swelling behavior. The pharmacodynamic effects of piroxicam entrapped in the complexes were determined using healthy rats. Results showed that gelatin and Eudragit L30 D-55 formed polyelectrolyte complexes that prolonged the antinociceptive effects of piroxicam in experimental rats. The performance of the polyelectrolyte complexes could be stated in the following descending rank order: 1:1 > 2:1 > 1:2 ratios of Eudragit L30 D-55 and gelatin. Nonstoichiometric interactions of gelatin and Eudragit L30 D-55 could yield matrices with adequate characteristics for the formulation of sustained release systems of drugs.

[Effects of intrathecal lornoxicam on withdrawal thresholds of rats to mechanical and thermal stimuli]

OBJECTIVE

To assess the effects of intrathecal lornoxicam on the withdrawal thresholds of rats to mechanical and thermal stimuli.

METHODS

After approval of the animal ethic committee, 18 healthy male adult rats were randomly allocated on average to receive the intrathecal solvent (Group S) 20 tL, intramuscular lornoxicam (Group IM) 120 microg/20 microL or intrathecal lornoxicam (Group IT) 120 microg/20 microL, and to do the mechanical withdrawal threshold measured by Dynamic Planter Aesthesiometer (Ugo Basile, Italy). Another 18 rats were allocated similarly to do the thermal withdrawal threshold measured by Hargreaves Test (Ugo Basile, Italy). The basal value of withdrawal threshold was first recorded, and then the intrathecal solvent, intramuscular or intrathecal lornoxicam was injected, and the withdrawal threshold values were measured once more in the period of total 150 min with each 30 min as a time section. The Student-Newman-Keuls test was used to identify the differences between groups, with the SPSS11.5 package.

RESULTS

In Group S, there was no difference between the threshold values after intrathecally injecting solvent and the basal value. In Group IM, 30 min after injection, the mechanical and thermal threshold values reached the peak [(31.1 +/- 4.05) g, (20.82 +/- 2.15)], and were different as compared with the basal value (P < 0.05, P < 0.01). The mechanical and thermal withdrawal threshold values decreased to the basal level at 60 min and 90 min respectively. In Group IT, 10 min after injection, the mechanical and thermal withdrawal threshold values [(35.0 +/- 2.76) g, (26.72 +/- 3.75) s] were different when compared with the basal value (P < 0.01). The mechanical and thermal withdrawal threshold values decreased to the basal level at 90 min and 120 min respectively. There was no difference of the basal value among the three groups. But at 10, 30, 60 min after lornoxicam administrated, the mechanical threshold values of Group IT were obviously higher than those of Group S; and at 10, 30 min, it was significantly higher than that of Group IM. At 10, 30, 60, 90 min, the thermal thresholds of Group IT were markedly higher than those of the other groups.

CONCLUSION

Both systemic and intrathecal lornoxicam can elevate the withdrawal threshold values of rats to mechanical and thermal stimuli, but the onset of this effect is faster, and the maintenance is longer by intrathecal route.

Impact of piroxicam beta-cyclodextrin on the efficacy of the intrauterine device in a rat model

OBJECTIVE

To elucidate the effect of piroxicam beta-cyclodextrin (PbetaCD), a non-steroidal anti-inflammatory drug (NSAID), on the efficacy of the intrauterine device (IUD) in a rat model.

METHODS

Forty nulliparous female Wistar rats were allocated to one of four groups, comprising each 10 of these animals. Group I: neither IUD nor medication; group II: IUD, but no medication; group III: IUD and PbetaCD; and group IV: PbetaCD only. In groups II and III, a string of 3/0 silk suture of 2 cm long was transcervically placed in one of the horns of the bicornuate uterus of the rat. Rats in group III were treated during the 18 days following IUD placement with 3 mg/kg/day PbetaCD administered via a feeding tube; group IV received PbetaCD for the same length of time, but had no IUD inserted. The rats were then mated. Thereafter, vaginal smears were taken and assessed daily, in the early morning, for the presence of spermatozoa. The day when spermatozoa were detected was considered to be the first day of gestation. On gestational day 19, both uterine horns of all rats were evaluated for the presence and number of embryos.

RESULTS

In group II, mean embryo counts in the horn with or without IUD were 1.0 +/- 0.2 and 4.5 +/- 0.3, respectively (p < 0.01). The comparison of group II with group I showed that the presence of an IUD in one horn did not affect the mean embryo counts in the contralateral horn (4.5 +/- 0.3 versus 5.1 +/- 0.9, p > 0.05). In groups II and III, mean numbers of embryos in the horn with IUD were 1.0 +/- 0.2 and 2.7 +/- 0.4, respectively (p < 0.01). No difference in the mean embryo counts was observed between group I (5.1 +/- 0.9) and IV (4.8 +/- 0.9; p > 0.05).

CONCLUSIONS

The IUD had a contraceptive effect in the rat model. The IUD in one horn did not affect the number of embryos in the contralateral horn. In this model, IUDs appear to exert a local effect, i.e. counteracted by PbetaCD. This drug had no adverse effect on the fertility of rats without IUD in situ.

Analgesic effects of lornoxicam after total abdominal hysterectomy

The authors investigated, in a randomized, placebo-controlled, 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 (50 percent N2O in O2) and fentanyl (2 microg/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 of antiemetics 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.

Electrochemical monitoring of piroxicam in different pharmaceutical forms with multi-walled carbon nanotubes paste electrode

The electrochemical behavior of piroxicam on a multi-walled carbon nanotubes electrode for the first time was investigated. A highly sensitive and fast responding sensor for determination of piroxicam was simply and conveniently fabricated. The constructed electrode exhibits efficiently catalytic activity for the electrooxidation of piroxicam at a reduced over potential with high sensitivity, stability, and long lifetime in the wide concentration rang of piroxicam. The oxidation process was found to be dependent on the pH of the supporting electrolyte. The behavior is further exploited as a sensitive detection method for piroxicam determination by differential pulse voltammetry. Under the optimized conditions the calibration plots are linear in the concentration range of 0.15-5 microg ml(-1). Application of the method for the determination of the drug in the dosage form (Feledene capsules and tablets and also piroxicam gel), without any interference, from the excipients, resulted in acceptable deviation from the stated concentrations. Recoveries were obtained in the range 96.35-104.16%. The detection limit of 0.1 microg ml(-1) was obtained for piroxicam determination.

Efficacy of lornoxicam in postoperative analgesia after total knee replacement surgery

In total knee replacement operation, patients have a severe pain in the postoperative period. Because of side effects of opioids, multiple postoperative pain treatment regimens are more suitable in these elderly patients. In this double-blind, randomized, placebo controlled study, the effect of lornoxicam administration (32 mg/48 hour) on morphine consumption and drug-related side effects were investigated in elderly patients undergoing total knee replacement. Group M (n=23) and Group L (n=23) received morphine with patient controlled analgesia (PCA) device postoperatively. Additionally Group L received lornoxicam 16 mg intravenously 15 minutes before surgery and 8 mg at postoperative 12th and 24th hours. Morphine consumption in Group L were significantly lower than in Group M at 2, 3, 6, 8, 24, 36 and 48th postoperative hours (p<0.05). At the end of 48th hour mean total morphine consumptions (mean+/-SD) for Group M and Group L were 63.70+/-15.70 mg and 34.60+/-16.32 mg, respectively. AUC (area under the curve) Morphine 0-48h in Group M was 59+/-13 and in Group L it was 30+/-13 (p<0.001). Incidence of side effects in Group M were 60% and 25% in Group L (p<0.05). In Group M, 8 patients (40%) experienced nausea and 3 (15%) patients experienced itching where as in Group L, 3 patients (15%) experienced nausea, 1 patient (5%) itching, 1 patient (5%) dry mouth. Lornoxicam administration in total knee replacement is associated with decreased morphine consumption for postoperative analgesia and fewer side effects.

Effect of piroxicam gel for pain control and inflammation in Nd:YAG 1064-nm laser hair removal

BACKGROUND

Laser-assisted hair removal is a variably uncomfortable and painful procedure.

OBJECTIVE

The aim of this study was to investigate the efficacy of piroxicam gel on pain control and subsequent inflammation in Nd:YAG 1064 nm laser hair removal in women volunteers.

METHODS

Fifty women volunteers were enrolled in this prospective, randomised, placebo-controlled study over a 6-month period. Subjects were randomly assigned to receive piroxicam gel as Group P or saline as a control group. Topical analgesic and saline were applied to the treatment sites for 45 minutes. The pain scores (VAS) and side effects were recorded before the hair removal, during the hair removal, at the end of the hair removal, and after 1 hour, 2 hours and 24 hours after the hair removal.

RESULTS

Subject characteristics and treatment settings in Nd:YAG 1064 nm laser were similar in both groups. The pain scores (VAS) were significantly lower in the Group P than those of the control group during the hair removal (p < 0.001). Inflammatory side effects such as erythema, edema, and folliculitis, were more frequent in the control group than those of Group P during the procedure (p < 0.001).

CONCLUSION

This study showed that piroxicam gel provided adequate pain relief after Nd:YAG 1064 nm laser hair removal in women volunteers. Piroxicam gel was associated with lesser inflammatory side effects when compared to placebo because of its anti-inflammatory effect after the procedure.

[Efficacy and safety of lornoxicam in an early postoperative period]

AIM

To compare quality of anesthesia with opioid drug and nonsteroid anti-inflammatory drugs in 123 patients after extensive operative interventions of the lungs and trachea, abdominal organs, lower limbs.

MATERIAL AND METHODS

Patients of group 1 took lornoxicam for relief of postoperative pain syndrome, those of group 2--promedol. Quality of anesthesia was assessed by visual-analogue and verbal scales, day dose of analgetic drug, administration of promedol, side effects incidence.

RESULTS

Lornoxicam in a dose 8 mg intravenously has comparable with 20 mg promedol analgetic effect. This justifies its use as a basic analgetic for treatment of acute pain after extensive surgery. Lornoxicam allows surgeons to do without opioids in 10-45% patients or to reduce their dose by 32-65%.

CONCLUSION

Adequate anesthesia with lornoxicam and promedol early after surgery on the chest and abdominal organs, major vessels of the lower limbs occurs in 82 and 87% patients, respectively. Lornoxicam administration as continuous intravenous infusion and controlled analgesia in older patients eliminates the need in opioid analgetics in 45% cases and is well tolerated.

Study of hydroxy propyl guar derivative for its gelling property and it's use in the formulation of tenoxicam gels

Gels of tenoxicam 1% w/w were formulated using 2% w/w hydroxy propyl guar derivative and 3% w/w sodium carboxy methyl cellulose as gelling agents. A detailed rheological investigation was carried out to study the influence of preservative, drug and preservative, solvent system and the preservative, drug, solvent system and the preservative on the pseudoplastic behaviour of polymers. Hydroxy propyl guar derivative in 2% w/w strength resulted in gels with a higher pseudoplastic index value of 3.383 in contrast to an index value of 1.797 for a 3% w/w sodium carboxy methyl cellulose gels of a similar composition. The gels were stored at different temperatures and variations in pH values were recorded. Hydroxy propyl guar derivative based gels revealed variations in pH values over a narrow range in contrast to sodium carboxy methyl cellulose gels. The gels were subjected to short term stability studies by storing gels at refrigerated temperature, lab temperature, at 37 degrees C and at 45 degrees C. Gels based on hydroxy propyl guar derivative revealed better drug keeping qualities in contrast to sodium carboxy methyl cellulose stabilized gels. Release studies of tenoxicam from formulations across hairless albino mice skin revealed a zero order drug release pattern from both the formulations.