The Specialist Forum Volume 13 No 11 November 2013 | Page 26

PAIN

intravenously in relieving moderate to severe post-laminectomy pain,
and had few adverse events.
Daglar et al conducted a study to compare the efficacy and tolerability of lornoxicam and diclofenac sodium in pain management after
coronary artery bypass grafting. The study concluded that the efficacy
of lornoxicam and diclofenac were similar in postoperative pain management and both study drugs were well tolerated.
Mentes et al conducted a randomised and prospective study to
compare the analgesic effects of lornoxicam and tramadol in patients
after inguinal hernia repair and concluded that both lornoxicam and tramadol provided rapid and effective analgesia and were well tolerated.
Staunstrup et al studied the efficacy and tolerability of lornoxicam
versus tramadol for postoperative pain relief following arthroscopic reconstruction of the anterior cruciate ligament. This randomised double
blind study consisted of 76 patients with moderate to unbearable pain.
Patients receiving a single dose of 16mg intramuscular lornoxicam experienced significantly greater pain relief than patients receiving 100mg
intramuscular tramadol over the following eight hours.
Lornoxicam had greater analgesic efficacy than tramadol in patients
with moderate baseline pain but was of equivalent efficacy in those with
severe or unbearable baseline pain. Fewer patients in the lornoxicam
group required rescue medication (58% versus 77% respectively).
The authors concluded that intramuscular lornoxicam offers a useful
alternative to tramadol for the treatment of moderate to severe postoperative pain.
Lornoxicam has also been compared to other NSAIDs in addition
to its comparison to opioid analgesics. Papadima et al compared
lornoxicam with parecoxib in the treatment of postoperative pain after
laparoscopic cholecystectomy in a prospective randomised placebo
controlled trial. The authors concluded that parecoxib 40mg intravenous and lornoxicam 8mg intravenous were equianalgesic and both
were more efficacious than placebo for the management of pain after
laparoscopic cholecystectomy.
Arslan et al studied the postoperative analgesic effect of lornoxicam after
thyroidectomy in a placebo controlled
randomised trial. They used a dose of
8mg IV at the end of surgery followed by
8mg twice a day for 24 hours postoperatively. The authors opinioned that pain
scores along with incidence of nausea
and vomiting decrease with the use of
lornoxicam.
Sapolya et al investigated the analgesic effects of lornoxicam after total abdominal hysterectomy in a randomised
placebo controlled double blind study.
Fifty patients were randomised to receive
either oral placebo or lornoxicam 8mg
one hour before surgery. All patients received patient controlled analgesia with
tramadol. The authors concluded that
a single oral dose of lornoxicam given
preoperatively enhanced the analgesic
effect of tramadol, decreasing tramadol
consumption and side effect and shortened the length of hospitalisation.
Inan et al studied the efficacy of

lornoxicam as a postoperative analgesic after total knee replacement
surgery. In this double blind randomised placebo controlled study, the
effect of lornoxicam (16mg intravenously 15 minutes before surgery followed by 8mg postoperatively at the 12th and 24th hours) on morphine
consumption was investigated. It was observed that lornoxicam administration decreased morphine consumption in the postoperative period
significantly and there were fewer side effects.
Erdogan et al studied the effect of lornoxicam on postoperative pain
after myomectomy and observed that a single dose IV lornoxicam
(8mg) was a safe and effective treatment option for relief of postmyomectomy pain. It reduced the consumption of morphine significantly.
There are only a few studies available in literature comparing the
analgesic effect of lornoxicam and diclofenac. Behdir et al studied
the comparison of the effects of lornoxicam versus diclofenac in pain
management after cardiac surgery in a single blind randomised study.
The study included 40 adult patients who were randomly assigned to
either receive lornoxicam 8mg intramuscularly eight hourly or diclofenac 75mg intramuscular 12 hourly for 48 hours. Pethidine 1mg/kg
intramuscular was given for additional analgesia postoperatively when
needed. No significant group difference in mean pain relief scores was
found at any point in both groups.
Sener et al in a prospective, randomised, placebo controlled double
blind study compared the efficacy of lornoxicam with diclofenac,
ketoprofen and dipyrone for relief of acute postoperative pain in patient undergoing septoplasty. Patients were divided into five groups
depending upon the drug used. The drugs were used intramuscularly.
They used lornoxicam (8mg twice daily), diclofenac (75mg twice daily),
ketoprofen (100mg twice daily), dipyrone (1gm thrice daily) and placebo
(twice daily).
Intramuscular pethidine 1mg/kg was used as rescue analgesia.
Pethidine requirement was found to be significantly higher in the placebo group. However, there was no significant difference among the
remaining four groups.
In comparative studies in healthy volunteers, lornoxicam 16mg/day induced
significantly less endoscopically verified
gastroduodenal injury than naproxen
1000mg/day. Lornoxicam 8mg/day
tended to cause less faecal blood loss
than indomethacin 100mg/day.

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Conclusion
The drug has been found to be safe in
elderly patients, patients with impaired
renal function and patients with impaired
hepatic functions. The data from clinical
studies indicate that lornoxicam has a
better analgesic effects and anti-inflammatory properties as compare to other
NSAIDs in the treatment of acute, moderate to severe pain. However, further
comparative studies are recommended.
Citation: Godara S, Srivastava RK,
Godara R, Bhutani G. Lornoxicam: a review of its therapeutic potential in different
clinical studies. Journal of Drug Delivery
and Therapeutics; 2013, 3(2), 145-148.? SF
November 2013 | The Specialist Forum