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Aim: The aim of this study is to evaluate the effect of tenoxicam compared to diclofenac sodium in controlling postoperative pain after third molar surgery. Materials and Methods: 36 patients with mean age 30 were selected randomly and placed them in two groups A and B, under group A there are 18 patients and in group B 18 patients were placed, group a is given with tenoxicam 30 mg and for group b diclofenac sodium 50 mg. Results: Group A experienced significantly less pain than those patients in group b. at 24 hr on the day of surgery, average pain scores of patients in both treatment groups did not differ significantly. On the evening of the third day postoperatively, the group a (tenoxicam) patients experienced significantly less pain than those in group b (diclofenac sodium). Discussion: It is generally accepted that pain following third molar surgery reaches moderate to severe intensity within the first 5 hr after surgery. Pain control in this period is thus of vital importance to the oral surgeon. NSAIDs have shown considerable analgesic activity for the relief of pain after surgery. Prostaglandin concentrations do not peak until 4 hr after surgical trauma. tenoxicam has been shown in our study to produce significant analgesia when compared to diclofenac sodium, especially at 3 to 4 hr postoperatively, the period when there is maximum prostaglandin formation in the tissue. Conclusion: Tenoxicam as administered in the present study was significantly more efficacious than diclofenac sodium and useful for pain control in these cases.

The use of non-steroidal anti-inflammatory drugs (NSAIDs) in inflammatory bowel diseases (IBDs) are contradictory between their beneficial effect in alleviating inflammation, and injurious outcomes in aggravating the symptoms of colitis. The study aimed to formulate trehalosomes (THs); innovative green trehalose-based nanocarriers, to alleviate the inflammation symptoms that might be provoked by NSAIDs in IBDs; as trehalose was proved to lighten the inflammation and the oxidative stress response, besides its resistance to the acidic conditions that rises its potentiality as a means for colon targeting. THs were fabricated using L-α-phosphatidylcholine (PL), trehalose, and transcutol, in a single step circumventing the incorporation of any organic solvent and loaded with Tenoxicam (TXM) as a model anti-inflammatory medication. A full 23 factorial design, using Design-Expert® software, was established to optimize the formulation variables. The optimized formulation composed of trehalose: PL at a weight ratio of 1:1, 377.72 mg transcutol, and sonicated for 4 min, possessed a spherical shape with a size of 268.61 nm and EE% of 97.83% and released 70.22% of its drug content over 24 h. The supreme protective action of TXM loaded THs compared to TXM suspension and drug-free THs was revealed by the suppression of the inflammatory biomarkers and the improved histopathology of the colonic tissue in male New Zealand rabbits. IL-1s, IL-6, and TNF-alpha levels were notably dampened with TXM loaded THs, and oxidative stress markers, measured as GSH and MDA, were significantly altered. The study indicates the successful role of green THs in colon targeting and its anti-inflammatory characteristics in protecting against possible NSAIDs-driven exacerbation of colitis.

Çalışmamızda mastektomi uygulanan hastalarda preemptif ve postoperatif tenoksikam kullanımının postoperatif ağrı üzerine etkilerinin karşılaştırılması amaçlandı. Haziran 2009-Eylül 2010 tarihleri arasında mastektomi uygulanan 75 hasta çalışmaya dahil edildi. Preemptif tenoksikam grubundaki (Grup CÖ-T, n=25) hastalara cerrahi başlangıcından 30 dk önce tenoksikam 20 mg iv (2 ml), cerrahi bitiminde serum fizyolojik (SF) 2 ml iv verildi. Cerrahi sonrası tenoksikam uygulanan gruptaki (Grup CB-T, n=25) hastalara ise cerrahi başlangıcından 30 dk önce SF, cerrahi bitiminde tenoksikam uygulandı. Kontrol grubundaki (Grup Kontrol, n=25) hastalara ise cerrahi başlangıcından 30 dk önce ve cerrahi bitiminde SF uygulandı. Postoperatif hasta kontrollü analjezi başlandı. Postoperatif Görsel Analog Skala (VAS) değerleri, bulantı kusma şiddeti ve morfin kullanım miktarları ile postoperatif ilk analjezik gereksinim ve mobilizasyon zamanları, hastanede kalış süreleri, 24 saatlik morfin tüketimleri, postoperatif komplikasyonlar, hasta ve hemşire memnuniyetleri kaydedildi. Postoperatif derlenme ünitesinde yapılan ilk değerlendirme (0. saat) VAS değeri Grup CÖ-T ve Grup CB-T’de benzer, Grup-Kontrol’de yüksek bulundu. (p

In this study, we aimed to investigate the effect of 2 different dosages of tenoxicam in the prevention of propofol injection pain.A total of 120 patients between the ages of 20-50 years who were scheduled for elective surgery were included in this prospective. Patients were randomly divided into 3 groups. Group 1 received 5 mL saline, group 2 received 10 mg tenoxicam in 5 mL saline, and group 3 received 20 mg tenoxicam in 5 mL saline intravenously as a pretreatment. Venous occlusion was applied for 60 seconds with a rubber tourniquet after the injection was completed. After injecting propofol, the pain at the injection site of the patient was questioned according to the Verbal Rating Scale.The overall pain incidence during propofol injection was 85% in group 1, 75% in group 2, and 60% in group 3 (P = .039). While there was no significant difference between groups 1 and 2 (P=.264), there was a significant difference between groups 1 and 3 (P=.012). Moreover, there was a significant decrease in the level of severe pain in group 3 compared to group 1 (P=.008). There was no significant difference between the groups in terms of mild and moderate pain levels (P.05).We found that 20 mg of tenoxicam pretreatment was effective in reducing the incidence and severity of propofol injection pain compared to the control saline group, but the 10 mg dose did not significantly reduce the injection pain.

Highly traumatic surgical interventions for head and neck tumors were performed in 62 adult patients under conditions of multimodal opioid-free general anesthesia, which included dexmedetomidine, lidocaine, nefopam, and sevoflurane. In 18 cases, due to trismus II – IV degree, fibro optic nasotracheal intubation was used, in 10 patients with laryngeal stenosis, the operation was started with tracheotomy under local anesthesia. In all 28 cases, local anesthesia was supplemented by sedation with intravenous (IV) administration of dexmedetomidine and lidocaine, which was enhanced by the addition of sub-drug doses (10–20 mg) of ketamine. Consciousness and spontaneous breathing were preserved in all observations. Before intubation, propofol and rocuronium were added, and at the stage of the main operation, against the background of intravenous infusion of dexmedetomidine and lidocaine, inhalation of sevoflurane vapors (1–1.5 MAC). In 62 cases, the course of the operation and anesthesia was smooth, awakening and restoration of spontaneous breathing occurred after the end of the operation. Postoperative pain relief for the first two days was in the form of a continuous iv infusion of a 3-component mixture of 1% lidocaine and two non-opioid analgesics (nefopam and tenoxicam) using a disposable elastomeric pump. In the next 3-4 days, they switched to intramuscular administration of nefopam and tenoxicam. The quality of pain relief was high, without clinically significant complications. Only in three cases, at the beginning of mastering the technique, it was necessary to resort to an additional single injection of promedol or tramadol.

Graphical abstract, This study presents an alternative therapy to conventional anti-Parkinson’s treatment strategies; where motor and non-motor symptomatic complications are considered. Thus; providing sustainability, patient compliance, therapeutic safety and efficiency, based on triggering secretion of endogenous dopamine (DA). Exogenous DA has long been considered the best therapy, however, its poor blood brain barrier (BBB) permeability, fluctuated plasma levels, and non-motor complications negligence, decreased response to therapy with time. Consequently; brain targeting Tween®80-coated pegylated lipomers were tailored for intravenous administration (IV) of L-Dopa, and two drugs of reported neuroprotective effect: lamotrigine (LTG) and tenoxicam (TX). Single-step nanoprecipitation method was used; for its reproducibility and ease of scaling-up. Formulation targeting and anti-PD efficiency was evaluated against marketed standards and L-Dopa. In-vitro and in-vivo pharmacokinetic and dynamic studies were carried out for setting optimization standards upon varying inter-components ratio. Results revealed that lipomers are, generally, significantly efficient in brain targeting compared to oral tablets. LTG-lipomers (LF20) showed the maximum anti-PD compared to its TX and L-Dopa analogues. Combining LTG and TX had synergistic effect; highlighting a new prescription for both drugs. Thus; offering a safe, targeted, and therapeutically efficient sustained dosage form, capable of mitigating PD risk and treating it though weekly administration. Hence; presenting a novel promising anti-neurodegenerative strategy; on employing various mechanisms that were previously achieved through additional therapeutic supplements.

Transdermal delivery of non-steroidal anti-inflammatory drugs (NSAIDs) is an effective route of drug administration, as it directs the drug to the inflamed site with reduced incidence of systemic adverse effects such as gastric hemorrhage and ulcers. Tenoxicam (TNX) is a member of NSAIDs that are marketed only as oral tablets due to very poor absorption through the skin. The current study intended to formulate and characterize a hydrogel loaded with nanostructured lipid carriers (NLCs) to enhance the transdermal delivery of TNX. Six formulations of TNX were formulated by slight modifications of high shear homogenization and ultrasonication method. The selected formula was characterized for their particle size, polydispersity index (PDI), zeta potential, entrapment efficiency (EE), in-vitro drug release and ex-vivo skin permeation studies. Moreover, the effectiveness of the developed formula was studied in-vivo using carrageenan-induced paw edema and hyperalgesia model in irradiated rats. Formula F4 was chosen from six formulations, as the average diameter was 679.4 ± 51.3 nm, PDI value of about 0.02, zeta potential of −4.24 mV, EE of 92.36%, globules nanoparticles without aggregations and absence of interactions in the developed formula. Additionally, the in-vivo study showed the efficacy of formula F4 (TNX-NLCs hydrogel) equivalent to oral TNX in reducing the exaggerated inflammatory response induced by carrageenan after irradiation. In conclusion, the present findings suggest that TNX-NLCs hydrogel could be a potential transdermal drug delivery system alternative to the oral formulation for the treatment of various inflammatory conditions.

Background Gout is an inflammatory arthritis that is characterised by the deposition of monosodium urate crystals in synovial fluid and other tissues. The natural history of articular gout is generally characterised by three periods: asymptomatic hyperuricaemia, episodes of acute gout and chronic gouty arthritis. Non-steroidal anti-inflammatory drugs (NSAIDs) including selective cyclo-oxygenase-2 (COX-2) inhibitors (COXIBs) are commonly used to treat acute gout. Published guidelines recommend their use to treat acute attacks, using maximum recommended doses for a short time. Objectives To assess the benefit and safety of NSAIDs (including COXIBs) for acute gout. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE for studies to 7 October 2013, the 2010 and 2011 ACR and EULAR abstracts and performed a handsearch of reference lists of articles. We searched the World Health Organization (WHO) trial register and ClinicalTrials.gov. We applied no date or language restrictions. Selection criteria We considered all published randomised controlled trials (RCTs) and quasi-randomised controlled clinical trials that compared NSAIDs with placebo or another therapy (including non-pharmacological therapies) for acute gout. Major outcomes were pain (proportion with 50% or more reduction in pain or mean pain when the dichotomous outcome was unavailable), inflammation (e.g. measured by joint swelling/erythema/tenderness), function of target joint, participant's global assessment of treatment success, health-related quality of life, withdrawals due to adverse events and total adverse events. Data collection and analysis Two review authors independently selected the studies for inclusion, extracted the data, performed a risk of bias assessment and assessed the quality of the evidence using the GRADE approach. Main results We included 23 trials (2200 participants). One trial (30 participants) of low-quality evidence compared an NSAID (tenoxicam) with placebo. More participants taking NSAIDs reported at least a 50% reduction in pain after 24 hours (11/15 participants) compared with those taking placebo (4/15 participants) (risk ratio (RR) 2.75, 95% confidence interval (CI) 1.13 to 6.72). There was no difference in the proportion of participants with at least 50% improvement in joint swelling after 24 hours (5/15 participants taking NSAIDs versus 2/15 participants taking placebo; RR 2.50, 95% CI 0.57 to 10.93). The trial did not measure function, participant global assessment of treatment success and health-related quality of life. There were no adverse events reported with the use of tenoxicam; two adverse events (nausea and polypuria) were reported in the placebo group. No between-group differences in outcomes were observed after four days. Moderate-quality evidence based upon four trials (974 participants) indicated that NSAIDs and COXIBs produced similar benefits in terms of pain, swelling and global improvement, but COXIBs were associated with fewer adverse events. Pain reduction was 1.9 points on a 0- to 10-point scale with COXIBs (0 was no pain) while pain reduction with NSAIDs was 0.03 points lower or better (mean difference (MD) -0.03, 95% CI -0.19 to 0.13). Joint swelling in the COXIB group was 1.64 points on a 0- to 3-point scale (0 is no swelling) and 0.13 points higher with NSAIDs (MD 0.13, 95% CI -0.08 to 0.34). Function was not reported. Participant-reported global assessment was 1.56 points on a 0- to 4-point scale with COXIBs (0 was the best score) and was 0.04 points higher with NSAIDs (MD 0.04, 95% CI -0.12 to 0.20). Health-related quality of life assessed using the 36-item Short Form showed no evidence of a statistically significant between-group difference (MD 0.49, 95% CI -1.61 to 2.60 for the physical component). There were significantly fewer withdrawals due to adverse events in participants treated with COXIBs (3%) compared with NSAIDs (8%) (RR 2.39, 95% CI 1.34 to 4.28). There was a significantly lower number of total adverse events in participants treated with COXIBs (38%) compared with NSAIDs (60%) (RR 1.56, 95% CI 1.30 to 1.86). There was moderate-quality evidence based on two trials (210 participants) that oral glucocorticoids did not differ in pain reduction, function or adverse events when compared with NSAIDs. Pain reduction was 9.5 on a 0- to 100-point scale with glucocorticoids, pain reduction with NSAIDs was 1.74 higher or worse (MD 1.74, 95% CI -1.44 to 4.92). The trials did not assess inflammation. Function measured as walking disability was 17.4 points on a 0- to 100-point scale with glucocorticoids, function with NSAIDs was 0.1 lower or better (MD -0.10, 95% CI -4.72 to 4.52). The trials did not measure participant-reported global assessment and health-related quality of life. There were no withdrawals due to adverse events. There was no evidence of a difference in total number of adverse events with glucocorticoids (31%) versus NSAIDs (49%) (RR 1.58, 95% CI 0.76 to 3.28). Authors' conclusions Limited evidence supported the use of NSAIDs in the treatment of acute gout. One placebo-controlled trial provided evidence of benefit at 24 hours and little or no harm. We downgraded the evidence due to potential selection and reporting biases, and imprecision. While these data were insufficient to draw firm conclusions, they did not conflict with clinical guideline recommendations based upon evidence from observational studies, other inflammatory arthritis and expert consensus, which support the use of NSAIDs in acute gout. Moderate-quality evidence suggested that selective COX-2 inhibitors and non-selective NSAIDs are probably equally beneficial although COX-2 inhibitors are likely to be associated with significantly fewer total and gastrointestinal adverse events. We downgraded the evidence due to an unclear risk of selection and reporting biases. Moderate-quality evidence indicated that systemic glucocorticoids and NSAIDs were also equally beneficial in terms of pain relief. There were no withdrawals due to adverse events and total adverse events were similar between groups. We downgraded the evidence due to unclear risk of selection and reporting bias. There was low-quality evidence that there was no difference in function. We downgraded the quality due to unclear risk of selection bias and imprecision.

Objective: Prolonged ischemia / reperfusion I/R in the lower extremity causes significant muscle damage to the local tissue. In this study, it was aimed to investigate the antioxidant activity of tenoxicam, a COX-2 inhibitor, in rat lower extremity I/R model.Material and Methods: Following anesthesia, 3-hour ischemia and 24-hour reperfusion were applied to the left lower extremity in male Wistar rats. The study included 4 groups, each with 7 subjects. Subjects were divided into Group 1 Control , Group 2 I/R, Sham , Group 3 I/R, 2.5 mg/kg Tenoxicam , and Group 4 I/R, 10 mg/kg Tenoxicam . Tenoxicam was administered intraperitoneally immediately after 3 hours of ischemia. At the end of the 24-hour reperfusion period, samples were taken from the gastrocnemius muscle and examined under an electron microscope.Results: In the study performed with electron microscopy, significant tissue damage was detected in Group 2 compared to Group 1 p=0.005 . In Group 2, intense leukocyte infiltration, necrosis, edema, dilatation of sarcoplasmic reticulum, loss of mitochondrial crystals, and myofibril disorganization were observed. In Group 3 and Group 4, sarcoplasmic reticulum dilatation, disappearance of cristae mitochondria, and myofibril disorganization were significantly lower than in Group 2 p=0.007 and p=0.006, respectively . There was less histopathological involvement in Group 3 and Group 4. Tenoxicam was observed to prevent dose-dependent histological changes.Conclusion: Significant histopathological changes occur in lower extremity I/R injury. Tenoxicam appears to have a protective effect in preventing muscle tissue ischemia-reperfusion injury, Amaç: Alt ekstremitede uzun süren iskemi/reperfüzyon İ/R lokal dokuda belirgin kas hasarına neden olur. Bu çalışmada alt ekstremite İ/R modelinde bir COX-2 inhibitörü olan tenoksikamın antioksidan etkinliğini araştırmak amaçlanmıştır.Gereç ve Yöntemler: Erkek Wistar ratlarda anestezi verilmesini takiben sol alt ekstremiteye 3 saat iskemi ve 24 saat reperfüzyon uygulandı. Çalışmaya, her birinde 7 denek bulunan 4 grup dâhil edildi. Denekler Grup 1 Kontrol , Grup 2 İ/R, Sham , Grup 3 İ/R, 2,5 mg/kg Tenoksikam ve Grup 4 İ/R, 10 mg/kg Tenoksikam gruplarına ayrıldı. Tenoksikam 3 saat’lik iskeminin ardından hemen intraperitoneal olarak uygulandı. 24 saatlik reperfüzyon dönemi sonunda gastroknemius kasından örnekler alınarak, elektron mikroskopunda incelendi.Bulgular: Elektron mikroskopi ile yapılan çalışmada Grup 2’de, Grup 1’e göre belirgin doku hasarı tespit edildi p=0,005 . Grup 2ʼde yoğun lökosit infiltrasyonu, nekroz, ödem, sarkoplazmik retikulum dilatasyonu, mitokondri kristalarında silinme, miyofibril dezorganizasyonu gözlendi. Grup 3 ve Grup 4ʼde, Grup 2’ye kıyasla özellikle sarkoplazmik retikulum dilatasyonu, mitokondri kristalarında silinme ve miyofibril dezorganizasyonu anlamlı olarak düşük bulundu Sırasıyla p=0,007 ve p=0,006 . Grup 3 ve Grup 4ʼde daha az histopatolojik etkilenme oldu. Tenoksikamın, doza bağlı olarak histolojik değişiklikleri önlediği gözlendi.Sonuç: Alt ekstremite İ/R hasarında belirgin histopatolojik değişiklikler ortaya çıkar. Tenoksikamın kas dokusu iskemi-reperfüzyon hasarını önlemede koruyucu bir etkisi olduğu görülmektedir

The objective of this study was to compare analgesic efficacy of erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), and intercostal nerve block (ICNB) after video-assisted thoracoscopic surgery (VATS).Prospective, randomized, single-blind study.University hospital, single institution.Adult patients undergoing VATS.Ultrasonography-guided ESPB, ultrasonography-guided TPVB, or ICNB.Patients were enrolled into the following three groups according to analgesia technique as ESPB, TPVB, or ICNB, respectively, group erector spinae plane block (GESP) (n = 35), group thoracic paravertebral block (GTPV) (n = 35), and group intercostal nerve block (GICN) (n = 36). Multimodal analgesia was achieved with paracetamol, tenoxicam, and intravenous morphine (via patient-controlled analgesia) for all study groups. Pain scores were assessed by visual analog scale, and morphine consumption, rescue analgesic requirement, and side effects were recorded postoperatively. Dynamic visual analog scale at the first hour as primary outcome was determined five (two-seven), four (one-six) and (two-six) in GESP, GTPV, and GICN, respectively. Dynamic pain scores were significantly lower in GTPV compared with GESP and GICN at 24 hours (p0.017). Dynamic pain scores in GICN were significantly lower at 12 hours compared with GESP (p0.017). Morphine consumption for the first 24 hours was similar in GICN and GTPV, and it was significantly lower in GICN and GTPV in comparison to GESP (p0.017). Rescue analgesic requirement and side effects were similar among groups.All three blocks can obtain sufficient analgesia after VATS; however, TPVB appeared to be the preferable method compared with ESPB and ICNB, with a more successful analgesia and less morphine consumption.

The aim of this review was to assess the efficacy of intra-articular analgesics in improving outcomes after temporomandibular joint (TMJ) arthrocentesis. An electronic search of PubMed, Scopus, and Google scholar databases was performed for papers in English published up to December 2017 reporting the use of intra-articular analgesics after TMJ arthrocentesis. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), comparative studies, retrospective studies, and case series were included while case reports, technical reports, animal studies, cadaveric studies, and review papers were excluded. Of the six studies included in the review, three were RCTs, two were randomized comparative studies, and one was a retrospective study. Both opioids and non-steroidal anti-inflammatory drugs have been used after TMJ arthrocentesis. Morphine, tramadol, fentanyl, buprenorphine, tenoxicam, and COX-2 inhibitors are the drugs used till date. Placebo-controlled studies reported improved outcomes after TMJ arthrocentesis with morphine and fentanyl but no such results with buprenorphine and tenoxicam. Tramadol was found to be better than COX-2 inhibitor. The quality of literature was not high. There is inconclusive evidence in literature on the benefits of using intra-articular analgesics after TMJ arthrocentesis. Well-designed high-quality RCTs with standard protocol studying the effects of intra-articular opioids and NSAIDS after TMJ arthrocentesis would provide stronger evidence on its use.

Background This clinical study aimed to radiologically and clinically compare the effect of intra-articular injection of methylprednisolone, sodium hyaluronate or tenoxicam following arthrocentesis with that of arthrocentesis alone in patients with non-reducing disc displacement. Material and Methods A total of 44 patients radiographically diagnosed with non-reducing disc displacement of the temporomandibular joint (TMJ) were randomly divided into four treatment groups, as follows: Group 1, arthrocentesis alone; Group 2, arthrocentesis plus methylprednisolone acetate; Group 3, arthrocentesis plus sodium hyaluronate; Group 4, arthrocentesis plus tenoxicam. Maximum mouth opening (MMO), lateral movement, pain severity and tenderness of TMJ and muscles of mastication on palpation were measured before treatment and at 1 week and 1, 3 and 6 months after treatment. Disc position, presence or absence of disc reduction, level of effusion, joint movement and joint space were also evaluated using magnetic resonance imaging (MRI) before treatment and 6 months after treatment. Results No significant differences in treatment success were found among the four groups. MRI findings did not vary significantly among the groups, but pre- and post-operative MRI findings varied significantly within all four groups (p

Achilles tendon rupture is one of the most frequent tendon injuries. The aim of this experimental study was to evaluate the effect of a non-steroidal anti-inflammatory drug (NSAID) and of aerobic exercise, in an isolated fashion and combined, on cell proliferation and on the biomechanical aspects of the Achilles tendon during healing process after a complete tenotomy in 156 male Wistar rats. Half of the animals received an intra-muscular injection of tenoxicam for 7 days and exercise was initiated on the 8th day for half the animals of each group. Animals were sacrificed at 1, 2, 4 and 8 weeks after the tenotomy and cell proliferation was evaluated by immunohistochemistry for PCNA, biomechanical evaluation was performed with ultimate load and gait cycle analysis was also carried out. Animals were divided into four treatment groups: A) no NSAID and no exercise (control group); B) NSAID plus exercise; C) no NSAID, with exercise; D) NSAID and no exercise. We used the test of two-way analysis of variance with equal cells number, Kruskal-Wallis test and also, Bonferroni method, in the R Project program 3.5.0. The highest intensity of PCNA immunostaining was found at 2 weeks in all groups except for group A (control) that had the highest intensity at 1 week. Animals submitted to exercise had significantly higher (P = 0.02) ultimate loads when compared to animals that were not submitted to exercise at 8 weeks after injury. The animals that received NSAID presented with a more stable gait cycle than the animals that did not receive NSAID. Aerobic exercise, initiated early after a complete Achilles tendon tenotomy, was beneficial to the biomechanical aspects of the tendon that occur during tendon regeneration and the combined use of NSAID improved the gait’s characteristics which could be protective against re-ruptures.

Background: childbirth is one of the most painful events of a woman's life. The experience of labor pain is a complex, multidimensional response to sensory stimuli generated during parturition and its intensity can vary greatly. Unlike other acute and chronic pain experiences, labor pain is not associated with pathology, but with the most basic and fundamental of life’s experiences Aim of the work: this work aimed to study the efficacy of intravenous tenoxicam for labor analgesia. Patient and methods: this was two-arm, randomized controlled trial. The first arm (Group T) represented subjects who received tenoxicam. The second arm (Group R) represented subjects who received routine analgesic pethidine and it is given at a dose of 50 mg diluted over 10 ml of normal saline. The parturient woman was given 3-4 cm of diluted pethidine whenever she has intolerable pain. Results: this study included 260 subjects that were allocated into two arms: tenoxicam arm (n=118) and pethidine arm (n=142) as the control group. Tenoxicam group included 118 subjects and the pethidine group included 142 subjects. Maternal age was 23.74 ± 3.76 in tenoxicam group vs 23.99 ± 3.5 in pethidine group. Gestational age was 39.04 ± 1.42 in tenoxicam group vs 38.93 ± 1.5 in pethidine group. Birth weight was 3.43 ± 0.26 in tenoxicam arm vs 3.41 ± 0.26 in pethidine arm, average fetal heart rate was 140.1 ± 17.12 in tenoxicam arm vs 138.1 ± 16.39 pethidine arm, cervical dilatation was 4.19 ± 0.77 in tenoxicam arm vs 4.25 ± 0.7 and interval to delivery was 5.89 ± 1.29 in tenoxicam arm vs 6.2 ± 1.62 in pethidine arm. Conclusion: tenoxicam (40 mg iv), a long acting NSAID that induces analgesia by inhibiting peripheral prostaglandin synthesis, reduced postpartum uterine contraction pain without apparent maternal or neonatal adverse effects. Furthermore, tenoxicam exhibits superior analgesic properties over the routinely used pethidine as labor analgesic. Further studies should evaluate analgesic effects vs side effects of iv tenoxicam as a function of dosage or as part of combination therapy with different opioid analgesics.

Objective: Epilepsy is a short-term paroxysmaldisturbances of brain functions observed between sudden, abnormal andhypersynchronization discharges and seizures of a group of neurons in thecentral nervous system. The nonsteroidal anti-inflammatory tenoxicam ischemical agent that selectively inhibits type 2 cyclooxygenase (COX2), whichconverts arachidonic acid to prostaglandins (PGs). The aim of this study was toinvestigate the effect of the cyclooxygenase-2 inhibitor tenoxicam onpentylenetetrazole on epileptic seizures.Method: Eighteen Wistar Albino male rats (220±20 g) were divided into threegroups: control (n=6), 10 mg/kg/day tenoxicam (n=6) and, 20 mg/kg/day tenoxicam(n=6). Tenoxicam was administered intramuscularly for ten days. On the tenthday, pentylenetetrazol (PTZ) was injected intraperitoneally at 70 mg/kg after45 minutes of drug administration and the animals were observed for 30 min.Stages were determined according to the Racine seizure scale (RC) and the firstmyoclonic jerk time (FMJ) was recorded in seconds. After completing procedure,whole brain tissues were removed and stained with toluidine blue stain. Thenumber of dark neurons withchromatin aggregation inhypocampal CA1 and dentate gyrus (DG) was determined as percentage.Results: Epileptic behavior were evaluated according to the RC, 10 mg/kg oftenoxicam significantly reduced the seizure stage compared to the control(p, Amaç: Epilepsi merkezi sinirsisteminde bir grup nöronun ani, anormal ve hipersenkronize deşarjları ilenöbetler halinde gözlenen beyin fonksiyonlarının kısa süreli paroksimalrahatsızlığı olarak tanımlanır. Nonsteroid anti inflamatuarlardan olantenoksikam araşidonik asidi prostaglandinlere dönüştüren tip 2 siklooksijenaz(COX2) enzimini selektif olarak inhibe eden kimyasal bir ajandır. Bu çalışmanınamacı siklooksijenaz-2 inhibitörü tenoksikam'ın pentilentetrazol ileoluşturulan epileptik nöbetlere üzerine etkisini araştırmaktır.Yöntem: Çalışmamızda 18tane 220-240 gr Wistar Albino erkek sıçan kullanılmıştır. Hayvanlar kontrol(n=6), 10 mg/kg/gün tenoksikam (n=6) ve 20 mg/kg/gün tenoksikam (n=6) olmaküzere üç gruba ayrıldı. On gün süre ile kontrol grubuna çözücü ve diğer ikigruba belirtilen dozlarda tenoksikam intramusküler olarak uygulandı. Onuncu günilaç uygulamalarından 45 dk sonra pentilentetrazol (PTZ) 70 mg/kgintraperitoneal olarak enjekte edildi. Hayvanlar 30 dk boyunca gözlemlendi.Racine nöbet skalasına göre evreleri belirlendi ve ilk miyoklonik jerk zamanı(FMJ) saniye olarak kaydedildi. İşlem bitiminden sonra hayvanların beyindokuları alındı. Beyin dokuları rutin histolojik takip sonrası toluidin blueboyası ile boyanandı. Hipokampüste CA1 ve dentat girus bölgelerinde nöronalhasarı gösteren ‘Dark nöron’ sayılarıyüzde olarak belirlendi. Bulgular: Epileptik davranış sonuçları Racine nöbet skalasına (RC) göredeğerlendirildiğinde, 10 mg/kg tenoksikam kontrole göre nöbet evresini anlamlıolarak azalttı (p

Objective: The aim of this study was to develop and validate two HPLC methods for the quantification of meloxicam and tenoxicam from transdermal therapeutic systems. Methods: Based on 1.0% hydroxypropyl methylcellulose 15000, transdermal patches containing meloxicam or tenoxicam were prepared by solvent evaporation technique. Analytical performances of the HPLC methods for the quantification of meloxicam and tenoxicam from such systems were assessed in terms of specificity, linearity, detection limit, quantification limit, recovery and precision. Results and discussion: The linearity of the method was assessed through a calibration curve in the 1.0 - 75.0 μg∙mL−1 concentration range, with a regression coefficient higher than 0.999. The detection limit and the quantification limit were found to be 0.46 μg∙mL−1 and 1.39 μg∙mL−1, for meloxicam; and 0.88 μg∙mL−1, respectively 2.64 μg∙mL−1 for tenoxicam. According to the European Pharmacopeia 5.0 the mean recovery was found to be between 75% and 125%. As performance criteria for precision was used the RSD% which were lower than 2.0% for both methods. Conclusions: The proposed liquid chromatography methods provide selective, linear and precise results for the quantification of meloxicam and tenoxicam from transdermal therapeutic systems. The presence of a single peak in the chromatograms of the analyzed transdermal patches with meloxicam or tenoxicam, certify the successful determination of the active pharmaceutical ingredient in the prepared patches.

This study evaluated the postoperative analgesic efficacies of fascia iliaca block and periarticular drug injection techniques after TKA (total knee arthroplasty) surgeries.Prospective, randomized clinical trial.University Teaching and Research Center.Seventy-one American Society of Anesthesiologists (ASA) I-III patients between 48 and 70 years of age who underwent total knee arthroplasty were randomized.Tenoxicam (20 mg) was administered intramuscularly to both groups of patients 30 minutes before surgery. Patients were randomized into two groups to receive fascia iliaca block before the induction of anesthesia (Group FI) or periarticular drug injection during the surgery (Group PI). All surgeries were performed under general anesthesia using standard techniques. Postoperative analgesia was provided with patient-controlled intravenous morphine.Total morphine consumption was the primary outcome measure and was recorded postoperatively at 1, 2, 6, 12 and 24 hours. Pain levels at rest and on movement (knee flexion) were evaluated using the Visual Analogue Scale (VAS) and recorded at the same time points. Patients' demographics, rescue analgesic demands, side effects, hemodynamics, and satisfaction scores were also recorded.The groups had similar VAS scores both at rest and on movement (P.05). However, the amount of cumulative morphine and use at each follow-up period was higher in Group PI (P.0001). The groups did not differ significantly in rescue analgesic use or side effects, such as nausea/vomiting, hemodynamic variables, and patient satisfaction scores (P.05).Fascia iliaca block may be used as an alternative method to periarticular injection, and it effectively reduces the amount of morphine used to relieve post-TKA pain.

Summary Background Recently, the potential impact of different medications on the rate of orthodontic tooth movement and the associated root resorption has been systematically reviewed in animal studies and various effects have been shown. However, animal data cannot be extrapolated to human clinical situations directly. Objectives To systematically investigate the most up to date available evidence from controlled human studies regarding the effect of medication administration on the rate of orthodontic tooth movement and associated root resorption development. Search methods We searched eight databases (covering also grey literature) without restrictions and we performed hand searching up until October 2018. Selection criteria Controlled studies in humans assessing the effect of various medications on the rate of orthodontic tooth movement and root resorption development. Data collection and analysis Study selection was followed by data extraction and risk of bias assessment using the ROBINS-I tool for non-randomized and the Cochrane Risk of Bias Tool for randomized studies. Results Eight studies, at various risk of bias, were finally identified. With regard to the rate of orthodontic tooth movement, local injections of prostaglandin E1 were found to exert an increasing effect, whereas systemic intake of nabumetone decreased it. Following tenoxicam administration, drinking water with fluoride or local injections of calcitriol (vitamin D metabolite), no significant effects were demonstrated. Concerning root resorption development, nabumetone administration was shown to reduce it, whereas fluoride, overall, was not observed to exert any effect. Only in individuals subjected to heavy orthodontic forces, did fluoride show a protective effect for the period of force application, but not in the longer term during retention. Conclusions The aforementioned substances may show varying effects on the rate of orthodontic tooth movement and root resorption development in human subjects. Despite the observed limitations, the orthodontist should be able to identify patients taking pharmaceuticals and consider any implications related to orthodontic treatment. Registration PROSPERO (CRD42017078208).

Purpose Opioids have long been used to treat acute postsurgical and postprocedural pain; however, opioid-related adverse events (AEs) contribute to poor patient outcomes. In addition, perisurgical exposure to opioids can potentially increase the risk for opioid-use disorder. NSAIDs reduce pain and inflammation by a mechanism different from that of opioid analgesics and may be useful in reducing the need for opioid drugs as part of a multimodal analgesia strategy. We conducted this review to assess the effectiveness and tolerability of adjunctive conventional NSAIDs given systemically in the perioperative setting in terms of opioid-sparing effects observed postoperatively. Methods Clinical trials published since 2000 that have assessed the opioid-sparing effects of conventional, nonselective NSAIDs were identified by a literature search using the PubMed search engine. Search terms were identified for the treatment of interest, the timing of the intervention, and the drugs of interest (NSAIDs). Data from studies that assessed opioid consumption outcomes with systemic NSAID administration were included in the review; data from studies in which NSAIDs were administered topically or via periarticular injection, local infiltration, or regional block were excluded. Findings Upon full-text review of the search results, 32 studies were chosen for inclusion in this literature review. These studies included those that assessed diclofenac, ketorolac, ibuprofen, ketoprofen, dexketoprofen, flurbiprofen, lornoxicam, tenoxicam, meloxicam, and piroxicam. In studies in which NSAIDs were associated with opioid-sparing effects within the setting of patient-controlled analgesia, opioid use was reduced by 17%–∼50% with diclofenac, 9%–66% with ketorolac, 22%–46% with ibuprofen, 34%–66% with ketoprofen, 36%–50% with dexketoprofen, 38%–41% with tenoxicam, 36%–54% with lornoxicam, and ∼50% with flurbiprofen. No opioid-sparing effect was noted with meloxicam (1 study). The majority of studies that reported on pain-score changes revealed either pain reductions with NSAIDs versus placebo or similar pain scores between groups, indicating that NSAIDs did not compromise pain control. Although many studies found no difference in the prevalence of AEs in NSAID-treated patients compared with controls, several studies noted lower rates of nausea, vomiting, sedation, and pruritus with NSAIDs versus placebo. Conversely, NSAID-related AEs were few overall but included gastrointestinal bleeding, injection site reactions, transient oliguric renal failure, and dizziness. No surgery-related bleeding complications were observed. Implications NSAIDs have the potential to play an important role in reducing postoperative opioid requirements. Reducing the amount of opioids used could be expected to reduce opioid-related side effects and contribute to reversing the opioid epidemic.

Background Intra-articular corticosteroid injections are widely applied in the treatment of symptomatic knee osteoarthritis (OA). There is an evidence of short-term effects of intra-articular corticosteroid injection (up to 3-4 weeks), however there is no consensus for the long-term benefit of this treatment yet (1). Tenoxicam is an effective analgesic and anti-inflammatory drug for symptomatic treatment of OA. Additionally, apart from oral use, tenoxicam is also applied as an intra-articular treatment option to minimize gastrointestinal side effects of NSAIDs (2). Clinical evidence suggests that the combined use of NSAIDs and corticosteroids is synergistic (especially macular edema after cataract surgery in ophthalmology) (3). Objectives The aim of this study is to compare the effectiveness of intra-articular administration of these treatments and their combination and determine whether the combination of intraarticular steroid and tenoxicam was more effective for a long period rather than only tenoxicam and steroid injection alone in OA treatment. Methods 90 patients (56 female, 34 male) with diagnosis of knee osteoarthritis were randomly divided into three groups (30 patients per group): Group 1 were treated by intra-articular injection of tenoxicam. Group 2 were treated by intra-articular injection of triamcinolone hexacetonide. Group 3 were treated by intra-articular injection of triamcinolone hexacetonide combined with tenoxicam. The estimation of the severity of pain by the visual analog scale (VAS) were enrolled at baseline and 1, 3, 6 months post-injection. Additionally, the Western Ontario and McMaster Universities Index (WOMAC) was used to determine the outcome measures of pain, stiffness and physical functioning at baseline and 1, 3, 6 months post-injection. Results The mean age of patients was 65.97±9.29 years. In tenoxicam group, median pre- and post-treatment (at 1, 3 and 6 months) VAS/WOMAC scores were 7.00/32.00, 2.00/10.00, 7.00/32.00 and 7.00/32.00, respectively. In steroid group, median pre- and post-treatment (at 1, 3 and 6 months) VAS/WOMAC scores were 8.00/34.00, 1.00/8.00, 8.00/34.00 and 8.00/34.00, respectively. In steroid plus tenoxicam group, median pre- and post-treatment (at 1, 3 and 6 months) VAS/WOMAC scores were 7.00/34.00, 0.00/6.00, 1.00/8.00 and 2.00/10.00, respectively. VAS and WOMAC scores in 1 month after the injection significantly decreased in both groups compared to baseline (p Conclusion The combination of corticosteroids and tenoxicam seems to produce a more effective result than alone therapy in reducing pain and improving functional recovery. References 1)Maricar N, Callaghan MJ, Felson DT, O’Neill TW. Predictors of response to intra-articular steroid injections in knee osteoarthritis- a systematic review. Rheumatology. 2013;52:1022-1032. [2] Evcik D, Kizilay B, Maralcan G. The efficacy of intraarticular tenoxicam in the treatment of knee osteoarthritis. The Pain Clinic. 2003;15:405-408. [3] Malik A, Sadafale A, Gupta YK, Gupta A. A comparative study of various topical nonsteroidal anti-inflammatory drugs to steroid drops for control of post cataract surgery inflammation. Oman J Ophthalmol. 2016;9:150-156. Acknowledgement None Disclosure of Interests None declared

Although intra-articular corticosteroid injections are widely applied in the treatment of knee osteoarthritis (OA), its effect is short term. Additionally, apart from oral use, tenoxicam is also applied as an intra-articular treatment option to minimize gastrointestinal side effects of NSAIDs. Clinical evidence suggests that the combined use of NSAIDs and corticosteroids is synergistic (especially macular edema after cataract surgery in ophthalmology). Therefore, the aim of this study is to determine whether the combination of intra-articular steroid and tenoxicam was more effective for a long period rather than only tenoxicam and steroid injection alone in OA treatment. Ninety patients were randomly divided into three groups (30 patients per group): group 1, group 2, and group 3 were treated by intra-articular injection of tenoxicam, triamcinolone hexacetonide, and triamcinolone hexacetonide plus tenoxicam, respectively. Visual analog scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were enrolled at baseline and 1, 3, and 6 months post-injection. The mean age of patients was 68.07 ± 8.08, 65.83 ± 10.13, and 67.07 ± 6.01 in group 1, group 2, and group 3, respectively. In tenoxicam group, median pre- and post-treatment (at 1, 3, and 6 months) VAS/WOMAC scores were 7.30 ± 0.53/32.50 ± 3.79, 2.27 ± 0.98/10.83 ± 2.61, 6.73 ± 1.14/30.33 ± 5.93, and 7.03 ± 0.80/31.37 ± 4.38, respectively. In steroid group, median pre- and post-treatment VAS/WOMAC scores were 7.60 ± 0.49/34.33 ± 3.40, 1.37 ± 1.21/8.83 ± 2.70, 6.87 ± 1.35/30.80 ± 7.70, and 7.27 ± 0.86/32.83 ± 4.87, respectively. In steroid plus tenoxicam group, median pre- and post-treatment VAS/WOMAC scores were 7.57 ± 0.50/33.20 ± 3.66, 0.33 ± 0.47/6.67 ± 0.95, 0.93 ± 0.98/7.87 ± 1.96, and 1.97 ± 1.12/10.43 ± 3.70, respectively. VAS and WOMAC scores in 1 month after the injection significantly decreased in both groups compared to baseline (p

Introduction Acute musculoskeletal injuries are one of the most common painful presentation when admission to the emergency department. The aim of the study is to compare the tenoxicam mesotherapy with intravenous dexketoprofen in pain control in patients with acute musculoskeletal injury. Methods This parallel randomized controlled trial was conducted with the patients admitted to the emergency department with musculoskeletal injury. Intravenous dexketoprofen was administered to the control group, and mesotherapy treatment was performed to the other group. Differences between 10th, 30th, 60th and 120th minutes VAS scores and on the admission VAS score, clinically meaningful change in pain intensity, and adverse effect of the procedures were compared among groups. The results The differences in VAS scores and the presence of clinically meaningful change in pain intensity were statistically significantly higher in mesotherapy group than the systemic therapy group in all time periods. During one-week follow-up period, there was no reported adverse effect neither in mesotherapy group nor in the systemic therapy group. Conclusions The mesotherapy treatment may be superior than the systemic therapy for pain relief in musculoskeletal injury in short term follow-up in emergency department settings.

Objective Several methods are used to control the pain after cesarean operations. Recently, the transverse abdominis plane block (TAP) has been proposed to compensate for the problems developed by preexisting methods. In the present study, we compared the analgesic efficacy of the TAP block after caesarean section in a prospective, randomized, double-blinded controlled trial. Methods In this study, thirty patients undergoing cesarean sections under general anesthesia were divided into two groups. Patients in Group T (n=15) on whom TAP Block with USG guidance was performed using 0.25% bupivacaine totally 60 ml. The patients in Group C were administered (n=15), 0.9% NaCl totally 60 ml (30 ml at each side) with USG guidance. Post-operative demand of meperidine using a patient-controlled analgesia device was recorded. Results First time on the need for analgesia were significantly higher in the control group (Group C). The total dose of meperidine, tenoxicam, paracetamol used for analgesia was significantly higher in the Group C. The outset times of breastfeeding and mobilization did not change between the groups. Conclusion The USG-TAP block with 0.25% bupivacaine 60 ml (30 ml on each side) significantly reduced post-operative pain in patients undergoing the cesarean section. We think that TAP block is a comfortable and feasible method which reduces post-operative analgesia need and does not lead any serious complications.

Aim To review the evidence for the use of different non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of biliary colic. Methods The strategies employed included an extensive literature review for articles and studies related to biliary colic from electronic databases including PubMed, Science Direct, Wiley Inter Science, Medline and Cochrane from last 15 years. Keywords: "Biliary colic", "management of biliary colic", "non-steroidal anti-inflammatory drugs", "cholelithiasis" and "biliary colic management". Six randomized control trials, 1 non-randomized trial and 1 meta-analysis were included in this review. The outcomes of these studies and their significance have been reviewed in this paper. Results Current evidence suggests there are no set protocols for biliary colic pain management. NSAIDs are potent in the management of biliary colic, not only in terms of symptom control but in disease progression as well. Apart from the studies on diclofenac and ketorolac, there are studies which have shown that intravenous tenoxicam and injectable flurbiprofen are equally effective in managing biliary colic. The efficacy of NSAIDs is superior in terms of lower number of doses and longer duration of action in comparison to other analgesic agents. Conclusion This literature review has found that NSAIDs are safe and effective for pain control in biliary colic, and reduce the likelihood of further complications.

Subacromial impingement syndrome (SIS) is one of the most frequent shoulder pathologies. Initial treatment is conservative. Subacromial injection of drugs achieves a high concentration at the pathologic site with less drug use and fewer systemic side effects. Glucocorticoids are most frequently injected. One concern with steroid use is the wide array of potential systemic and local complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also peripherally acting and can be used locally. Although intraarticular (IA) use of NSAIDs is common in orthopedic practice, it is mostly restricted to the knee joint. Reports of local NSAID for joint pathologies are relatively rare. This study compared the efficacy of single-dose subacromial injections of betamethasone and lornoxicam for treatment of SIS. Subacromial injections of either 7.0 mg betamethasone or 8 mg lornoxicam were received by 70 patients with mean age 53 (46-68) years. Treatment outcome was assessed with Constant-Murley and UCLA questionnaires before injection and at 2aEuro, 4aEuro, and 6aEuroweek follow-ups. The change in outcome scores compared to pretreatment was higher in the steroid group at all follow-ups (p < 0.001). Patients in the steroid group showed a significant improvement at all follow-ups compared to pretreatment (p < 0.001) and previous follow-ups (p < 0.05) at all times. Patients in the lornoxicam group showed a significant functional improvement in week 2 (p < 0.001), which was not evident in the following weeks (p > 0.05). Although functional recovery halted after week 2, outcome scores remained significantly higher than the pretreatment values at all weeks (p < 0.001). Although a single subacromial lornoxicam injection provides rapid functional recovery, which partially extends into the intermediate term, its results are inferior to betamethasone and it may be an alternative only in patients where corticosteroids are contraindicated.

Clinical Scenario:For active individuals, plantar fasciitis (PF) is one of the most clinically diagnosed causes of heel pain. When conservative treatment fails, one of the next most commonly used treatments includes corticosteroid injections. Although PF has been identified as a degenerative condition, rather than inflammatory, corticosteroid injection is still commonly prescribed. However, the literature has not been examined to determine the effect of corticosteroid injection on PF.Focused Clinical Question:Are corticosteroid injections more effective than other interventions (placebo, platelet-rich plasma, and tenoxicam injections) in the short- and long-term treatment of PF?Summary of Key Findings:Corticosteroid injections are not more effective in the long-term treatment of PF pain than other treatments (platelet-rich plasma, tenoxicam).Clinical Bottom Line:The level 2 and 3 evidence shows that corticosteroids are more effective than placebo injections but are no more effective than tenoxicam injections and perhaps less effective than platelet-rich plasma treatment.Strength of Recommendation:Level 2 and 3 evidence suggests that corticosteroid injections are not more effective in the long-term treatment of PF than platelet-rich plasma or tenoxicam.

Aim: This study aimed to determine the risk factors for postoperative nausea and vomiting (PONV) in children receiving dental treatment under general anesthesia and to identify the subcategories leading to risk formation. Materials and Methods: The study comprised of 100 American Society of Anesthesiologists I patients aged 2–7 years who were administered dental treatment under general anesthesia. Patients were evaluated with regard to PONV risk. Eight different independent risk factors were identified as follows: age, gender, weight, duration of anesthesia, duration of recovery, postoperative pain, rescue analgesia, and type of dental treatment. Classification and regression trees method was used to choose the best predictor for PONV. Results: The incidence of PONV was 25%. No significant difference was found between those with PONV and those without PONV with regard to gender, weight, duration of anesthesia, duration of recovery, or the type of dental treatment (P > 0.05). However, postoperative pain level and use of rescue analgesia with tenoxicam were both predictors of PONV (P < 0.05). For the postoperative pain (≤1.5) subgroup, age proved to be the best predictive variable. Conclusion: The risk limit for PONV was determined to be ≥5.5 years for children who underwent dental procedures under general anesthesia. Postoperative pain and rescue analgesia constituted risks for PONV.Keywords: Children, postoperative nausea and vomiting, postoperative pain, risk factors

Background/aim: This study aimed to compare two nonsteroidal antiinflammatory agents in relation to pain, swelling, and trismus following impacted third molar surgery. Materials and methods: The study was a randomized and a double-blinded study and included 50 healthy individuals. After the operation, patients were randomly assigned to 2 groups in which diclofenac potassium and tenoxicam were used. Impacted third molars were surgically extracted with local anesthesia. Pain was assessed postoperatively by visual analog scale at the 2nd, 6th, 8th, 12th, 24th, and 48th hours and on the 3rd, 5th, and 7th days. Swelling was evaluated using the method of Ustun et al. and trismus was measured with calipers on the postoperative 3rd and 7th days. Results: There was statistically significant difference between the groups in VAS levels at the 2nd and 6th hours; however, VAS levels of the tenoxicam group were significantly lower as compared to diclofenac potassium at the 8th, 12th, 24th, and 48th hours and on the 3rd, 5th, and 7th days (P < 0.05, P < 0.01). No difference was noted regarding trismus and swelling between the groups. Conclusion: Diclofenac potassium and tenoxicam are similarly effective for reduction of swelling and trismus following the extraction of mandibular third molars; however, tenoxicam surpasses diclofenac potassium for controlling pain.

Pain is an undesirable side effect of orthodontic tooth movement, which causes many patients to give up orthodontic treatment or avoid it altogether. The aim of this study was to investigate, through an analysis of the scientific literature, the best method for managing orthodontic pain. The methodological aspects involved careful definition of keywords and diligent search in databases of scientific articles published in the English language, without any restriction of publication date. We recovered 1281 articles. After the filtering and classification of these articles, 56 randomized clinical trials were selected. Of these, 19 evaluated the effects of different types of drugs for the control of orthodontic pain, 16 evaluated the effects of low-level laser therapy on orthodontic pain, and 21 evaluated other methods of pain control. Drugs reported as effective in orthodontic pain control included ibuprofen, paracetamol, naproxen sodium, aspirin, etoricoxib, meloxicam, piroxicam, and tenoxicam. Most studies report favorable outcomes in terms of alleviation of orthodontic pain with the use of low-level laser therapy. Nevertheless, we noticed that there is no consensus, both for the drug and for laser therapy, on the doses and clinical protocols most appropriate for orthodontic pain management. Alternative methods for orthodontic pain control can also broaden the clinician's range of options in the search for better patient care.

To study the changes in pain syndrome and its characteristic in patients with ankylosing spondylitis (AS) who received tenoxicam after non-effective treatment with NSAIDs on the 'on-demand' basis.Forty patients with AS, who had BASDAI ≥4.0 at baseline and after 52 weeks of NSAIDs on the 'on-demand' basis, were randomized into 2 groups: 30 patients were prescribed 20 mg of tenoxicam oraly per day, 10 patients continued previous therapy. The BASDAI, ASDAS indices were calculated in 52 and 56 weeks.BASDAI and ASDAS indices decreased in patients treated with tenoxicam, the AS activity in patients with on-demand NSAID intake did not change. The change of the ineffective long-term NSAID intake in the 'on-demand' basis to permanent drug intake was associated with a rapid (within 4 weeks) decrease in the clinical activity of ankylosing spondylitis.Цель исследования. Изучить изменение болевого синдрома и отдельных его характеристик у больных с анкилозирующим спондилитом, получающих лечение теноксикамом после неэффективного приема нестероидных противовоспалительных препаратов (НПВП) в режиме 'по требованию'. Материал и методы. В исследование включены 40 пациентов с анкилозирующим спондилитом, имевших BASDAI ≥4,0 исходно и через 52 нед приема НПВП в режиме 'по требованию'. Больные были рандомизированы в 2 группы: 30 пациентам назначили постоянный пероральный прием теноксикама в дозировке 20 мг/сут, 10 пациентов продолжали проводимую ранее терапию. Рассчитывали индексы BASDAI, ASDAS через 52 и 56 нед лечения. Результаты и заключение. На фоне постоянного приема НПВП (теноксикам) уменьшились исходно повышенные индексы BASDAI и ASDAS. Показатели активности анкилозирующего спондилита у больных, принимавших НПВП по требованию, не изменились. Замена неэффективного длительного приема НПВП в режиме 'по требованию' на постоянный прием теноксикама ассоциируется с быстрым (в течение 4 нед) уменьшением клинической активности анкилозирующего спондилита.

Objective Postoperative dynamic cryo-compression (DC) therapy has been proposed as a method of reducing pain and the inflammatory response in the early postoperative period after orthopedic joint reconstruction surgery. Our aim was to analyze the analgesic efficacy of DC therapy after adult lumbar spinal surgery. Methods DC was applied for 30 minutes every 6 hours after surgery. Pain was measured by a visual analogue scale (VAS) in the preoperative period, immediately after surgery, and every 6 hours postoperatively for the first 72 hours of the hospital stay. Patients’ pain medication requirements were monitored using the patient-controlled analgesia system and patient charts. Twenty patients who received DC therapy were compared to 20 historical controls who were matched for demographic and surgical variables. Results In the postanesthesia care unit, the mean VAS back pain score was 5.87 ± 0.9 in the DC group and 6.95±1.0 (p=0.001) in the control group. The corresponding mean VAS scores for the DC vs. control groups were 3.8±1.1 vs. 5.4±0.7 (p < 0.001) at 6 hours postoperatively, and 2.7±0.7 vs. 6.25±0.9 (p

The goal of our study was to investigate the incidence of Stevens-Johnson syndrome (SJS), the frequency of SJS diagnosis, and the association between SJS and prior use of allopurinol, carbamazepine or phenytoin. This case-control study utilized data from the National Health Insurance Research Database (NHIRD) of Taiwan. Controls visited the emergency department of the same hospital for trauma or fractures (excluding burns) and used allopurinol, carbamazepine or phenytoin during the past 3 months. We determined whether patients were prescribed a combination of drugs in addition to allopurinol, carbamazepine or phenytoin within the last 3 months. We identified 1 853 985 controls and 7327 SJS-diagnosed patients using the Taiwan NHIRD records for 2000-2008. Higher use of allopurinol (49.8%), carbamazepine (39.1%) or phenytoin (21.3%) was observed among patients (n = 3131) than among controls (n = 2858). The overall SJS incidence rate was 3.6/1 000 000. Drug combinations were uncommon (

Background and Aim: Postoperative pain is well known and usually disturbing complication of surgery. Inflammation plays an important role in the development and progression of postoperative pain. We aimed to investigate possible relationship between preoperatively measured neutrophil‑lymphocyte ratio (NLR) – as an inflammation marker – and postoperative analgesic demand in patients underwent orthognathic surgery.Materials and Methods: We retrospectively investigated medical and anesthesia records of 177 patients underwent orthognathic surgery. Demographical data, preoperative NLR, type of surgery, modified Mallampati score, difficulty degree of intubation, duration of surgery, and postoperative analgesic (tenoxicam – as the first drug of choice, paracetamol, tramadol, or pethidine) usage were recorded. A cutoff value of NLR ≥2 was determined for inflammation threshold. Two groups (Group 1 NLR ≥2, Group 2 NLR

WOS: 000371084600025, PubMed ID: 26374114, Aim There are many alternatives for post-operative pain relief in patients who have had general anaesthesia. The aim of this study was to evaluate the efficacy of intra-articular bupivacaine + morphine and bupivacaine + tenoxicam applications in post-operative pain control in patients undergoing knee arthroscopy with general anaesthesia. Method This was a prospective study. Standard anaesthesia procedures were applied to each patient, and the 240 patients chosen at random were then divided into two groups. Each group received a different combination of drugs for this double-blind study. The first group (group A: 120 patients) received 0.5 % bupivacaine 100 mg + tenoxicam 20 mg (22 ml); the second group (group B) received 0.5 % bupivacaine 100 mg + morphine 2 mg (22 ml); both groups received their drugs at the end of the intra-articular operation before tourniquet deflation. Before the operation, patients were asked about their post-operative pain at particular periods over the following 24 hours using the visual analogue scale (VAS) and the numeric rating scale (NRS). An additional analgaesic requirement and possible side effects were also recorded. Results Group A patients needed analgaesics sooner after operation than patients in group B. In Group B, VAS and NRS values were statistically higher compared with group A at the 12th hour. There were also fewer side effects seen in group A versus group B. Conclusion Effective and reliable results were obtained in post-operative pain control in bupivacaine added to the morphine or tenoxicam groups following arthroscopic meniscectomy. In the tenoxicam group, patients reported less pain, fewer side effects and less need for analgesics at 12 hours after the operation.

NSAIDs and analgesic drugs are used intra-articularly after knee arthroscopy for pain relief. However, synovial effusion is still a common cause of delayed physical therapy. The aim of this study was to demonstrate the beneficial effect of intra-articular injection of Tenoxicam on knee effusion after arthroscopy. This was a prospective non-randomized study on 134 patients with a mean age of 36.7 years. Knee arthroscopy on a day-case basis was performed; normal saline was used for irrigation. At the end of the procedure, fluid was aspirated from the knee joint and 20 ml of Tenoxicam diluted with 20 ml of 0.9 % normal saline was injected into the knee five minutes before deflation of limb tourniquet. The same surgeon performed clinical examination for knee effusion 14 days postoperatively. Encountered pathologies included meniscal injury, degenerative arthropathy, synovial plica and ACL rupture. Knee effusion developed in 15.7 % of the patients, particularly in those with degenerative arthropathy (p = 0.006) and meniscal lesions (p = 0.06). Intra-articular Tenoxicam is a simple method for the prevention of postoperative knee effusion. Degenerative arthropathy and meniscal lesions are major risk factors for post arthroscopy knee effusion.

Fixed drug eruption (FDE) with oxicams is very rare. FDE due to tenoxicam has been reported in several case reports. Skin patch test with the suspected or responsible drug is applied on sites of previous lesions developing with FDE. Recently, the test has been used quite often for diagnosis of FDE although results are variable. Our case was a 63-year-old woman who had developed itching and erythematous lesions 3-5 cm in size localized on her hands and elbows 3-4 hours after the intake of tenoxicam and ranitidine. The lesion became vesiculobullous a few days later. After two weeks, it resolved with hyperpigmentation. The diagnosis of tenoxicaminduced FDE was confirmed after applying patch and provocation tests. Here we described a case of bullous fixed drug eruption due to tenoxicam and we demonstrated the contribution of skin patch tests to the FDE diagnosis.

Background and objective: The use of transversus abdominis plane block with different local anesthetics is considered as a part of multimodal analgesia regimen in laparoscopic cholecystectomy patients. However no studies have been published comparing bupivacaine and levobupivacaine for transversus abdominis plane block. We aimed to compare bupivacaine and levobupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy. Methods: Fifty patients (ASA I/II), undergoing laparoscopic cholecystectomy were randomly allocated into two groups. Following anesthesia induction, ultrasound-guided bilateral transversus abdominis plane block was performed with 30 mL of bupivacaine 0.25% in Group B (n = 25) and 30 mL of levobupivacaine 0.25% in Group L (n = 25) for each side. The level of pain was evaluated using 10 cm visual analog scale (VAS) at rest and during coughing 1, 5, 15, 30 min and 1, 2, 4, 6, 12 and 24 h after the operation. When visual analogue scale > 3, the patients received IV tenoxicam 20 mg. If visual analogue scale remained >3, they received IV. tramadol 1 mg.kg−1. In case of inadequate analgesia, a rescue analgesic was given. The analgesic requirement, time to first analgesic requirement was recorded. Results: Visual analogue scale levels showed no difference except first and fifth minutes postoperatively where VAS was higher in Group L (p 3, os pacientes receberam 10 mg de tenoxicam por via intravenosa (IV). Se a escala visual analógica permanecesse > 3, os pacientes recebiam tramadol IV (1 mg.kg−1). Em caso de analgesia inadequada, um analgésico de resgate foi administrado. A necessidade de analgésico e o tempo até a primeira solicitação de analgésico foram registrados. Resultados: Os escores da escala visual analógica não mostraram diferença, exceto no primeiro e quinto minutos de pós-operatório, onde a escala visual analógica foi maior no Grupo L (p < 0,05). A necessidade de analgésico foi semelhante em ambos os grupos. O tempo até a primeira solicitação de analgésico foi menor no Grupo L (4,35 ± 6,92 min vs. 34,91 ± 86,26 min, p = 0,013). Conclusões: Bupivacaína e levobupivacaína apresentaram eficácia similar no bloqueio TAP em pacientes submetidos à colecistectomia laparoscópica. Keywords: Bupivacaine, Cholecystectomy, Laparoscopic surgery, Levobupivacaine, Postoperative analgesia, Palavras-chave: Bupivacaína, Colecistectomia, Cirurgia laparoscópica, Levobupivacaína, Analgesia pós-operatória

The aim of this study was to compare the efficacy of intra-articular injections of three different agents with well known anti-inflammatory properties.Between April 2010 and January 2013 a total of 100 patients who were diagnosed as temporomandibular joint disorder in the Department of Otolaryngology at Bozok University School of Medicine were prospectively studied. Patients with symptoms of jaw pain, limited or painful jaw movement, clicking or grating within the joint, were evaluated with temporomandibular CT to investigate the presence of cartilage or capsule degeneration. In the study group there were 55 female and 45 male patients who were non-responders to conventional anti-inflammatory treatment for TMJ complaints. The patients were randomly divided into four groups consisting of a control group and three different groups who underwent intra-articular injection of one given anti-inflammatory agent for each group. We injected saline solution to intra-articular space in the control group. Of three anti-inflammatory agents including hyaluronic acid (HA, Hyalgan intra-articular injection, Sodium hyaluronate 10 mg/ml, 2 ml injection syringe, Bilim Pharmaceutical Company, Istanbul, Turkey); betamethasone (CS, Diprospan flacon, 7.0 mg betamethasone/1 ml, Schering-Plough Pharmaceutical Company, Istanbul, Turkey) and; tenoxicam (TX, Tilcotil flacon, 20 mg tenoxicam/ml, Roche Pharmaceutical Company, Istanbul, Turkey) were administered intra-articularly under, ultrasonographic guidance. Following the completion of injections the, changes in subjective symptoms were compared with visual analogue scales, (VAS) scores at 1st and 6th weeks' follow-up visits between four groups.The HA group did significantly better pain relief scores compared to the, other groups at 1st and 6th weeks (p0.05). TX and CS groups' pain scores were better than control group values (p0.05, for both agents). The pain relief effect of TX was noted to decrease significantly between the 1st and 6th week (p0.05) (Fig. 1). We did not observe the same pattern in HA, CS and control (saline) groups between 1st and 6th week (p0.05).We found that HA produced better pain relief scores when compared to the other anti-inflammatory agents studied. The main disadvantage of HA is its relatively higher cost. Additionally it does not have a reimbursement status by state or private health insurance systems in Turkey. Despite the lower VAS scores, intra-articular TX and CS may be assessed as more economic alternatives to intra-articular HA injections.

Pacijentica u dobi od 54 godine bila je primljena s jakim bolovima u gingivi i obraznim sluznicama. Oralnim pregledom uočene su plamenocrvene desni i ulcerirane lezije s bijelim strijama prekrivene pseudomembranama na objema obraznim sluznicama. Bolovala je od hipertenzije, dislipidemije, subkliničkog hipotiroidizma i artritisa. Bila je pod terapijom atorvastatina, hidroklorotijazida, valsartana, levotiroksina i nesteroidnih protuupalnih lijekova (NSAID). Oralne lezije pacijentice blago su se smanjile nakon terapije kremom s pimekrolimusom, 0,1-postotnim triamkinolon-acetonidom u orabazi i injekcijama. Nakon što je Diclofenac zamijenjen Tenoxicamom i oralne lezije tretirane različitim steroidima, stanje se znatno poboljšalo. Na temelju biopsije bukalne sluznice dijagnosticiran je lihen planus. Patch-test pokazao je pozitivnu reakciju na živu, zlatni natrijev tiosulfat i platinu. Nakon godinu dana na lijevoj obraznoj sluznici pojavila se crvena, okrugla papilomatozna lezija. Patohistološkim nalazom potvrđeno je da je riječ o nespecifičnom ulkusu s kroničnom upalom. Lezije su buknule nakon zamjene amalgamskih ispuna u zubima krunama. Nakon terapije ugljično-dioksidnim laserom, lezije su se donekle smanjile. Direktna i indirektna imunofluorescencija lezija bila je negativna. Ovaj prvi prikaz slučaja pokazuje da tijekom palijativne terapije refraktorne oralne lihenoidne lezije snažnim topikalnim steroidima sedam godina nije bilo nuspojava. U ovom slučaju CO2-laser može biti alternativna terapija., A 54-year-old female presented with severe pain on the gingiva and buccal mucosa. Oral findings revealed generalized fiery red gingiva, ulcerative with white striae covered by pseudo-membranes on both buccal mucosae. She had hypertension, dyslipidemia, subclinical hypothyroidism and arthritis. She was treated with atorvastatin, hydrochlorothiazide, valsartan, levothyroxine and non-steroidal anti-inflammatory drug (NSAIDs). Her oral lesions were a slight improvement from a previous treatment with pimecrolimus cream, triamcinolone acetonide 0.1% orabase and injection. After diclofenac was replaced with tenoxicam and oral lesions were treated with various topical steroids, the lesions showed marked improvement. The biopsy from the buccal mucosa revealed oral lichen planus. Patch test showed positivity to mercury, gold sodium thiosulfate and palladium. One year later the left buccal mucosa showed red, round papillomatous-like lesions. The histopathological report showed a non-specific ulcer with chronic inflammation. The lesions flared up after replacing amalgam with crowns. After CO2 laser treatment, the lesions showed some improvement. Direct and indirect immunofluorescence of the lesions proved to be negative. This first case report showed that the palliative treatment of refractory oral lichenoid lesions with potent topical steroids for 7 years had no side-effects. CO2 laser can be an alternative treatment of refractory lesion in this case.

Temporomandibular joint disorders affect a big portion of the population. There are a variety of treatment methods currently in use. Conservative treatment modalities are followed by more invasive approaches like arthrocentesis or arthroscopy. The aim of the study is to compare the effects of intra-articular tenoxicam injection and arthrocentesis plus viscosupplementation on patients in which a previous arthrocentesis plus viscosupplementation has failed to relieve pain and restore function. The study group consists of 18 TMJs in 16 patients (15 female and 1 male) and the patients were randomly divided into two groups as the arthrocentesis plus viscosupplementation group (n: 8) and tenoxicam injection (n: 10). 20 mg of tenoxicam was injected to the upper compartments of 10 joints without arthrocentesis. The other 8 joints were treated with a second arthrocentesis and sodium hyaluronate injection. VAS scores and maximum mouth opening with and without assistance were recorded in the post operative first week, first month and third month. The results show that there is little benefit in using relatively conservative methods once an arthrocentesis together with viscosupplementation has failed to relieve the patients pain. It is concluded that more invasive procedures should be considered for the patients who do not benefit from arthrocentesis.

Aim. Postoperative pain is a major problem in patients who have undergone surgery of the shoulder joint. We retrospectively evaluated 26 patients in whom a subacromial catheter had been placed for postoperative pain management following shoulder surgery. Method. Infusion of local anesthetics and/or opioids through a subacromial catheter, placed at the end of the procedure, was started after surgery. This catheter was kept in place for 24 hours. The patients’ pain was evaluated by using a visual analog scale (VAS). Patients with a VAS score greater than 7 were given meperidine, 0.5 mg/kg i.v., those with a score of 5-7 received tenoxicam, 20 mg i.v., and patients who continued to have a score of >5 at the end of 30 minutes were given paracetamol, 1 g i.v. as an additional analgesic injection. Results. None of the patients had a need for meperidine after 24 hours of surveillance. Seven patients with a VAS score of 5-7 were given tenoxicam, while seven patients, all female, who had continuing pain, received paracetamol. Conclusion. A subacromial catheter, which does not cause adverse effects or complications, is easy to apply and allows effective analgesia, can be used with confidence in the postoperative pain management of patients undergoing shoulder surgery. The need for supplementary analgesia in women only is significant, indicating the role of the patient’s sex in pain perception.

Summary Esophageal stricture, one of the important complications of corrosive esophagus, develops following edema and granulation tissue that forms during and after the inflammatory reactions. Tenoxicam, a non-steroid anti-inflammatory drug with a long half-life, prevents various leukocyte functions including phagocyte and histamine secretion by inhibiting prostaglandin synthesis and removes various oxygen radicals in the region of inflammation. We designed this as a histopathological study using tenoxicam in rats for which we created a corrosive esophagus model. After necessary authorizations were obtained, the study was performed in Canakkale 18 Mart University experimental animal laboratory. Twenty-four Wistar albino rats, weighing 220–240 g, were used for the experiment. Experimental animals were randomized into three groups: tenoxicam group (group T, n:8), control group (group C, n:8), and sham group (group S, n:8). Tenoxicam 0.5 mg/kg/day was administered to animals in group T, where esophageal burn was developed experimentally, 5 mg/kg 0.9% NaCL was administered i.p. to rats in group C for 15 days, once in 24 hours. No procedure was applied to rats in group S. After 15 days, all animals were sacrificed under general anesthesia and their esophagi were extracted. As a result of histopathological evaluation, inflammation and fibroblast proliferation was not observed in rats in the sham group (group S). Intense inflammation was observed in six rats (6+/2−) in the control group, and fibroblast proliferation was observed as 5+/3−. And in treatment groups, inflammation was evaluated as 3+/5−, and fibroblast proliferation as 3+/5−. In our study, histopathologic damage score was higher in the control group (P < 0.005). We deduce that tenoxicam can be useful in the treatment of caustic esophageal injuries in the acute phase, but think that these drugs require further researches and clinical studies before routine clinical use.

Background/Aims: The present study investigates the effects of pregabalin (PGB), acetaminophen (ACET) and tenoxicam (TNX) administration in somatic and visceral nociception, using the tail flick test and the writhing test in mice. Methods: In the tail flick test, the substances were administered orally and the latency time response was recorded 15, 30, 60, 90 and 120 min after administration. In the writhing test, pain responses were scored every 5 min during a 30-min period after intraperitoneal injection of diluted acetic acid. Results: Our study demonstrated that oral administration of the combination PGB-ACET resulted in a stronger increase of latency reaction - statistically significant after 15 min compared to TNX and after 30 min compared to PGB in tail flick test. In the writhing test, the combination PGB-ACET, but also PGB-TNX, resulted in a stronger decrease of writhe numbers - statistically significant compared to the effects of the separate administration of each substance. This decrease was more intense in animals treated with the combination PGB-ACET than with PGB-TNX. Conclusion: These results suggest an antinociceptive activity which may be a consequence of the synergic action of the substances.

Background The aim of the present study was to compare the effects of preemptive intravenous tenoxicam and methylprednisolone administrations on extraction of impacted third molars. Material/Methods This was a placebo-controlled, randomized, double-blind, clinical trial. A total of 60 adult patients ages 18–40 years with the complaints of impacted third molar teeth were included in the study. Results The postoperative swelling ratios (p

Objectives In this study, we aimed to compare the postoperative analgesic efficiency of an ultrasound-guided fascia iliaca compartment block and a 3 in 1 block in patients who underwent hip prosthesis surgery as a result of hip fracture. Methods With approval from the local ethics committee, 70 patients, aged 20 to 80, undergoing hip prosthesis surgery under elective conditions were included in this randomized, prospective, controlled study. They were informed of the patient-controlled analgesia (PCA) device and visual analog scale (VAS). All patients were separated randomly into three groups. Anaesthesia induction was standardized for all groups. An ultrasound guidance fascia iliaca compartment block (FICB) was applied to the first group before anaesthesia induction. For the second group, a 3 in 1 block was applied, while for the control group no block was applied. After incision on all patients, 20 mg tenoxicam and 1 mg/kg tramadol were injected intravenously. Following surgery, IV tramadol PCA was begun on all patients routinely. In our study, the presence of cortisol and ACTH levels, hemodinamical parameters, nausea and sedation were determined. Results We observed a decrease in VAS values and opioid consumption, no adverse effects on nausea and sedation, and a suppression of stress hormones in both the ultrasound-guided FICB and 3 in 1 block groups. Conclusion We believe that the safe and efficient application of the ultrasound-guided 3 in 1 block and the FICB is necessary in multimodal analgesic treatment in order to enable postoperative analgesia in hip prosthesis surgery.

In patients who are hospitalized for surgery, anxiety disorders are frequently observed. Anxiety affects the patient’s perception of postoperative pain and has a negative impact on recovery from anesthesia. This study attempted to compare the effect of preoperative anxiety on postoperative pain control and recovery from anesthesia in patients undergoing laparoscopic cholecystectomy. A total of 80 patients were enrolled who were undergoing laparoscopic cholecystectomy. Demographic characteristics of the patients were recorded. Beck’s anxiety inventory (BAI) was administered to the patients: patients with anxiety were included in the high-anxious patient group (group H) and patients without anxiety were enrolled in the low-anxious group (group L). Duration of surgery, duration of anesthesia, extubation time, and adverse effects were recorded. During the postoperative period, patient-controlled analgesia with tramadol was used for pain control. Visual analog scale (VAS) scores and tramadol consumption of all patients were recorded. Among all patients, 31 (38.75 %) patients had preoperative anxiety, and significant correlation was found between the days of hospitalization and preoperative score of BAI. In group L, extubation time, the time for the modified Aldrete score to reach 9, was seen as significantly shorter and fewer postoperative side effects were determined. Also in group L, postoperative VAS score and tramadol consumption were significantly lower, and less tenoxicam was needed. A high preoperative anxiety level negatively affects recovery from anesthesia and control of postoperative pain. In this patient group, the increased need for postoperative analgesia must be adequately met.

Amac: Bu calismada septoplasti sonrasi agri yonetiminde intravenoz parasetamol ve tenoksikamin etkinligi karsilastirildi. Hastalar ve Yontemler: Bu randomize kontrollu calismaya Mayis 2008 Ocak 2009 tarihleri arasinda klinigimizde septoplasti yapilan 40 eriskin erkek hasta (ort. yas 21.7 yil; dagilim 19-24 yil) dahil edildi. Hastalar her bir grupta 20 kisi olacak sekilde rastgele iki gruba ayrildi. Ameliyat sonrasi analjezi, birinci grupta (parasetamol grubu) her alti saatte bir intravenoz 1 gr parasetamol ile; ikinci grupta (tenoksikam grubu) ise, ilk 24 saatte intravenoz tek doz 20 mg tenoksikam ile saglandi. Gorsel analog olcegi (GAO), ameliyat sirasinda ve ameliyat sonrasi 30. dakikada, 1, 2, 6, 12. ve 24. saatlerde agri duzeyini degerlendirmek icin kullanildi. Ameliyat sonrasi komplikasyonlar her iki grupta da kaydedildi. Bulgular: Gruplar arasinda ameliyat sirasi agri skorlari acisindan anlamli fark yoktu (p=0.47). Gorsel analog olcegi skoru parasetamol grubunda 30. dakika (p=0.018), 1, 2. ve 6. saatlerde tenoksikam grubundan anlamli olarak daha dusuktu (sirasiyla p=0.0001; p=0.001; p=0.04). Sonuc: Septoplasti ameliyati sonrasi erken donemde, orta duzey agri mevcuttur. Bu durum ise analjeziklerle onlenebilmektedir. Anahtar Sozcukler: Lokal; parasetamol; ameliyat sonrasi agri; septoplasti; tenoksikam. Objectives: This study aims to compare the efficacy of intravenous paracetamol and tenoxicam in the management of postoperative pain following septoplasty. Patients and Methods: Between May 2008 and January 2009, 40 male adults (mean age 21.7 years; range 19 to 24 years) who underwent septoplasty in our clinic were included in this randomized controlled study. Patients were randomly divided into two groups, including 20 in each group. Analgesia was achieved through intravenous paracetamol 1 g every six hours in the first group (paracetamol group) and intravenous tenoxicam 20 mg at a single dose within the first 24 hours in the second group (tenoxicam group). Visual analog scale (VAS) was used to assess the pain severity preoperatively and at 30 minutes, 1, 2, 6, 12 and 24 hours postoperatively. Postoperative complications for both groups were also recorded. Results: There was no significant difference in intraoperative pain scores between the groups (p=0.47). The VAS scores at 30 minutes (p=0.018), 1, 2 and 6 hours were significantly lower in paracetamol group, compared to tenoxicam group (p=0.0001; p=0.001; p=0.04, respectively). Conclusion: Early postoperative moderate pain is accompanied following septoplasty. This can be prevented by using analgesics.

Objective To detect the effect of intra-peritoneal instillation of local anesthetic with or without NSAIDs on pain relief after gynecological laparoscopy. Methods Seventy five patients scheduled for laparoscopy were included in the study and randomly divided into three groups. At the end of the laparoscopic procedure, 100 mL normal saline in the first group, or 100 mL normal saline contains 200 mg lidocaine in the second group, or 100 mL normal slaine containing 200 mg lidocaine and 20 mg tenoxicam in the third group were splashed into the pelvis by the surgeon. Post-operative pain were monitored and compared. Results The incidence and severity of immediate postoperative shoulder pain reduced from 44% of patients scoring 2-5 in saline group to 16% scoring 2-3 in lidocaine group and 8% scoring 2-3 in lidocaine-tenoxicam group. Compared with saline group, abdominal pain scores were significantly lower in lidocaine group and lidocaine-tenoxicam group over 24 hours after surgery. At 12 and 24 hours after surgery, abdominal pain scores were significantly reduced in lidocaine-tenoxicam group compared with lidocaine group. No pain on deep respiration was reported in 84%, and 68% in lidocaine-tenoxicam and lidocaine groups respectively compared to 12% in those in the saline group. The mean time to first request for analgesia was increased from (2.3 ±1.9) hours in saline group to (4.4 ± 2.4) hours in lidocaine group and to (8.3 ± 10.2) hours in lidocaine-tenoxicam group. Conclusion Intraperitoneal balanced analgesia (local anesthetics ± NSAIDS) is a simple and safe technique for analgesia following gynaecological Laparoscopy.