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Preemptive analgesia by lornoxicam – an NSAID – significantly inhibits perioperative platelet aggregation

Published online by Cambridge University Press:  01 September 2008

M. Felfernig ,
A. Salat ,
O. Kimberger ,
P. Gradisek ,
M. R. Müller  and
D. Felfernig
M. Felfernig*
Affiliation:
Royal Medical Wing-Al Mafraq, Department of Anaesthesia and Intensive Care, Abu Dhabi, UAE Medical University Vienna, Department of Anaesthesiology and Intensive Care Medicine, Vienna, Austria
A. Salat
Affiliation:
Medical University Vienna, Department of General Surgery, Vienna, Austria
O. Kimberger
Affiliation:
Medical University Vienna, Department of Anaesthesiology and Intensive Care Medicine, Vienna, Austria
P. Gradisek
Affiliation:
University of Ljubljana, Department of Anaesthesiology and Intensive Therapy, Slovenia
M. R. Müller
Affiliation:
Medical University Vienna, Department of Cardiothoracic Surgery, Vienna, Austria
D. Felfernig
Affiliation:
Medical University Vienna, Department of Anaesthesiology and Intensive Care Medicine, Vienna, Austria
*
Correspondence to: Michael Felfernig, Department of Anaesthesia and Intensive Care, RMW-Al Mafraq, Abu Dhabi, UAE. E-mail: [email protected]; Tel: +971 501248029; Fax: +971 25823763
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Summary

Background and objective

To investigate whether preemptive administered lornoxicam changes perioperative platelet function during thoracic surgery.

Methods

A total of 20 patients scheduled for elective thoracic surgery were randomly assigned to receive either lornoxicam (16 mg, i.v.; n = 10) or placebo (n = 10) preoperatively. All patients underwent treatment of solitary lung metastasis and denied any antiplatelet medication within the past 2 weeks. Blood samples were drawn via an arterial catheter directly into silicone-coated Vacutainer tubes containing 0.5 mL of 0.129 M buffered sodium citrate 3.8% before, 15 min, 4 h and 8 h after the study medication was administered. Platelet aggregation curves were obtained by whole blood electrical impedance aggregometry (Chrono Log®).

Results

Platelet aggregation was significantly reduced 15 min, 4 h and 8 h after lornoxicam administration compared to placebo (P < 0.05) for collagen, adenosine diphosphate and arachidonic acid as trigger substances. Adenosine diphosphate-induced platelet aggregation decreased by 85% 15 min after lornoxicam administration, and remained impaired for 8 h.

Conclusion

Platelet aggregation assays are impaired for at least 8 h after lornoxicam application. Therefore perioperative analgesia by use of lornoxicam should be carefully administered under consideration of subsequent platelet dysfunction.

Keywords

PLATELET AGGREGATIONANALGESIA POSTOPERATIVELORNOXICAM
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 9 , September 2008 , pp. 726 - 731
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Woolf, CJ, Chong, MS. Preemptive analgesia treating postoperative pain by preventing the establishment of central sensitation. Anesth Analg 1993; 77: 362–379.CrossRefGoogle Scholar
2.Goodwin, SA. A review of preemptive analgesia. J Perianesth Nurs 1998; 13: 109–114.CrossRefGoogle ScholarPubMed
3.Hitzenberger, G, Radhofer-Welte, F, Takacs, F, Rosenow, D. Pharmacokinetics of lornoxicam in man. Postgrad Med J 1990; 66: 22–26.Google Scholar
4.Staunstrup, H, Ovesen, J, Larsen, UT et al. Efficacy and tolerability of lornoxicam versus tramadol in postoperative pain. J Clin Pharmacol 1999; 39: 834–841.CrossRefGoogle ScholarPubMed
5.Rosenow, DE, Albrechtson, M, Stolke, D. A comparison of patient controlled analgesia with lornoxicam versus morphine in patients undergoing lumbar disk surgery. Anesth Analg 1998; 86: 1045–1050.Google ScholarPubMed
6.Norholt, SE, Sindet-Pedersen, S, Larsen, U et al. Pain control after dental surgery: a double blind, randomised trial of lornoxicam versus morphine. Pain 1996; 67: 335–343.CrossRefGoogle ScholarPubMed
7.Ilias, W, Jansen, M. Pain control after hysterectomy: an observer-blind, randomised trial of lornoxicam versus tramadol. Br J Clin Pract 1996; 50: 197–202.CrossRefGoogle ScholarPubMed
8.Inan, N, Ozcan, N, Takmaz, SA et al. Efficacy of lornoxicam in postoperative analgesia after total knee replacement surgery. Agri 2007; 19: 38–45.Google ScholarPubMed
9.Arslan, M, Tuncer, B, Babacan, A et al. Postoperative analgesic effects of lornoxicam after thyroidectomy: a placebo controlled randomized study. Agri 2006; 18: 27–33.Google Scholar
10.Sen, S, Ugur, B, Aydin, ON, Ogurlu, M, Gezer, E, Savk, O. The analgesic effect of lornoxicam when added to lidocaine for intravenous regional anaesthesia. Br J Anaesth 2006; 97: 408–413.CrossRefGoogle ScholarPubMed
11.Papadima, A, Lagoudianakis, EE, Antonakis, PT et al. Parecoxib vs. lornoxicam in the treatment of postoperative pain after laparoscopic cholecystectomy: a prospective randomized placebo-controlled trial. Eur J Anaesthesiol 2007; 24: 154–158.CrossRefGoogle ScholarPubMed
12.Yakhno, N, Guekht, A, Skoromets, A et al. Analgesic efficacy and safety of lornoxicam quick-release formulation compared with diclofenac potassium: randomised, double-blind trial in acute low back pain. Clin Drug Investig 2006; 26: 267–277.Google Scholar
13.Sener, M, Yilmazer, C, Yilmaz, I et al. Patient-controlled analgesia with lornoxicam vs. dipyrone for acute postoperative pain relief after septorhinoplasty: a prospective, randomized, double-blind, placebo-controlled study. Eur J Anaesthesiol 2008; 25: 177–182.CrossRefGoogle ScholarPubMed
14.Kocaayan, E, Ozkardeler, S, Ozzeybek, D, Bayindir, S, Akan, M. Comparison of effects of preoperatively administered lornoxicam and tenoxicam on morphine consumption after laparoscopic cholecystectomy. Eur J Anaesthesiol 2007; 24: 714–719.CrossRefGoogle ScholarPubMed
15.Kullich, W, Klein, G. Die Ausschüttung der körpereigenen Opiatpeptide Dynorphin und ß-Endorphin unter dem Einfluß des nichtsteroidalen Antirheumatikums Lornoxicam i.v. Akt Rheumatol 1992; 17: 128–132.CrossRefGoogle Scholar
16.Aabakken, L, Osnes, M, Frenzel, W. Gastrointestinal tolerability of lornoxicam compared to that of naproxen in healthy male volunteers. Aliment Pharmacol Ther 1996; 10: 151–156.CrossRefGoogle ScholarPubMed
17.Meling, TR, Aabakken, L, Roseth, A, Osnes, M. Faecal calprotectin shedding after short-term treatment with nonsteroidal anti-inflammatory drugs. Scand J Gastroenterol 1996; 31: 339–344.CrossRefGoogle Scholar
18.Balfour, JA, Fitton, A, Barradell, LB. Lornoxicam. A review of its pharmacology and therapeutic potential in the management of painful and inflammatory conditions. Drugs 1996; 51: 639–657.CrossRefGoogle ScholarPubMed
19.Blaicher, AM, Landsteiner, HT, Zwerina, J et al. Effect of non-selective, non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 selective inhibitors on the PFA-100 closure time. Anaesthesia 2004; 59: 100–102.CrossRefGoogle ScholarPubMed
20.Berg, J, Fellier, H, Christoph, T, Grarup, J, Stimmeder, D. The analgesic NSAID lornoxicam inhibits cyclooxygenase (COX)-1/-2, inducible nitric oxide synthase (iNOS), and the formation of interleukin (IL)-6 in vitro. Inflamm Res 1999; 48: 369–379.CrossRefGoogle ScholarPubMed
21.Steinberg, RB, Tessier, EG, Grass, JA. Gastrointestinal bleeding after administration of ketolorac. Anesthesiology 1993; 73: 1146–1147.Google Scholar
22.Kehlet, H, Dahl, JB. The value of “multimodal” or “balanced analgesia” in postoperative pain. Br J Anaesth 1993; 70: 434–439.Google Scholar
23.Souter, AJ, Fredman, B, White, P. Controversies in the perioperative use of nonsteroidal antiinflammatory drugs. Anesth Analg 1994; 79: 1178–1190.CrossRefGoogle Scholar
24.Thwaites, BK, Nigus, DB, Bouska, GW et al. Intravenous ketolorac thromethamine does not worsen platelet function during knee arthroscopy under general anesthesia. Anesth Analg 1995; 81: 119–124.Google Scholar
25.Siemens, HJ, Breuckner, S, Hagelberg, S et al. Course of molecular hemostatic markers during and after different surgical procedures. J Clin Anesth 1999; 11: 622–629.CrossRefGoogle ScholarPubMed
26.Cardinal, DC, Flower, RJ. The electronic aggregometer: a novel device for assessing platelet behavior in whole blood. J Pharmacol Methods 1980; 3: 135–158.Google Scholar
27.Mueller, MR, Schreiner, W, Wohlfart, A, Salat, A, Wollner, E. The influence of sample age on collagen-induced platelet aggregation in whole blood. Thromb Res 1990; 60: 477–487.CrossRefGoogle Scholar
28.Schreiner, W, Mueller, MR, Premauer, W, Wolner, E. Computerized acquisition and evaluation of whole blood aggregometry data. Comput Biol Med 1991; 2: 435–441.CrossRefGoogle Scholar
29.Mueller, MR, Salat, A, Schreiner, W et al. Influence of hematocrit and platelet count on impedance and reactivity of whole blood for electrical aggregometry. J Pharmacol Methods 1995; 34: 17–22.CrossRefGoogle Scholar
30.Blaicher, AM, Landsteiner, HT, Al-Falaki, O et al. Acetylsalicylic acid, diclofenac, and lornoxicam, but not rofecoxib, affect platelet CD 62 expression. Anesth Analg 2004; 98: 1082–1085.CrossRefGoogle Scholar
31.Kozek-Langenecker, SA. The effect of drugs used in anaesthesia on platelet membrane receptors and on platelet function. Curr Drug Targets 2002; 3: 247–258.CrossRefGoogle ScholarPubMed
32.Aoki, H, Mizobe, T, Nozuchi, S, Hiramatsu, N. In vivo and in vitro studies of the inhibitory effect of propofol on human platelet aggregation. Anesthesiology 1998; 88: 362–370.CrossRefGoogle ScholarPubMed
33.Kokores, JA, Economopoulos, TC, Alexopoulos, C, Pyrovolakis, J, Papayannis, AG. Platelet function tests during major operation for gastro-intestinal carcinoma. Br J Surg 1977; 64: 147–149.CrossRefGoogle ScholarPubMed
34.Niemi, TT, Taxell, C, Rosenberg, PH. Comparison of the effect of intravenous ketoprofen, ketolorac and diclofenac on platelet function in volunteers. Acta Anaesthesiol Scand 1997; 41: 1353–1358.CrossRefGoogle Scholar
35.Sommers, DK, Kovarik, JM, Meyer, EC et al. Effects of diclofenac on isradipine pharmacokinetic and platelet aggregation in volunteers. Eur J Pharmacol 1993; 44: 391–393.Google ScholarPubMed
36.Laitinen, J, Nuutinen, LS, Puranen, J et al. Effect of non-steroidal anti-inflammatory drug, diclofenac, on haemostasis in patients undergoing total hip replacement. Acta Anaesthesiol Scand 1992; 36: 486–489.CrossRefGoogle ScholarPubMed
37.Brooks, PM. Nonsteroidal anti-inflammatory drugs. In: Bowdle, T, Horita, A, Kharasch, E, eds. The Pharmacologic Basis of Anesthesiology. New York: Churchill Livingstone Inc, 1994: 683–684.Google Scholar