Comparison of the effects of intravenous dexketoprofen, lornoksicam and diclofenac sodium on analgesic effect and tramadol consumption in patients receiving patient controlled tramadol

Comparison of The Effects of Intravenous Dexketoprofen, Lornoksicam and Diclofenac Sodium on Analgesic Effect and Tramadol Consumption In Patients Receiving Patient Controlled TramadolBackground and Goal of study: This prospective, randomized, double blinded, controlled study was designed to compare the effects of dexketoprofen, lornoksicam and diclofenac sodium, starting 30 minutes before the end of anaesthesia and continuing for 24 hour as an intermittent bolus, on postoperative analgesic effect and tramadol consumption in patients receiving postoperative patient controlled tramadolMaterial and Methods: Following approval of drug research ethical committee and patient written consent, 80 patients undergoing elective laparotomy were recruited. Patients were randomly allocated into four groups. Thirty minutes before the end of anaesthesia; the first group (Group I) received 50 mg of dexketoprofen, the second group (Group II) received 8 mg of lornoksicam, the third group (Group III) received 75 mg of diclofenac sodium and the fourth group (Group IV) the control group and received 2 cc of 0.9 % saline intravenously. At the closure of peritoneum, all patients were given a loading dose of tramadol (1 mg/kg) for the management of postoperative analgesia. Patients were allowed to use a patient-controlled analgesia (PCA) device giving a bolus dose of tramadol 0.2 mg/kg. Discomfort, sedation, pain scores, cumulative tramadol consumption, supplement meperidine requirement and side effects were recorded at the first minute and at 1,2, 6, 12 and 24 hours after start of PCA.Results: Pain scores were significantly higher in group IV at each study period after postoperative 30 min than in the other groups (p<0.01). It was also significantly higher in group IV at 1st, 15th min, 6th and 12 hours than in group III (p<0.01). Tramadol consumption was significantly lower in group III at each study period after the first postoperative hour than in group IV (p<0.009). It was also significantly higher in group IV at each study period after the second postoperative hour than in the other treatment groups (p<0.001). Supplement meperidine requirement were found significantly higher in group IV at each study period after postoperative 30 min than in the other groups (p<0.01). No significant side effect was reported between groups.Conclusion: Among the treatment groups, diclophenac sodium provided lowest tramadol consumption and lower pain scores compared to the other treatment drugs.Key words: Postoperative pain, dexketoprofen, lornoksicam, diclofenac sodium, Tramadol