Assessment of postoperative analgesia after intraperitoneal instillation of lornoxicam in laparoscopic appendectomy: a randomized study

Anil Kumar, Rekha Kumari, Sushil Kumar, Pragati Raj


Background: The laparoscopic surgeries though results in less postoperative pain it is not a pain-free procedure and early postoperative pain is the most dominant complaint which requires strong analgesia. This study assessed post-operative analgesia after intraperitoneal instillation of lornoxicam in laparoscopic appendicectomy.

Methods: This single blind randomized controlled trial was done in a tertiary care Centre of Patna from January 2016 to December 2016. A total of 60 patients scheduled for laparoscopic appenticectomy were randomly assigned into two groups of 30 each (Group A and B) using computer generated random numbers. Patients in group A received intraperitoneal instillation of 8 mg lornoxicam (Diluted in 100 ml of normal saline) and in group B patients received 100 ml of intraperitoneal normal saline. During the post-operative period pain and requirement of analgesia were assessed.

Results: The demographic characteristics, clinical presentation and preoperative evaluation for vitals was comparable in group A and B. The mean VAS score was significantly low in group A compared to group B at fourth, sixth, eight and twelfth hour interval (p<0.050). In patients with group B, the requirement of analgesia was high (53.33%) compared to group A (33.33%) (p=0.118).

Conclusions: The intraperitoneal instillation of lornoxicam is simple analgesic technique that reduces the pain without adverse effects compared to normal saline.


Intraperitoneal instillation, Laparoscopic appendectomy, Lornoxicam

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Switzer NJ, Gill RS, Karmali S. The evolution of the appendectomy: from open to laparoscopic to single incision. Scientifica. 2012;2012.

Kim HO, Yoo CH, Lee SR, Son BH, Park YL, Shin JH, et al. Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery. J Korean Surg Soc. 2012;82(3):172-8.

Memedov C, Menteş Ö, Şimşek A, Can KE, Yağci G, Harlak A, et al. Comparison of analgesic effects of intraperitoneal lornoxicam and ropivacaine administration in laparoscopic cholecystectomy. Balkan Med J. 2010;2010(3):142-9.

Ortiz J, Rajagopalan S. A review of local anesthetic techniques for analgesia after laparoscopic surgery. J Minim Invasive Surg Sci. 2014;3(2):e11310.

Møiniche S, Mikkelsen S, Wetterslev J, Dahl JB. A qualitative systematic review of incisional local anaesthesia for postoperative pain relief after abdominal operations. Br J Anaesthesia. 1998;81(3):377-83.

Kehlet H, Gray AW, Bonnet F, Camu F, Fischer HB, McCloy RF, et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy. Surg Endosc. 2005;19:1396-415.

Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. Lancet. 1991;338(8782-8783):1569-70.

Loughney AD, Sarma V, Ryall EA. Intraperitoneal bupivacaine for the relief of pain following day case laparoscopy. Br J Obstet Gynaecol. 1994;101(5):449-51.

Papadima A, Lagoudianakis EE, Antonakis P, Filis K, Makri I, Markogiannakis H, et al. Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy. Surgery. 2009;146(3):475-82.

Williamson KM, Cotton BR, Smith G. Intraperitoneal lignocaine for pain relief after total abdominal hysterectomy. Br J Anaesth. 1997;78(6):675-7.

Kaufman Y, Hirsch I, Ostrovsky L, Klein O, Shnaider I, Khoury E, et al. Pain relief by continuous intraperitoneal nebulization of ropivacaine during gynecologic laparoscopic surgery-a randomized study and review of the literature. J Minim Invasive Gynecol. 2008;15(5):554-8.

Inan A, Sen M, Dener C. Local anesthesia use for laparoscopic cholecystectomy. World J Surgery. 2004;28(8):741-4.

Raetzell M, Maier C, Schroder D, Wulf H. Intraperitoneal application of bupivacaine during laparoscopic cholecystectomy--risk or benefit?. Anesthesia Analgesia. 1995;81(5):967-72.

Trampitsch E, Pipam W, Moertl M, Sadjak A, Dorn C, Sittl R, Likar R. Preemptive randomized, double-blind study with lornoxicam in gynecological surgery. Schmerz (Berlin, Germany). 2003;17(1):4-10.