Postoperative Intravenous Analgesia With Lornoxicam In Pediatrics

Objectives: To evaluate the feasibility and safety of intravenous analgesia with lornoxicam in pediatrics, to assess the analgesic effect and the changes of coagulation and immune function.Methods: Sixty ASA I-II children aged 3-7 yr scheduled for elective surgery under general anesthesia were selected and randomly divided into three groups ( n = 20 ) . Group A as control group received traditional analgesia, group B received PCA with 0.03 mg/kg/h lornoxicam continuous intravenous analgesia; Group C was induced by an intravenous injection with lornoxicam 0.3 mg/kg at the end of the operation. The visual analogue score face ( VASf ) and FLACC pain score , the Ramsay sedation score, Bruggrmann comfort scale ( BCS ), verbal rating scale ( VRS ) and adverse effects were assessed to determine the analgesic effectiveness and adverse effects of lornoxicam. To evaluate the effects of postoperative pain treatment with lornoxicam on cytokine, blood samples in three groups were taken 24h preoperatively and 48h postoperatively to test the index of coagulation and 8 from each group to test the levels of Interlukine 2 and Interlukine 6 by the ELISA.Results: There were no significant differences among three groups in ages, sex, weight, duration and type of operation(P>0.05). The VASf scores were consistent with FLACC on the whole(P>0.05). The scores of pain at 12h after operation in group B and C were significantly lower than that of group A(P<0.05), but there were no significant differences between group B and C(P>0.05). The scores of pain in group B decreased gradually during the postoperative period, but in group C the scores at 12h were higher than that at 8h. Bruggrmann comfort scale approximated the pain score. Ramsay sedation scores and the incidences of nausea showed no difference among three groups (P>0.05). The levels of Interlukine 2 were decreased while that of Interlukine 6 were increased evidently 48h postoperatively compared with preoperative values(P<0.05). The degrees of change in group B and C were significant lower than group A(P<0.05). The degrees of decrease of Interlukine 2 were no difference between group B and C(P>0.05)while the levels of Interlukine 6 in group B increased less than group C(P<0.05). There were no significant differences of PTs, APTT and PLT before or after operation among all groups(P>0.05), only PTs in group B and C significantly prolonged(P<0.05), but the value was still in the normal range. There were no abnormal hemorrhage among all groups.Conclusion: Postoperative intravenous analgesia with lornoxicam in pediatrics provided satisfactory postoperative pain relief, without increasing adverse events such as nausea, vomit, had no significant effects on the PLT counter and coagulation function. The technique is efficient in maintaining the balance of pro/anti-inflammatory cytokine, alleviating inflammatory stress response and immunology injury, which is beneficial to the postoperative recovery of children, thus it is a worthwhile technique in clinic.