Single dose oral lornoxicam for acute postoperative pain in adults Stable (no update expected for reasons given in 'What's new')

Abstract

Abstract Background

Lornoxicam is one of the oxicam class of non‐steroidal anti‐inflammatory drugs (NSAIDs), producing analgesic and antipyretic effects in part through the non‐selective inhibition of cyclo‐oxygenase‐1 and ‐2. It is prescribed for osteoarthritis, rheumatoid arthritis, acute lumbar‐sciatica conditions and for postoperative pain management. Lornoxicam is available in 31 countries in Europe, the Middle East, Far East and South America, and is becoming more widely available.

Objectives

To assess the efficacy, the time to onset of analgesia, the time to use of rescue medication and any associated adverse events of single dose oral lornoxicam in acute postoperative pain.

Search methods

We searched CENTRAL, MEDLINE, EMBASE and PubMed to June 2009.

Selection criteria

Single oral dose, randomised, double‐blind, placebo‐controlled trials of lornoxicam for relief of established moderate to severe postoperative pain in adults.

Data collection and analysis

Studies were assessed for methodological quality and the data extracted by two review authors independently. Summed total pain relief over 6 hours (TOTPAR 6) was used to calculate the number of participants achieving at least 50% pain relief. These derived results were used to calculate, with 95% confidence intervals (CIs), the relative benefit compared to placebo, and the number needed to treat (NNT) for one participant to experience at least 50% pain relief over 6 hours. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals was collected.

Main results

Three studies, with 628 participants, met the inclusion criteria; 434 participants were treated with various doses (2 mg to 32 mg) of lornoxicam, 118 with placebo, and 76 with other active therapies. All the participants had pain following third molar extraction, and study duration was 8 to 24 hours. The NNT for at least 50% pain relief over 6 hours after a single dose of lornoxicam 8 mg was 2.9 (2.3 to 4.0). There were insufficient data to analyse other doses or use of rescue medication. No serious adverse events or withdrawals were reported by any of the studies.

Authors' conclusions

Oral lornoxicam is effective at treating moderate to severe acute postoperative pain, based on limited data. Adverse events did not differ significantly from placebo.

Author(s)

Peter E Hall, Sheena Derry, R Andrew Moore, Henry J McQuay

Abstract

Plain language summary

Single dose lornoxicam (trade names Xefo, Xafon, Lorcam, Acabel) for acute postoperative pain in adults

Lornoxicam is a non‐steroidal anti‐inflammatory drug (NSAID) that is used as a painkiller (analgesic). A high level of pain relief is experienced by about 45% of those with moderate to severe postoperative dental pain after a single dose of lornoxicam 8 mg, compared to about 10% with placebo. This is comparable to the proportion experiencing the same level of pain relief with ibuprofen 200 to 400 mg. Adverse events were generally mild and did not differ from placebo in these singe dose studies. There were insufficient data to assess duration of action, but it is likely to be similar to ibuprofen 200 mg.

Author(s)

Peter E Hall, Sheena Derry, R Andrew Moore, Henry J McQuay

Reviewer's Conclusions

Authors' conclusions

Implications for practice

This review has found that lornoxicam is effective at providing postoperative pain relief in approximately half of adult patients. This is similar to results for ibuprofen 200 mg. Lornoxicam was not associated with any serious adverse events in this limited data set.

Implications for research

Given the large number of available drugs of this and similar classes to treat postoperative pain, there is no urgent research agenda. More studies would be helpful to more accurately determine efficacy, particularly in areas other than dental surgery. Improvements could be made to the reporting of outcomes other than pain relief, such as time to remedication. Much of the recent literature on lornoxicam has evaluated intravenous administration in the perioperative setting, rather than oral administration in established pain.

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