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Postoperative analgesia is not different after local vs systemic administration of meloxicam in patients undergoing inguinal hernia repair

[L'analgésie postopératire ne diffère pas après l'administration locale ou intraveineuse de méloxicam pour une herniorraphie inguinale]

Janne Rømsing, MSC PHARM PhD^*, Steffen Mysager, MD, Peter Vilmann, MD DMSC, Jesper Sonne, MD DMSC, Niels Erik Larsen, MSC CHEM and Doris Østergaard, MD

^* From the Department of PharmaceuticsThe Royal Danish School of PharmacyCopenhagen
The Department Of AnesthesiologyThe Department Of SurgicalGastroenterology and
The Department Of ClinicalPharmacology
Gentofte University HospitalHellerup Denmark.

Dr. Janne Rømsing, Department of Pharmaceutics, The Royal Danish School of Pharmacy, 2 Universitetsparken, DK-2100 Copenhagen, Denmark. Phone: +45 35 30 62 39; Fax: +45 35 30 60 30; E-mail: jr{at}dfh.dk

Purpose: To distinguish between local and systemic drug effects, we compared pain scores, analgesic consumption and plasma concentrations after local vs iv administration of meloxicam 7.5 mg in patients with inguinal hernia repair.

Methods: In a double-blind, randomized study 56 patients received either local or iv meloxicam 7.5 mg. Postoperative pain was assessed with a visual analogue scale (VAS) at rest, on mobilization, and on coughing, the need for supplementary analgesics (fentanyl iv and/or acetaminophen-codeine tablets) was recorded, and blood samples were drawn during 24 hr after meloxicam administration.

Results: No significant differences were found between groups with respect to pain scores, or in the consumption of supplementary analgesics. Following local application of meloxicam, the peak plasma concentration (C_max) of 0.5 ± 0.2 mg•L^–1 achieved after 1.8 ± 0.5 hr was much lower than the C_max of 2.5 ± 0.9 mg•L^–1 achieved immediately after iv administration (P <0.05). Mean meloxicam plasma concentration after infiltration was significantly lower than after iv doses for the first three hours after administration (P <0.05).

Conclusion: We showed no differences in pain scores and analgesic consumption between local and iv administration of meloxicam 7.5 mg during the first 24 hr after herniorrhaphy, while plasma concentration of meloxicam was lower after local administration. These results indicate a lack of difference in pain relief after concentrating meloxicam at the hernia wound or after achieving high blood levels rapidly (iv). Local administration of meloxicam may confer an advantage over systemic administration by eliciting lower incidences of systemic adverse effects.