Title

The effect of premedication with Intravenous Lornoxicam on Propofol injection pain at induction of general Anaesthesia in adults: a randomised placebo-controlled trial

Date of Award

2019

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Prof. Vitalis Mung'ayi

Second Supervisor/Advisor

Dr. Ednah Kemunto Gisore

Third Supervisor/Advisor

Dr. Sikolia Wanyonyi

Department

Anaesthesiology (East Africa)

Abstract

Background: Propofol is widely used for the induction and maintenance of general anaesthesia and offers many key attractive pharmacological qualities that make it suitable for these indications. However, pain on injection is one of its major drawbacks and can be very distressing to patients. There is a paucity of studies that have looked at the effect of lornoxicam on propofol injection pain either as a sole intervention or in combination with any other method.

Primary objective: To determine whether premedication with intravenous lornoxicam had any effect on the intensity of propofol injection pain at induction of general anaesthesia in adult patients.

Secondary Objectives: (I)To determine whether premedication with lornoxicam had any effect on the incidence of propofol injection pain at induction of general anaesthesia in adult patients.(II)To document any adverse events (allergic reactions, nausea, vomiting, gastritis and/or gastrointestinal bleeding, dizziness, phlebitis) that resulted from the administration of intravenous lornoxicam for the purposes of this study.

Study Design: A single centre, randomized, placebo-controlled trial.

Methods: 121 adult patients of American Society of Anaesthesiologists (ASA) physical status 1 and 2 were recruited from the anaesthesia clinic, day care surgery unit and the wards and randomized into the intervention and control groups following informed consent. The intervention group received 8mg of lornoxicam intravenously thirty minutes prior to induction of general anaesthesia while the control group received normal saline (inactive placebo) intravenously. Both groups then received a propofol-lignocaine admixture at induction of general anaesthesia and the pain scores during propofol injection were recorded using the critical care pain observation tool (CPOT).

Results: Patients baseline characteristics were similar across both the intervention and the control groups. The lornoxicam group had a better mean pain score (0.6 ± 0.8) compared to placebo (4.5 ± 1.2), a statistically significant difference of 3.9 (95% CI, 3.57 to 4.32), t (119) = 21.1, P < .001. vi

Conclusion: Premedication with lornoxicam, when combined with the fairly standard practice of a propofol-lignocaine admixture, significantly reduces the intensity of propofol injection pain at induction of general anaesthesia in adult patients.

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