Lornoxicam is a non-selective NSAID that provides potent analgesic and anti-inflammatory effects through inhibition of cyclooxygenase and prostaglandin synthesis. Several studies have found lornoxicam to be effective in relieving post-operative pain following various surgical procedures like hysterectomy, tonsillectomy, and septoplasty. While NSAIDs can inhibit platelet function and potentially increase bleeding risk, the evidence regarding lornoxicam specifically is mixed, and studies have used it without reports of major bleeding. Lornoxicam provides an alternative to opioids for post-operative pain relief due to its short half-life and reduced adverse effect profile.

1. Lornoxicam
(Xefo)
Dr. Ashraf Arafat Abdelhalim, MD
Professor of anesthesia
Department of Anesthesia, Faculity of Medicine Alexandria University, Egypt
1

2. Post-operative pain is a significant problem
and has several unwanted consequences,
such as
excessive use of analgesics,
longer period of hospitalization,
Intolerance to diet
poorer quality of life
2

3. Although the systemic administration of
opioids is traditionally used in the
treatment of post-operative pain, their
potential side-effects such as respiratory
depression, sedation, ileus, urinary
retention and itching, limit their
administration particularly following a
surgical procedure involving the upper
respiratory pathway
3

4. pre-emptive analgesia to be effective in
perioperative pain.
NSAIDs have analgesic effects due to their
peripheral anti-inflammatory actions by
reducing the synthesis of prostaglandins
through the inactivation of cyclooxygenase.
This peripheral action of the NSAIDs can thus
indirectly inhibit central neural sensitization and
reduce the amplification of pain.
4

5. Lornoxicam (Xefo) is a non-selective NSAID of
the oxicam group, a potent analgesic with anti-
inflammatory properties, which decreases
prostaglandin synthesis by inhibition of
cyclooxygenase.
It is rapidly eliminated with a plasma
elimination half-life of 3–5 h, and this short
plasma half-life may be responsible for
lornoxicam’s reduced incidence of adverse
effects. 5

6. Lornoxicam 8 mg IV was found to be superior to
placebo and equianalgesic to tramadol 50 mg
IV in relieving moderate to intolerable post-
hysterectomy pain.
Ilias W, Jansen M. Pain control after hysterectomy: An
observer- blind, randomised trial of lornoxicam versus
tramadol. Br J Clin Pract 1996; 50:197-202.
6

7. Işik et al.[10] found that pre-operative 8
mg lornoxicam was more effective than 50
mg tramadol with respect to early post-
operative tonsillectomy pain in adult patients,
and the side- effects profile was similar.
Isik B, Arslan M, Ozsoylar O, Akcabay M. Effects of
preoperative lornoxicam versus tramadol on
postoperative pain and adverse effects in adult
tonsillectomy patients. Agri 2009; 21:113-20.
7

8. Staunstrup et al. compared the analgesic
efficacy of a single dose of intramuscular
lornoxicam 16 mg and tramadol 100 mg in 76
patients following arthroscopic reconstruction of
the anterior cruciate ligament and found that
lornoxicam is alternative to tramadol for the
treatment of moderate to severe pain.
Staunstrup H, Ovesen J, Larsen UT, Elbaek K, Larsen
U, Kroner K. Efficacy and tolerability of lornoxicam
versus tramadol in postoperative pain. J Clin Pharmacol
1999; 39:834-41.
8

9. Sener and colleagues in their study on 200
patients scheduled for
elective septoplasty under general anesthesia
reported that lornoxicam 8 mg (twice daily) was
effective for post-operative analgesia and
reduction of opioid requirement.
Sener M, Yilmazer C, Yilmaz I, Bozdogan N, Ozer
C, Donmez A, et al. Efficacy of lornoxicam for acute
postoperative pain relief after septoplasty: A comparison
with diclofenac, ketoprofen, and dipyrone. J Clin
Anesth 2008; 20:103-8.
9

10. Another study [13] revealed the efficacy and
better tolerability of IV lornoxicam in patient-
controlled analgesia for post-operative pain
relief after septorhinoplasty.
Sener M, Yilmazer C, Yilmaz I, Caliskan E, Donmez
A, Arslan G. Patient-controlled analgesia
with lornoxicam vs. dipyrone for acute postoperative
pain relief after septorhinoplasty: A prospective,
randomized, double-blind, placebo-controlled study. Eur
J Anaesthesiol 2008; 25:177-82.
10

11. Daabiss et al.[14] reported that lornoxicam 16 mg is
comparable to fentanyl as intraoperative IV analgesia
and that it is associated with a significantly lower
incidence of adverse events, but is more effective than
fentanyl in preventing early post-operative pain in
patients undergoing minor to moderate day-case ENT
surgical procedures.
Daabiss M, Al-Sherbiny M, Al-Otaibi R , Al-Nimar R.
Analgesia in day-case ENT surgery: The efficacy of
lornoxicam. BJMP 2009; 2:46-50.
11

12. Lornoxicam decreased the VAS score and the
need for opioids as compared to ketorolac, by its
pre-emptive administration. It was found to be an
equally effective analgesic like ketorolac in
abdominal surgeries.
AComparative Study of Ketorolac with Lornoxicam as Pre-emptive
Analgesics in Patients Who were Undergoing Elective Abdominal Surgery
under General Anaesthesia. Journal of Clinical and Diagnostic Research.
2012 May (Suppl-1), Vol-6(3):418-422
12

13. Intraoperative preincisional intravenous lornoxicam
enhanced postoperative analgesia after tonsillectomy
in children.
In comparison, the analgesic efficacy of locally applied
lornoxicam was inferior to intravenous administration
and was associated with increased incidence of
intraoperative bleeding.
Preincisional peritonsillar vs. intravenous lornoxicamfor posttonsillectomy analgesia:
A clinical and platelet aggregometry comparative study. Egyptian Journal of
Anaesthesia (2012) 28, 107–115
13

14. Trampitsch et al. have investigated the effect of
administration of lornoxicam pre-emptively in patients
undergoing gynecological operation and have
reported better quality of post-operative analgesia and
reduced consumption of opioid analgesics.
Similar results have been obtained when 16 mg of
lornoxicam was administered after thyroidectomy,
where the time needed for the first analgesic
requirement was prolonged with decreased opioid
requirements.
1-Trampitsch E, Pipam W, Moertl M, Sadjak A, Dorn C, Sittl R, et al. Preemptive
randomized, double-blind study with lornoxicam in gynecological surgery. Schmerz
2003; 17:4-10.
2-Arslan M, Tuncer B, Babacan A, Taneri F, Karadenizli Y, Onuk E, et al.
Postoperative analgesic effects of lornoxicam after thyroidectomy:
A placebo controlled randomized study. Agri 2006; 18:27-33.
14

15. NSAIDs are claimed to increase the risk of
perioperative bleeding caused by inhibition of platelet
function by inhibiting cyclooxygenase and
consequently inhibiting thrombocyte aggregation
Blaicher et al. compared the effect of rofecoxib
(a selective NSAID) and three non-selective
NSAIDS: acetylsalicylic acid, diclofenac, and
lornoxicam, on platelet function and they
reported that platelet function was significantly
inhibited by acetylsalicylic acid, diclofenac and
lornoxicam but not by rofecoxib.
Blaicher AM, Landsteiner HT, Al-Falaki O, Zwerina J, Volf I, Gruber D, et al.
Acetylsalicylic acid, diclofenac, and lornoxicam, but not rofecoxib affect platelet CD 62 P
expression. Anesth Analg 2004; 98:1082-5.
15

16. As platelets play an important role in the
coagulation process,
some authors believe that NSAIDS should be
avoided during surgical procedures like
tonsillectomy [1]
Other authors reported that NSAIDS are a
useful analgesic for post-operative pain relief,
without an increase in perioperative bleeding [2].
1-Splinter WM, Rhine EJ, Roberts DW, Reid CW, MacNeill HB. Preoperative ketorlac
increases bleeding after tonsillectomy in children. Can J Anaesth 1996; 43:560-3.
2-Jeyakumar A, Brickman TM, Williamson ME, Hirose K, Krakovitz P, Whittemore K, et
al. Nonsteroidal anti-inflammatory drugs and postoperative bleeding following
adenotonsillectomy in pediatric patients. Arch Otolaryngol Head Neck Surg 2008;
134:24-7.
16

17. Moiniche et al. analyzed 25 studies in
their quantitative systematic review and
concluded that although there is some
evidence of an increased risk of re-
operation because of bleeding with
NSAIDs, the evidence is equivocal and the
risk–benefit ratio is not straightforward.
Moiniche S, Romsing J, Dahl JB, Tramèr MR. Nonsteroidal antiinflammatory
drugs and the risk of operative site bleeding after tonsillectomy: A quantitative
systematic review. Anesth Analg 2003; 96:68-77.
17

18. Krishna et al. after their meta-analysis
including1368 patients to determine the risk of
post-operative hemorrhage associated with the
administration of NSAIDs after tonsillectomy
reported that the incidence of the post-operative
bleeding was not affected by NSAID
consumption.
Krishna S, Hughes LF, Lin SY. Postoperative hemorrhage with nonsteroidal anti-
inflammatory drug use after tonsillectomy: A meta-analysis. Arch Otolaryngol Head Neck
Surg 2003; 129:1086-9.
18

19. several studies used lornoxicam without any
evidence of major perioperative bleeding. [1-5]
1- Trampitsch E, Pipam W, Moertl M, Sadjak A, Dorn C, Sittl R, et al. Preemptive
randomized, double-blind study with lornoxicam in gynecological surgery. Schmerz
2003; 17:4-10.
2- Karaman Y, Kebapci E, Gurkan A. The preemptive analgesic effect of lornoxicam in
patients undergoing major abdominal surgery: A randomized controlled study. Int J
Surg2008; 6:193-6.
3-Ilias W, Jansen M. Pain control after hysterectomy: An observer- blind, randomised
trial of lornoxicam versus tramadol. Br J Clin Pract 1996; 50:197-202.
4-Isik B, Arslan M, Ozsoylar O, Akcabay M. Effects of preoperative lornoxicam versus
tramadol on postoperative pain and adverse effects in adult tonsillectomy patients.
Agri 2009; 21:113-20.
5-Daabiss M, Al-Sherbiny M, Al-Otaibi R , Al-Nimar R. Analgesia in day-case ENT
surgery: The efficacy of lornoxicam. BJMP 2009; 2:46-50.
19

20. Conclusion
20

21. 21