The analgesic efficacy of preoperative versus postoperative lornoxicam in varicocele repair.

Study Objective: To determine whether intravenous injection of lornoxicam 30 minutes before skin incision provides better pain relief after varicocelectomy than postoperative administration of lornoxicam.

Design: Prospective, double-blind, randomized clinical investigation.

Setting: Operating room and postoperative recovery area.

Patients: 44 ASA physical status I and II adult male patients undergoing varicocelectomy.

Interventions: Patients were randomized either to receive 8 mg lornoxicam infusion 30 minutes before skin incision, followed by saline infusion immediately after skin closure (group 1), or to receive the identical injections but in reverse order (group 2). All patients received local anesthesia with bupivacaine.

Measurements: Postoperative pain scores were evaluated hourly for the first 8 hours after surgery, then at 12, 16, 20, and 24 hours after surgery, using a 10-cm visual analog scale. Time to first analgesic request and patients' global assessments also were recorded.

Main Results: Patients in group 1 reported significantly lower pain scores (P < 0.05) at all time intervals except at 24 hours and better global assessment (P = 0.001) than did group 2. There were significantly fewer patients in the preemptive group than group 2 who required rescue analgesic within the first 24 hours (0% vs 22.7%; P = 0.024). Mean time to first analgesic request was also significantly longer in the preemptive group (P = 0.001).

Conclusion: Intravenous lornoxicam administered before surgery has a better analgesic effect for varicocelectomy than when administered postoperatively.