Administering Meloxicam Before Colorectal Surgery Linked to Decreased Opioid Use

Intravenous meloxicam was well-tolerated and efficacious for the treatment of postsurgical pain when administered prior to and after colorectal surgery. These results, from a randomized, double-blind, multicenter, placebo-controlled study, were published in Pain Management.

Adult patients (N=57) undergoing a primary open or laparoscopic colorectal surgery at 10 clinical sites were recruited for this study. Patients were randomized in a 1:1 ratio to receive 30 mg meloxicam (n=27) or placebo (n=30) 30 minutes prior to their scheduled surgery. Additional doses were administered every 24 hours until discharge. Patients were assessed for adverse events and clinical outcomes.

The mean age of patients was 59.7 years (standard deviation [SD], 11.1); 41.8% were women, 81.8% were White, and their average body mass index was 28.2 kg/m² (SD, 5.2). Most patients were having surgery for colon cancer (40.0%), diverticular disease (23.6%), or

(10.9%).

Most of these surgeries (78.2%) were laparoscopic; 9.1% were open surgeries, and 12.7% were laparoscopic procedures converted to openones. The average surgery lasted 2.5 hours (SD, 1.1), and patients stayed in the postanesthesia care unit for a mean of 104.1 minutes (SD, 61.4).

Patients received 2 or 3 doses of meloxicam or placebo; in the meloxicam group, 37% received 2 doses and 56% received 3; in the placebo group, 29% received 2 doses and 61% received 3. Among the meloxicam group, 4% had used omeprazole and 37% had used pantoprazole prior to or during the study, which was lower than among the placebo group (14% and 57%, respectively).

Opioid consumption was significantly lower among meloxicam recipients (29.2±5.2 mg vs 45.2±5.2 mg; P =.03).

As measured by the Brief Pain Inventory 1 day after surgery, those who received meloxicam reported lower intensity of pain (4.0±2.0 vs 5.3±1.9; P =.03). The meloxicam group had shorter times to first bowel sound (8.9±2.1 vs 21.7±4.0 h; P =.02), first flatus (37.7±2.8 vs 50.1±4.5 h; P =.03), first bowel movement (51.5±5.3 vs 62.4±5.1 h; P =.02), and total hospitalization (86.2 h; SD, 42.4 vs 111.7 h; SD, 48.5; P =.0162).

Most patients (89%) reported at least 1 adverse event. Fewer patients in the treatment group reported fewer average adverse events compared with those in the placebo group (85% reported an average of 2.4 adverse events and 93% reported an average of 3.4 adverse events, respectively).

Serious adverse events were reported by 11% who received meloxicam and 14% who received the placebo. These adverse events included ileus, incision-site cellulitis, wound dehiscence, hypoglycemia, and paranasal sinus benign neoplasm.

This study was limited by its small sample size; however, due to the clear differences between the treatment and placebo groups, the investigators chose to stop the study prematurely.

These data indicate that treatment with intravenous meloxicam prior to and after colorectal surgery successfully decreased overall opioid consumption, pain, time to bowel recovery, and hospitalization stay and was generally well-tolerated. Meloxicam may be a candidate for incorporation into enhanced recovery after surgery protocols after additional confirmation studies.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.

Reference

Silinsky JD, Marcet JE, Anupindi VR, et al. Preoperative intravenous meloxicam for moderate-to-severe pain in the immediate post-operative period: a Phase IIIb randomized clinical trial in 55 patients undergoing primary open or laparoscopic colorectal surgery with bowel resection and/or anastomosis. Published online October 23, 2020. Pain Manag. doi: 10.2217/pmt-2020-0061