Efficacy of Piroxicam as a Perioperative Analgesic for Patients Undergoing Maxillofacial Fracture Fixation: A Randomized Controlled Trial

Background: Fixation of maxillofacial fractures is a commonly performed surgical procedure and is often associated with moderate to severe pain. Postoperative pain management can be achieved using nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, or a combination of both. This study aimed to assess the effectiveness and postoperative complications of intramuscular piroxicam.
Methods: This randomized controlled study was conducted on 62 adult patients aged 16–25 years who had mandibular or maxillary fractures and received open reduction and internal fixation, were randomly divided into two groups, the piroxicam group (PG) (31 patients), received a dose of 0.4 mg/kg of intramuscular piroxicam, and the non-piroxicam group (NPG) (31 patients), did not. Our primary outcome included the total rescue analgesic dosage required. The secondary outcomes included visual analogue score, time to the first analgesic dose, and postoperative nausea and vomiting.  
Results: Similar demographic profiles, initial characteristics, and surgical techniques in both groups (p>0.05) were noticed. Visual analog scores at 6, 12, and 24 h, as well as the total dose of rescue analgesic, were significantly higher in the non-piroxicam group (NPG) than in the piroxicam group (PG) (p < 0.05). There were no statistically significant differences between the two groups in terms of visual analog scores three hours later or in the occurrence of postoperative nausea and vomiting (p>0.05).
Conclusion: In patients undergoing maxillofacial fracture fixation, intramuscular administration of piroxicam has been found to be effective in providing perioperative analgesia and may also potentially reduce the requirement for postoperative rescue analgesia while maintaining a similar incidence of postoperative nausea and vomiting.