Meloxicam in the management of post-operative pain: Narrative review

Phototoxic action of meloxicam contributes to dysregulation of redox homeostasis in normal human skin cells - Molecular and biochemical analysis of antioxidant enzymes in melanocytes and fibroblasts

The phototoxic effect of meloxicam (MLX) raises the question of the effect of the drug on the redox homeostasis of normal human skin cells. The main objective of the study was to analyze the effect of MLX and/or UVA radiation (UVAR) on the redox homeostasis of human normal skin cells - melanocytes and fibroblasts. MLX was found to affect the activity and expression of enzymes of the antioxidant system differently depending on the cell line used. The drug decreased the activity and expression of superoxide dismutase type 1 and 2 (SOD1 and SOD2), catalase (CAT) and glutathione peroxidase (GPx) in fibroblasts, while increasing the activity of these enzymes in melanocytes. UVA radiation enhanced the effects of the drug. In conclusion, MLX in combination with UVAR induces oxidative stress in melanocytes and fibroblasts, however, the analyses showed that the drug's effect the activity and expression of SOD, CAT and GPx differently, depending on the cell line. The observed dissimilarity between tested cell lines may result from the presence of melanin pigments.

Emerging green synthetic routes for thiazole and its derivatives: Current perspectives

This review article provides an overview of the green synthesis of thiazole derivatives, emphasizing sustainable and environmentally friendly methodologies. Thiazole derivatives possess significant value and find diverse applications across various fields. However, conventional synthesis methods often involve hazardous reagents and generate substantial waste, posing environmental concerns. The green synthesis of thiazole derivatives employs renewable starting materials, nontoxic catalysts, and mild reaction conditions to minimize environmental impact. Innovative techniques such as microwave irradiation, ultrasound synthesis, green solvents, a green catalyst-based approach, and mechanochemistry-mediated synthesis are employed, offering advantages in terms of scalability, cost-effectiveness, and purification simplicity. The resulting thiazole derivatives exhibit comparable or enhanced biological activities, showcasing the feasibility and practicality of green synthesis in drug discovery. This review paper underscores the importance of sustainable approaches in functional molecular synthesis and encourages further research in this domain.

Long-Acting Drug Delivery Technologies for Meloxicam as a Pain Medicine

Meloxicam, a selective COX-2 inhibitor, has demonstrated clinical effectiveness in managing inflammation and acute pain. Although available in oral and parenteral formulations such as capsule, tablet, suspension, and solution, frequent administration is necessary to maintain therapeutic efficacy, which can increase adverse effects and patient non-compliance. To address these issues, several sustained drug delivery strategies such as oral, transdermal, transmucosal, injectable, and implantable drug delivery systems have been developed for meloxicam. These sustained drug delivery strategies have the potential to improve the therapeutic efficacy and safety profile of meloxicam, thereby reducing the frequency of dosing and associated gastrointestinal side effects. The choice of drug delivery system will depend on the desired release profile, the target site of inflammation, and the mode of administration. Overall, meloxicam sustained delivery systems offer better patient compliance, and reduce the side effects, thereby improving the clinical applications of this drug. Herein, we discuss in detail different strategies for sustained delivery of meloxicam.

Green Synthetic Strategies and Pharmaceutical Applications of Thiazine and its Derivatives: An Updated Review

Thiazines are a sizable class of organic heterocycles that are notable for their skeletal versatility and relative chemical simplicity, making them among the most flexible sources of biologically active compounds. The term "green synthesis" refers to implementing energy-efficient procedures for the nature-friendly production of materials and chemicals using green solvents, catalysts, and suitable reaction conditions. Considering the importance of green chemistry and the outstanding therapeutic profile of thiazines, the present work was designed to review the recent advances in green chemistry-based synthetic strategies of thiazine and its derivatives. The green synthetic approaches, including microwave-assisted, ultrasound-assisted, and various other synthetic methods for thiazine and its derivatives, were discussed and generalized. In addition, applications of thiazine and its derivatives in pharmaceutical sciences were explained with examples of marketed drugs.The discussed sustainable synthetic methods for thiazines and their derivatives could be useful in developing other medicinally important lead molecules. They could also aid in developing new synthetic schemes and apparatuses that may simplify chemical manufacturing processes and enable novel reactions with minimal by-products while questing for optimal, green solvents. This review can help anyone interested in this fascinating class of heterocycles to make decisions about selecting targets and tasks for future research.

Applying in-situ visible photopolymerization for fabrication of electrospun nanofibrous carrier for meloxicam delivery

Despite meloxicam's many benefits, it will cause many drawbacks if the meloxicam release rate is not controlled. Accordingly, we introduced a technique based on the electrospinning process to control the release rate and also to reduce side effects. For this purpose, different nanofibers were used as drug couriers. Nanofibers were prepared using polyurethane, polyethylene glycol, and light curable poly (ethylene glycol) diacrylate (PEGDA) by electrospinning. In fact, light curable poly (ethylene glycol) diacrylate (PEGDA) was synthesized as a hydrophilic functional group. Next, PEGDA and polyurethane were used simultaneously to fabricate the drug carrier nanofiber in a single processing step, and the electrospinning apparatus was equipped with a blue light source for in-situ photopolymerization during the electrospinning process. The molecular structures of nanofibers and PEGDA were investigated by FT-IR, 1H NMR, 13C NMR, SEM, TEM, XRD, and DSC analyses. Finally, we reduced in vitro drug release to 44% within ten hours, while the minimum release of meloxicam from the tablet was 98%.

Liquid Chromatography-Tandem Mass Spectrometry Method for Detection and Quantification of Meloxicam and 5'-Carboxymeloxicam in Oral Fluid Samples

A sensitive, selective and particularly fast method of liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed and validated for the determination of meloxicam and its main metabolite, 5'-carboxymeloxicam, in oral fluid samples. Meloxicam and its major metabolite were separated using a Shim-Pack XR-ODS 75 L × 2.0 column and C18 pre-column at 40 °C using a mixture of methanol and 10 mM ammonium acetate (80:20, v/v) with an injection flow rate of 0.3 mL/min. The total time of the analytical run was 5 min. Sixteen volunteers had oral fluid samples collected sequentially before and after taking a meloxicam tablet (15 mg) for up to 96 h. With the concentrations obtained, the pharmacokinetic parameters were determined using the Phoenix WinNonlin software. The parameters evaluated for meloxicam and 5'-carboxymeloxicam in the oral fluid samples showed linearity, accuracy, precision, medium-quality control (MQC-78.12 ng/mL), high-quality control (HQC-156.25 ng/mL), lower limits of quantification (LLOQ-0.6103 ng/mL), low-quality control (LQC-2.44 ng/mL), stability and dilution. Prostaglandin E₂ (PGE₂) was also detected and quantified in the oral fluid samples, demonstrating the possibility of a pharmacokinetic/pharmacodynamic (PK/PD) study with this methodology. All the parameters evaluated in the validation of the methodology in the oral fluid samples proved to be stable and within the possible variations in each of the described parameters. Through the data presented, the possibility of a PK/PD study was demonstrated, detecting and quantifying meloxicam, its main metabolite and PGE₂ in oral fluid samples using LC-MS/MS.

Nanocrystals in cosmetics and cosmeceuticals by topical delivery

The main issues with local delivery of cosmetics are their high sensitivity and limited drug loading of active pharmaceutical ingredient. Nanocrystal technology offers consumers cutting-edge and effective products and exhibits enormous development potential in the beauty business as a new delivery method to address the issue of low solubility and low permeability of sensitive chemicals. In this review, we described the processes for making NCs, along with the impacts of loading and the uses of different carriers. Among them, nanocrystalline loaded gel and emulsion are widely used and may further improve the stability of the system. Then, we introduced the beauty efficacy of drug NCs from five aspects: anti-inflammation and acne, anti-bacterial, lightening and freckle removal, anti-aging as well as UV protection. Following that, we presented the current scenario about stability and safety. Finally, the challenges and vacancy were discussed along with the potential uses of NCs in the cosmetics industry. This review serves as a resource for the advancement of nanocrystal technology in the cosmetics sector.

Early perioperative versus postoperative meloxicam for pain control in patients undergoing orthopedic surgery: a systematic review and Meta-analysis of randomized controlled trials

OBJECTIVE

Post-orthopaedic operative pain is a serious concern that often requires the administration of analgesics; however, the optimal time of analgesic administration is still inconclusive. Perioperative analgesia is administrating pre-emptive analgesia before and during the surgery followed by postoperative analgesia to decrease the procedure associated nociceptive response. We aim to assess perioperative meloxicam versus postoperative meloxicam for pain control after orthopaedic operations.

METHODS

A systematic review and meta-analysis involving randomized controlled trials from PubMed, Embase, Scopus, WOS, and Cochrane until 28th May 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol in PROSPERO with ID: CRD42022336046.

RESULTS

We included five RCTs with 964 patients. All the included trials showed high risk of performance and detection biases because of lack of blinding. Pooled analysis favored perioperative meloxicam in reducing pain score after six hours (MD: -0.42 with 95% CI [-0.63, -0.21], p = .0001), 12 h (MD: -0.54 with 95% CI [-0.69, -0.39], p = .00001), and 24 h (MD: -0.23 with 95% CI [-0.36, -0.10]. Pooled analysis favored perioperative meloxicam in improving patient global assessment scale after 12 h (MD: -0.66 with 95% CI [-0.86, -0.46], p = .00001), 24 h (MD: -0.30 with 95% CI [-0.49, -0.11, p = .002), and 48 h (MD: -0.17 with 95% CI [-0.33, -0.01], p = .04). Pooled analysis favored perioperative meloxicam in reducing patient-controlled analgesia (MD: -4.25 with 95% CI [-5.96, -2.54], p = .00001).

CONCLUSION

Short-term pain management after orthopaedic procedures is better accomplished with perioperative meloxicam than postoperative meloxicam. Before recommending perioperative meloxicam for pain control following orthopaedic surgeries, further multicentre trials are still warranted to examine the impact of perioperative meloxicam in different orthopaedic procedures.

Development of poly(lactide-co-glycolide) microparticles for sustained delivery of meloxicam

Poly(lactide-co-glycolide) (PLGA) polymers have been widely used for drug delivery due to their biodegradability and biocompatibility. One of the objectives of encapsulating a drug in PLGA microparticles (MPs) is to achieve an extended supply of the drug through sustained release, which can range from weeks to months. Focusing on the applications needing a relatively short-term delivery, we investigated formulation strategies to achieve a drug release from PLGA MPs for two weeks, using meloxicam as a model compound. PLGA MPs produced by the traditional oil/water (O/W) single emulsion method showed only an initial burst release with minimal increase in later-phase drug release. Alternatively, encapsulating meloxicam as solid helped reduce the initial burst release. The inclusion of magnesium hydroxide [Mg(OH)₂] enhanced later-phase drug release by neutralizing the developing acidity that limited the drug dissolution. The variation of solid meloxicam and Mg(OH)₂ quantities allowed for flexible control of meloxicam release, yielding MPs with distinct in vitro release kinetics. When subcutaneously injected into rats, the MPs with relatively slow in vitro drug release kinetics showed in vivo drug absorption profiles consistent with in vitro trend. However, the MPs that rapidly released meloxicam showed an attenuated in vivo absorption, suggesting premature precipitation of fast-released meloxicam. In summary, this study demonstrated the feasibility of controlling drug release from the PLGA MPs over weeks based on the physical state of the encapsulated drug and the inclusion of Mg(OH)₂ to neutralize the microenvironmental pH of the MPs.

Challenges with Assessing and Treating Pain in Research Primates: A Focused Survey and Literature Review

Research primates may undergo surgical procedures making effective pain management essential to ensure good animal welfare and unbiased scientific data. Adequate pain mitigation is dependent on whether veterinarians, technicians, researchers, and caregivers can recognize and assess pain, as well as the availability of efficacious therapeutics. A survey was conducted to evaluate primate veterinary approaches to pain assessment and alleviation, as well as expressed challenges for adequately managing primate pain. The survey (n = 93 respondents) collected information regarding institutional policies and procedures for pain recognition, methods used for pain relief, and perceived levels of confidence in primate pain assessment. Results indicated that 71% (n = 60) of respondents worked at institutions that were without formal experimental pain assessment policies. Pain assessment methods were consistent across respondents with the majority evaluating pain based on changes in general activity levels (100%, n = 86) and food consumption (97%, n = 84). Self-reported confidence in recognizing and managing pain ranged from slightly confident to highly confident, and there was a commonly expressed concern about the lack of objective pain assessment tools and science-based evidence regarding therapeutic recommendations of analgesics for research primates. These opinions correspond with significant gaps in the primate pain management literature, including limited specific pharmacokinetic data and efficacy testing for commonly used analgesics in research primate species as well as limited research on objective and specific measures of pain in research primates. These results demonstrate that there are inconsistencies in institutional policies and procedures surrounding pain management in research primates and a lack of objective pain assessment methods. Demonstrating the gaps and challenges in primate pain management can inform guideline development and suggest areas for future research.

Electrospun Nanofibers for Wound Management

Electrospun nanofibers show great potential in biomedical applications. This mini review article traces the recent advances in electrospun nanofibers for wound management via various approaches. Initially, we provide a short note on the four phases of wound healing, including hemostasis, inflammation, proliferation, and remodeling. Then, we state how the nanofiber dressings can stop bleeding and reduce the pain. Following that, we discuss the delivery of therapeutics and cells using different types of nanofibers for enhancing cell migration, angiogenesis, and re-epithelialization, resulting in the promotion of wound healing. Finally, we present the conclusions and future perspectives regarding the use of electrospun nanofibers for wound management.

Postoperative pain: a review of emerging therapeutic options

INTRODUCTION

Postoperative pain is often managed by opioid medications, even though they carry a risk of adverse effects such as vomiting, constipation, sedation, respiratory depression and physical dependence. Furthermore, opioid use in the healthcare setting has likely contributed to the epidemic. However, the mismanagement of postoperative pain can result in delayed recovery time, impaired physical function, increased risk of morbidity and mortality, chronic pain, and higher healthcare costs.

AREAS COVERED

This review explores emerging therapeutic options and strategies in the management of acute postoperative pain and focuses on opioid-sparing, multimodal analgesia. This includes regional anesthetic techniques, non opioid pharmacotherapy, novel opioids and non-pharmacologic therapy. We have also discussed examples of novel analgesics and formulations which have potential benefits in reducing postoperative pain and opioid use after surgery.

EXPERT OPINION

The development of novel regional anesthesia techniques allows for opioid minimization in increasing number of surgical procedures. This synergizes with the availability of novel non-opioid analgesic adjucts. In addition, several novel opioid drugs have been developed which may be pathway selective and associated with less adverse effect than conventional opioids.

Microanalysis of Two Members of Oxicam Drugs by Quenching the Fluorescence of Newly Isolated Carbonaceous Materials From Incense Ash

For the first time ever, useful fluorescent (FL) carbonaceous materials (CMTS) were isolated from incense ash using facile procedure on two steps; dispersion of the CMTS in water followed by filtration. The CMTS were characterized using the following techniques; dynamic light scattering (DLS), transmission electron microscopy (TEM) and Fourier transform infrared (FT-IR) spectroscopy. The CMTS exhibit excitation wavelength dependent fluorescence emission, so it can be used as a FL probe. The FL probe was employed for sensing and quantitative determination of two members of oxicam family (tenoxicam (TEN) and meloxicam (MEL)) that belongs to non-steroidal anti-inflammatory drugs (NSAIDs). The method is based on the quenching of the FL intensity of the isolated CMTS by inner filter effect mechanism (IFE). The FL intensity decreases in linear relationship with increasing the concentrations of the two cited drugs within the range of 4.0 - 30.0 µg/mL with mean percentage recoveries of 100.04 ± 0.95 and 100.07 ± 1.06 with detection limits of 1.31 µg/mL and 1.06 µg/mL for TEN and MEL, respectively. Finally, the developed sensing system was validated as per ICH guidelines and it was proved to be accurate and precise and applied successfully for quantitative determination of the two cited drugs in their capsule dosage forms with excellent percentage recoveries reaching to 97.66 ± 0.39and 98.19 ± 1.12 for TEN and MEL, respectively.

Using a stable isotope-labeled internal standard for liquid chromatography-tandem mass spectrometry quantitation of meloxicam in human plasma

A sensitive and highly efficient LC-ESI-MS/MS method using a stable isotope-labeled internal standard (SIL IS) to detect meloxicam in human plasma was developed and validated. Sample preparation used only 50 μL human plasma with one-step methanol protein precipitation. A gradient mobile phase system was adopted for chromatographic separation on a Poroshell 120 SB-C₁₈ column (2.1 × 50 mm, 2.7 μm). Positive ion pattern was chosen for quantification under multiple reaction monitoring. Ion pairs were [M + H]⁺ m/z 352.1 → 115.1 for meloxicam and [M + H]⁺ m/z 355.1 → 187.1 for meloxicam-d3 (SIL IS). Total run time was 4.0 min. Standard curve was linear over a concentration range from 8.00 to 1600 ng mL^-1 . This method was fully validated to evaluate its performance, including specificity, carryover, sensitivity, linearity, accuracy, precision, recovery, matrix effects, stability, dilution reliability and incurred sample reanalysis, which provided a reliable basis for pharmacokinetic studies of meloxicam in 28 healthy Chinese volunteers. After a single-dose oral administration of 7.5 mg meloxicam, the main pharmacokinetic parameters were as follows: C_max , 814.79 ± 201.37 ng mL^-1 ; T_max , 4.54 ± 1.42 h; AUC_0-t , 24,572.04 ± 5766.93 ng·h mL^-1 ; AUC_0-∞ , 25,810.89 ± 6796.60 ng·h mL^-1 and t_1/2 , 21.11 ± 5.35 h.

Unveiling meloxicam monohydrate process of dehydration by an at-line vibrational multi-spectroscopy approach

Meloxicam (MLX) is a non-steroidal anti-inflammatory drug, extensively used for inflammatory diseases and pain treatments, which exhibits five known solids forms. Form IV of MLX, a zwitterionic monohydrate (MH), is an emblematic hydrate case with promissory dissolution properties in a poorly soluble drug. However, the lack of information about MH stability regarding the dehydration process and phase transition impedes the development of further stability studies. A multi-spectroscopic/chemometric approach was implemented coupling middle- (MIR), near-infrared (NIR) and Raman spectroscopies to monitor the heat-mediated dehydration process of MH. The application of multivariate curve resolution-alternating least squares (MCR-ALS) to multi-source spectra by data fusion allow a complete view of the phenomena, improving the selectivity and precision to establish the transition temperatures and to identify involved species. It was revealed a two-step mechanism, where MH changes to Form V at 90 °C obtaining its complete dehydration at 130 °C, Form V remains unchanged during the temperature range 130-190 °C and then the polymorphic conversion to Form I starts, which reaches 100 % at 230 °C before melting MLX (248 °C). The findings of this work allow set targets in the process control of products using MH. Additionally, MCR-ALS detected an event not evidenced by conventional thermal analysis, the transformation of Form V to Form I.

Ultrasound-Guided Funicular Block: Ropivacaine Injection into the Tissue around the Spermatic Cord to Improve Analgesia during Orchiectomy in Dogs

Simple Summary

Orchiectomy is a common surgical procedure performed on small animals and postoperative analgesia is very important because pain causes various negative effects that prevent patient recovery. Our study aimed to compare the intraoperative ultrasound-guided funicular block with ropivacaine and general anaesthesia using hypnotic and/or analgesic drugs and the postoperative hemodynamic stability and pain scores. This study demonstrated that the use of ultrasound-guided funicular, using ropivacaine, guarantees long-lasting and high-quality analgesic coverage and minimises the post-surgical pain inevitably associated with orchiectomy. This study stemmed from a general trend towards increasing attention on postoperative pain after orchiectomy in dog. Since veterinarians are becoming more focused on relieving surgical pain, anaesthetists are expected to use better protocols that can minimise pain. In fact, acute postsurgical pain is of great interest due to potential risk of becoming chronic if not treated properly. The routine use of the intraoperative ultrasound-guided funicular block with ropivacaine block is considered a useful alternative for pain management for orchiectomy in dogs, which can be performed under sedation or superficial general anaesthesia. In addition, the intraoperative ultrasound-guided funicular block with ropivacaine block ensures satisfactory analgesic coverage that lasts for at least 6 h postoperatively.

Abstract

Orchiectomy is a common surgical procedure performed on small animals, and it requires postoperative pain management despite its relative simplicity. This study aimed to evaluate the hemodynamic stability, intraoperative administration of additional hypnotic and/or analgesic drugs, and postoperative pain scores following the combination of ultrasound-guided injection of ropivacaine hydrochloride into the spermatic cord and infiltration by the same anaesthetic of the incisional prescrotal line (ROP) or general anaesthesia. Dogs in the ROP group showed greater intraoperative hemodynamic stability and lower pain scores than the control group. The locoregional approach used in this study proved effective in minimising the responses to the surgical stimulus and ensured adequate analgesia intra- and postoperatively. This method, called ultrasound-guided funicular block, allows orchiectomy to be performed under deep sedation without general anaesthesia.

Analysis of Animal Well-Being When Supplementing Drinking Water with Tramadol or Metamizole during Chronic Pancreatitis

Simple Summary

Pain management during in vivo experiments can considerably improve the wellbeing of animals. However, often it is not clear, which drugs are best for the animals and how to apply these drugs without causing stress. In this study, we evaluated mice when metamizole or tramadol was provided via drinking water. Neither of these two drugs reduced the amount of consumed water or body weight in healthy mice or influenced their natural behavior, such as nest building or burrowing activity. Both analgesics were then given to mice suffering from chronic pancreatitis. Mice drinking tramadol supplemented water, at some time-points, experienced less loss in body weight and consumed more water than mice drinking metamizole. However, no major differences in other methods measuring wellbeing of mice was observed. In conclusion, both analgesics can be used during chronic pancreatitis, but tramadol seems to be moderately advantageous when compared to metamizole.

Abstract

Pain management during in vivo experiments is an animal welfare concern and is in many countries also legally required. In this study, we evaluated C57Bl/6J mice when 3 g/L metamizole or 1 g/L tramadol was provided via drinking water, before and during cerulein-induced chronic pancreatitis. Supplementation of drinking water with metamizole or tramadol did not significantly reduce the amount of consumed water. In order to evaluate the wellbeing of mice, a distress score, burrowing activity, nesting behavior, and body weight was assessed. Before induction of pancreatitis, neither tramadol nor metamizole influenced these readout parameters. Chronic pancreatitis caused a significantly increased distress score, decreased burrowing activity and a reduction in body weight. Mice drinking tramadol-supplemented water experienced less loss in body weight and consumed more water than mice drinking metamizole, at a few time-points during chronic pancreatitis. Pancreatic atrophy, a characteristic feature of chronic pancreatitis was not differentially influenced by either analgesic. In conclusion, both analgesics can be used during 33 days of chronic pancreatitis, but tramadol seems to be moderately advantageous when compared to metamizole.

[Control of pain in the early post-traumatic period in the outpatient practice. Results of the multi-center observational study RAPTOR (Rational Analgesia PostTraumatic: an Observational Research)]

AIM

Evaluate the frequency, nature and course of PTP, as well as the effectiveness and safety of NSAIDs in PTP in real clinical practice.

MATERIALS AND METHODS

The assessment of the condition and need for NSAIDs (original meloxicam) in 1115 outpatient patients who suffered a fracture of the radius (32.2%), injury to the knee (35.2%) or ligaments of the ankle (32.6%); women/men 51.5 and 48.5%, average age 46.915.5 years. We evaluated the dynamics of pain intensity (on a numerical rating scale NRS 010) at rest and during movement, the preservation of moderate and severe pain, as well as the development of adverse drugs reactions (ADR) to NSAIDs 48 weeks after injury.

RESULTS

The average intensity of pain during movement decreased from 7.031.66 to 2.211.38 (p0.001), at rest from 4.462.07 to 0.710.989 (p0.001). The number of people with pain severity 4 in the NRS in 48 weeks after the radius fracture, injury of the knee and ligaments of ankle was 21.0, 16.9 and 11.9%, with moderate or severe impairment of the injured limb 40.4, 26.2 and 16.3%, respectively. The need for taking NSAIDs up to 7 days was noted in 43.3%, 714 days-in 41.8%, more than 2 weeks or constantly in 14.9% of patients. Weak or moderate ADR were observed in 20.8% of patients, mainly dyspepsia and hypertension. Discontinuation of NSAIDs due to ADR was required in only 2.6% of patients. Pain retention 4 in NRS was associated with initially expressed pain (7 in NRS) OR 2.75 (95% CI 0.834.13; p0.001) and the presence of osteoarthritis of knee and/or hip OR 1.56 (95% CI 1.032.34; p=0.039).

CONCLUSION

PTP decreases rapidly in most patients after a radius fracture, injury of the knee, and ankle ligament injury while taking the original meloxicam. However, in a significant part of patients, moderate or severe PTP persists after 48 weeks, which requires prolonged analgesic therapy and active rehabilitation.

Evaluation of Experimental Multi-Particulate Polymer-Coated Drug Delivery Systems with Meloxicam

The objectives of this study are the development and evaluation of modified release multi-particulate drug delivery systems containing a BCS class II drug (meloxicam), formulated as polymer-coated pellets. Inert seeds containing microcrystalline cellulose, lactose monohydrate, and polyvinylpyrrolidone were prepared by extrusion-spheronization. The obtained cores were loaded with meloxicam using the drug layering technique, by spray coating in a fluidized bed with a liquid dispersion of the drug. The resulting drug pellets were film-coated with various polymers (Acryl-EZE® 93O, Eudragit® RS 30-D as well as experimental composite obtained by adding Methocel™ E5 Premium LV as pore forming agent to the extended release polymer Eudragit® RS 30-D). All experimental systems were evaluated by scanning electron microscopy and in vitro release testing, in an attempt to investigate the characteristics of the film coatings and their influence on drug release from the multi-particulate systems. The in vitro release study was performed in two stages, using two media with pH values corresponding to the gastric and intestinal environment (HCl 0.1N, pH = 1.2 for the first two hours of the test and phosphate buffer 50 mM, pH 6.8 for the next 4 h). The in vitro release data have highlighted the impact of the formulation factors on the drug release.

Effect of castration procedure on the pharmacokinetics of meloxicam in goat kids

The aim of this study was to determine the changes in the pharmacokinetics of meloxicam in goat kids who were castrated following the administration of xylazine. Six goat kids were used for the study. The study was performed in two periods according to a longitudinal study, with a 15-day washout period between periods. In the first period (Control group), 1 mg/kg meloxicam was administered by i.v. route to kids. In the second period (Castration group), the kids were sedated with 0.3 mg/kg xylazine and castration was performed following meloxicam administration. Plasma meloxicam concentration was analyzed using HPLC-UV, and pharmacokinetic parameters were calculated by noncompartmental model. In the control group following the administration of meloxicam, mean elimination half-life (t_{1/2 ʎz} ), area under the concentration-time curve (AUC_0-∞ ), total body clearance (Cl_T ), and volume of distribution at steady-state (V_dss ) were 13.50 ± 0.62 hr, 41.10 ± 2.86 hr µg/ml, 24.43 ± 1.75 ml hr^-1  kg^-1 , and 0.45 ± 0.03 L/kg, respectively. In the castration group, the t_{1/2 ʎz} of meloxicam prolonged, AUC_0-∞ increased, and Cl_T and V_dss decreased. In conclusion, the excretion of meloxicam from the body slowed and the t_{1/2 ʎz} was prolonged in the castrated goat kids following xylazine administration. However, there is a need to determine the pharmacodynamics of meloxicam in castrated goat kids.

Abcg2 transporter affects plasma, milk and tissue levels of meloxicam

ATP-binding cassette (ABCG2) is an efflux transporter that extrudes xenotoxins from cells in liver, intestine, mammary gland, brain and other organs, affecting the pharmacokinetics, brain accumulation and secretion into milk of several compounds, including antitumoral, antimicrobial and anti-inflammatory drugs. The aim of this study was to investigate whether the widely used anti-inflammatory drug meloxicam is an Abcg2 sustrate, and how this transporter affects its systemic distribution. Using polarized ABCG2-transduced cell lines, we found that meloxicam is efficiently transported by murine Abcg2 and human ABCG2. After oral administration of meloxicam, the area under the plasma concentration-time curve in Abcg2^-/- mice was 2-fold higher than in wild type mice (146.06 ± 10.57 µg·h/ml versus 73.80 ± 10.00 µg·h/ml). Differences in meloxicam distribution were reported for several tissues after oral and intravenous administration, with a 20-fold higher concentration in the brain of Abcg2^-/- after oral administration. Meloxicam secretion into milk was also affected by the transporter, with a 2-fold higher milk-to-plasma ratio in wild-type compared with Abcg2^-/- lactating female mice after oral and intravenous administration. We conclude that Abcg2 is an important determinant of the plasma and brain distribution of meloxicam and is clearly involved in its secretion into milk.

The Role of Exparel Plus Meloxicam for Postoperative Pain Management

PURPOSE OF REVIEW

Acute postoperative pain reduction is a major target against the opioid crisis. While opioids have traditionally been the mainstay for postoperative analgesia, current practice has focused on a multimodal approach to pain control, including ultrasound-guided blocks with longer acting local anesthetic agents.

RECENT FINDINGS

Non-steroidal anti-inflammatory drugs (NSAIDs), such as meloxicam, are an important class of medications utilized to manage pain in the perioperative period. An additional treatment used in perioperative or postoperative pain relief is Exparel, a bupivacaine (sodium channel blocker) liposomal injectable suspension with a 3-4-day duration of action. The long-acting mechanism and formulation of Exparel consistently has demonstrated decreased opioid use and pain scores in patients undergoing many different surgical procedures. A concern is that pH negatively alters the efficacy of bupivacaine, as in cases of inflamed tissue and acidic fluid pH. For this reason, a combination medication with both meloxicam and bupivacaine has been developed, which normalizes pH and has anti-inflammatory and anti-pain conduction properties. Clinical studies demonstrate that this combination agent can be extremely beneficial in treating postoperative pain. This manuscript summarizes the newest developments with regard to liposomal bupivacaine and the non-steroidal meloxicam, their roles in effective treatment of postoperative pain, contraindications, special considerations of using these medications, and future considerations. HTX-011 pairs up a new extended-release formulation of the local anesthetic bupivacaine with meloxicam, a well-established non-steroidal anti-inflammatory drug (NSAID).

Comparison of analgesic effect, knee joint function recovery, and safety profiles between pre-operative and post-operative administrations of meloxicam in knee osteoarthritis patients who underwent total knee arthroplasty

AIMS

This study aimed to compare the efficacy and safety of pre-operative and post-operative meloxicam administration regarding post-operative pain control and knee joint function recovery in knee osteoarthritis (KOA) patients who underwent total knee arthroplasty (TKA).

METHODS

Totally, 196 KOA patients who underwent TKA were consecutively enrolled and randomly assigned into pre-operative (N = 98) and post-operative administration group (N = 98) as 1:1 ratio. Pre-operative administration group received meloxicam 15 mg at 24 h pre-operation and 7.5 mg at 4 h, 24 h, 48 h, and 72 h post-operation, respectively. Post-operative administration group received meloxicam 15 mg at 4 h post-operation and 7.5 mg at 24 h, 48 h, and 72 h post-operation, respectively. Pain visual analog scale (VAS) at rest and at flexion, patient's global assessment (PGA), patient-controlled analgesia (PCA) consumption, hospital for special surgery (HSS), knee score, and adverse events were assessed.

RESULTS

Pre-operative meloxicam administration attenuated pain VAS score at rest at 6 h, 12 h, and 24 h; and pain VAS score at flexion at 6 h, 12 h, 24 h, and 48 h; as well as PGA score at 6 h, 12 h, 48 h post-TKA compared with post-operative meloxicam administration. Additional and total consumption of PCA were both decreased in pre-operative meloxicam administration group than post-operative meloxicam administration group, while HSS knee score at 3 months post-TKA was similar between pre-operative and post-operative meloxicam administration groups. Regarding safety, the incidence of adverse events was of no difference between the two groups.

CONCLUSION

Pre-operative administration of meloxicam might assist the post-operative pain management and care in KOA patients who underwent TKA.

Early preoperative versus postoperative administration of meloxicam in pain control, patient global status improvement, knee function recovery of arthroscopic knee surgery

BACKGROUND

This study aimed to investigate the efficacy and safety between early preoperative administration and postoperative administration of oral meloxicam in patients underwent arthroscopic knee surgery (AKS).

METHODS

Totally 296 patients with the intention to undergo AKS were recruited and randomly allocated as 1:1 ratio into early preoperative analgesia (EPA) group and postoperative analgesia (POA) group. Pain visual analog scale (VAS) score and severity (at rest and at flexion), patient global assessment (PGA) score, the consumption of rescue analgesia (pethidine), and adverse events were evaluated during the perioperation. And knee range of motion (ROM), International Knee Documentation Committee (IKDC) score, and Lysholm score were assessed at baseline and at 3 months after AKS.

RESULTS

Both pain VAS score and severity (at rest and at flexion) were decreased at 4, 8, and 12 hours, but similar at -24, -2, 24, 36, and 48 hours after AKS in EPA group compared with POA group. Besides, PGA score was lower at 4, 8, 12, and 24 hours, but similar at -24, -2, 36, and 48 hours after AKS in EPA group compared with POA group. As to the consumption of pethidine in perioperative period, it was decreased in EPA group compared with POA group. No difference was observed in knee ROM, IKDC score, Lysholm score, and adverse effects between EPA group and POA group.

CONCLUSION

Early preoperative administration of meloxicam was a superior approach in pain control compared with postoperative administration in treating patients underwent AKS.