A. Yatskevych, I. Trutyak, U. Abrahamovych, O. Yatskevych

Danylo Halytsky Lviv National Medical University

Introduction. Today the main method of complex treatment of severe foot deformities in adults is a surgery. Every surgery benefi  cial to a patient is accompanied by iatrogenic and inflammatory tissue damage of different degrees and related complications of wounds. No exception is made for corrective surgery on foot. After a corrective intervention, and also after postoperative changes of anatomical relationships in segments, there occurs inflammatory reaction which is accompanied by a prolonged swelling and foot pain. It is believed that meloxicam has not the least analegtic and anti-inflammatory activity as traditional anti-inflammatory drugs and specific (highly selective) inhibitors COX-2, dominating them on the degree of safety and the least number of side effects. Moreover, for the orthopedic patients very important is their positive impact on the components of the musculoskeletal system, in particular promoting the normalization of metabolism in cartilage. Evaluation of the efficacy of meloxicam (“Movalis”) in patients after surgery on flat foot deformity has not been investigated.

The aim of the study is to determine the efficacy of meloxicam (“Movalis”) in patients after flatfoot surgery.

Materials and methods. The results of effi  cacy determining of meloxicam treatment were analyzed (“Movalis” firm Boehringer Ingelheim GmbH) in 107 patients (27 men and 80 women, average age 48.4 years), operated with flatfoot (research groups). All patients were performed a corrective osteotomy of foot and various options of arthroplasty and miotenoplasty operations. All operations were performed according to McBride, SCARF osteotomy, Weil, Akin, Chevrone. “Movalis” was prescribed in injection (15.0 mg daily). On the sixth day after the operation patients were prescribed a single oral use of “Movalis” with daily dose of 15.0 mg or twice a day 7.5 mg for another 10 days. The control group totaled 104 patients, similar by age, sex and foot surgery, which did not use NSAIDs, and (if necessary) performed anesthesia using Metamizole (50.0 mg for patients with moderate pain) and narcotic drug (Tramadol 50.0 mg) in cases of pronounced and significant pain. In all patients of experimental and control groups in the postoperative period were observed: 1) the severity and dynamics of pain according to the VAS scale; 2) the severity of aseptic inflammation by the severity of local swelling of the foot before the operation, evaluation of its dynamics every day in the morning after waking and before the load measurment with a measuring tape on the level of the fi  fth tuberous metatarsal bone, which can be easily determined during the palpation in all patients; 3) the dynamics of the wound healing with an assessments of the postoperative wound healing results, for which we used and modified for specificanatomical location clinical system developed by prof. H. T. Nishanovym with co-authors.

Results and discussion. Thus, the proposed scheme of treatment can achieve not only an adequate analgesic effect, but also provides a strong anti-inflammatory effect. In the fi  rst days of treatment it can not only prevent the growth of inflammatory syndrome (unlike the patients in the control groups), but to reduce it to 44.7 % compared with control group of patients that have not been treated with “Movalis”. By the end of the fi  rst week inflammatory syndrome, as a result of a treatment by the proposed scheme, is expressed in 4.2 times less than in control group of patients. The scheme of treatment has a positive effect on the components of the syndrome of inflammation, but the anti swelling effect is expressed the most. There were no vesicles in patients of the research group, while they were detected in 2.3 % of patients in the control group. In general, treatment of patients with ‘Movalis’ helped to reduce the rate of postoperative inflammatory and wound’s complications in 2.9 times – from 14.8 to 5.1%. Total tolerance to meloxicam (“Movalis”) was seen as very good in 77 patients (71.9 %), good – in 27 (25.2 %), satisfactory – in 2 (1.8 %), and in one patient (0.9 %) as poor (allergic reaction). In 2 patients were detected gastrointestinal side effects (heartburn, discomfort in epigastric area), but they did not require discontinuation of “Movalis”.

Conclusions. The use of meloxicam (“Movalis”) in patients after fl  at foot surgery is effective, achieves good analgesic effect, and provides a strong anti-inflammatory effect. “Movalis”is well tolerated and significantly reduces the incidence of wound complications.

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