Ugeskrift for laeger
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Based on 19 studies (7,238 participants) a Cochrane review concludes that the addition of caffeine to an analgesic drug provides superior analgesia compared with the analgesic drug alone. The benefit is small, with a number needed to treat of approx. 16. The use of analgesics containing caffeine is associated with an increased risk of the development of physical dependence, overuse headache, and withdrawal symptoms upon abrupt discontinuation. Combination analgesics with caffeine should only be used temporarily and exclusively for the treatment of acute pain conditions.
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This paper focuses on the current evidence regarding age as an independent predictor of impaired post-operative outcome and on the possibilities of perioperative interventions in elective and emergent surgery. Co-morbidity and functional parameters, i.e. frailty, are better predictors than age and can be combined with intraoperative data to help identifying patients who might benefit from increased level of care and observation. Most elderly patients go through surgery without impaired outcome, however, further studies are needed to identify who might benefit from increased level of care.
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The management of post-operative pain in the elderly represents a challenge due to coexisting diseases, concurrent medications, and age-related pharmacodynamic and pharmacokinetic changes. Analgesic therapy in this group of patients should balance the potential efficacy with the risk of interactions and side effects. In general, doses should be smaller and the dosing intervals longer ("start low and go slow") and the use of regional blocks and non-pharmacological treatment should be encouraged. Continuous assessment of pain, pain relief and side effects is particularly important in elderly patients.
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Ugeskrift for laeger · Sep 2013
Case Reports[Bilateral rupture of the Achilles tendons after treatment with ciprofloxacin].
We report a case of spontaneous non-traumatic bilateral rupture of the Achilles tendons following ciprofloxacin treatment. A 54-year-old man presented with spontaneous Achilles tendon rupture on the left side, tendinitis and partial tear on the right side following few days of treatment with ciprofloxacin 500 mg twice daily and long-term treatment with prednisolon 10 mg once daily. This rare side effect caused by concurrent treatment with steroids and ciprofloxacin should be kept in mind. Any signs of tendinitis following this treatment should arouse the physicians' suspicion towards ciprofloxacin.