Clinical therapeutics
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Clinical therapeutics · May 1997
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialBromfenac sodium, acetaminophen/oxycodone, ibuprofen, and placebo for relief of postoperative pain.
The objective of this double-masked, parallel-group, multicenter, inpatient study was to compare bromfenac with an acetaminophen/oxycodone combination and ibuprofen in patients who had pain due to abdominal gynecologic surgery. In the 8-hour, single-dose phase, 238 patients received single oral doses of bromfenac (50 or 100 mg), acetaminophen 650 mg/oxycodone 10 mg, ibuprofen 400 mg, or placebo. In the multiple-dose phase, 204 patients received bromfenac, acetaminophen/oxycodone, or ibuprofen for up to 5 days. ⋯ The acetaminophen/oxycodone group reported more somnolence and vomiting. Single doses of bromfenac provided analgesia at least equivalent to that of the acetaminophen/oxycodone combination, with a longer duration of action. Both doses of bromfenac and acetaminophen/oxycodone were superior to ibuprofen in this study.
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Clinical therapeutics · May 1997
ReviewPharmacokinetics and pharmacodynamics of midazolam given via continuous intravenous infusion in intensive care units.
Critically ill patients often benefit from sedation to optimize their care and their ventilatory support. Ideally, incremental doses of a drug are administered to produce the desired level of sedation without toxicity or overdose. Because metabolism and elimination of drugs are often altered in critically ill patients, knowledge of the pharmacokinetics of sedative hypnotics is essential to ensure their appropriate selection and administration. ⋯ Midazolam is readily distinguished from other benzodiazepines because of its rapid onset and short duration of action, low incidence of thrombophlebitis and pain on injection, and minimal cardiovascular and respiratory effects. The physiochemical properties of midazolam allow for enhanced water solubility, which limits physicochemical incompatibilities. These properties make midazolam a valuable sedative that can be given via continuous intravenous infusion in the intensive care unit.
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Clinical therapeutics · May 1997
Review Case ReportsNonsteroidal anti-inflammatory drugs, traditional opioids, and tramadol: contrasting therapies for the treatment of chronic pain.
The treatment of chronic pain is an important function of physicians. In the United States, available drug treatments for chronic pain currently include simple analgesics such as acetaminophen, salicylates and other nonsteroidal anti-inflammatory drugs, traditional opioid drugs, and adjuvant agents (eg, antidepressants, anticonvulsants). ⋯ Tramadol is an effective analgesic that works through a combined mechanism of weak mu receptor binding and the inhibition of serotonin and norepinephrine reuptake. Tramadol has a favorable adverse-effect profile and therefore is likely to have an important role in the management of chronic pain syndromes.