Pharmacotherapy
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Randomized Controlled Trial Clinical Trial
Evaluation of ketorolac, ibuprofen, acetaminophen, and an acetaminophen-codeine combination in postoperative oral surgery pain.
Two-hundred six outpatients with postoperative pain after the surgical removal of impacted third molars were randomly assigned on a double-blind basis to receive oral doses of ketorolac tromethamine 10 and 20 mg, ibuprofen 400 mg, acetaminophen 600 mg, a combination of acetaminophen 600 mg plus codeine 60 mg, or placebo. Using a self-rating record, subjects rated their pain and its relief hourly for 6 hours after medicating. All active medications were significantly superior to placebo. ⋯ Repeat-dose data indicated that on the day of surgery ketorolac 10 and 20 mg and ibuprofen 400 mg were superior to acetaminophen 600 mg; ketorolac 20 mg was also superior to acetaminophen-codeine. Differences among active medications were not significant when data for the entire postoperative period (days 0-6) were evaluated. The frequency of adverse effects was similar for the active medications.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intravenous ketorolac tromethamine and morphine sulfate in the treatment of postoperative pain.
This study compared the efficacy and safety of ketorolac tromethamine and morphine sulfate in alleviating moderate or severe pain immediately after major surgery. One hundred twenty-two patients were randomly assigned to receive single intravenous injections of ketorolac 10 mg, ketorolac 30 mg, morphine 2 mg, or morphine 4 mg; patients could receive a second dose 15 minutes thereafter, upon request, and most received both available doses. Analgesic efficacy was measured by interviewing patients and assessing pain intensity and pain relief for 6 hours after the first medication administration. ⋯ One patient who took morphine 4 mg withdrew because of drowsiness; other common adverse events reported included nausea, vomiting, somnolence, and dyspepsia. There were no statistically significant differences in the frequency of adverse events among the treatment groups. Intravenous ketorolac is effective for the treatment of postoperative pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Parenteral ketorolac: opiate-sparing effect and lack of cardiorespiratory depression in the perioperative patient.
Two studies evaluated the intraoperative and postoperative use of ketorolac, a nonopioid analgesic. Compared with the opioid analgesic alfentanil, ketorolac administered intraoperatively exerted no adverse effects on cardirespiratory functions (i.e., no changes in heart rate, arterial partial pressure of carbon dioxide, or mean arterial pressure, and no associated apnea). Analgesic efficacy of both agents was judged to be equal. ⋯ The lack of respiratory depression with ketorolac, which would be anticipated from its inability to bind to central opioid receptors, was also demonstrated. In the placebo group, arterial partial pressure of carbon dioxide was significantly increased postoperatively, whereas a similar increase was not found in the ketorolac group. Results of the two investigations demonstrate the absence of opioid effects with ketorolac, and support its use for intraoperative and postoperative analgesia in patients undergoing major surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy and safety of single doses of intramuscular ketorolac tromethamine compared with meperidine for postoperative pain.
Ketorolac tromethamine, a potent nonnarcotic prostaglandin synthetase-inhibiting analgesic, was compared with meperidine for relief of moderate to severe postoperative pain. In a double-blind, randomized study, 125 patients received single intramuscular doses of ketorolac 30 or 90 mg or meperidine 50 or 100 mg. The degree of pain and pain relief were quantified verbally and with visual analog scales at baseline and 30 minutes, then hourly for 6 hours. ⋯ Compared with both doses of meperidine, the two doses of ketorolac exhibited significantly longer duration of analgesic effect, as measured by the percentage of patients who terminated the study because of inadequate pain relief. The frequency of side effects was not significantly different between the drugs. The prolonged efficacy of intramuscular ketorolac combined with the reduced risk of respiratory depression suggest an important use of this drug for the relief of postoperative pain.
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Review Multicenter Study Clinical Trial
Acylated plasminogen-streptokinase activator complex: a new approach to thrombolytic therapy.
Acylated plasminogen-streptokinase activator complex (APSAC; antistreplase) is an inactive complex of human plasminogen and streptokinase. When it is injected, a controlled deacylation of the catalytic center occurs, activating the complex so that thrombolysis may begin. This process extends the half-life of streptokinase, allowing for 4-6 hours of fibrinolytic activity. ⋯ Serious bleeding reactions are uncommon, with the frequency of cerebrovascular accident reported at 0.4-0.6%. The special advantage of anistreplase is its administration as a 30-U intravenous bolus injected over 5 minutes, eliminating the need for long infusions and increasing the ease of administration. Based on its efficacy and ease of administration, anistreplase may become the drug of choice in the emergency treatment of acute myocardial infarction.