Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialPiroxicam versus tenoxicam in spine surgery: a placebo controlled study.
In double-blind trial 60 patients undergoing spine surgery were randomized to receive either placebo, tenoxicam 40 mg intravenously (i.v.), tenoxicam 40 mg intramuscularly (i.m.) or piroxicam 40 mg i.m., immediately following the induction of general anesthesia. As compared to placebo, the 24 hour morphine consumption was reduced in all groups. This reduction was only statistically significant (p = 0.023) in the i.v. group (21.7 +/- 11.27 versus 36.53 +/- 20.33 mg). ⋯ With piroxicam only rest pain scores at 24 hours were lower. Less urinary retention was noticed in the i.v. tenoxicam group. This study shows that, following spine surgery, i.v. tenoxicam induces a morphine sparing effect (41%) while offering lower rest and dynamic pain scores and a lower incidence of urinary retention.
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Acta Anaesthesiol Belg · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous tramadol compared to propacetamol for postoperative analgesia following thyroidectomy.
We compared the efficacy and side effects of propacetamol (P), an injectable prodrug of acetaminophen, 2 g and tramadol (T), a weak synthetic opioid, 1.5 mg.kg-1, given intravenously following thyroidectomy. 80 patients were randomly assigned to blindly receive one dose of P or T on request in the PACU. Residual pain was treated with i.v. PCA morphine. ⋯ More patients complained of nausea and vomiting (p = 0.01) during the first two hours following injection of tramadol, but there was no difference throughout the whole study. Oversedation was not observed in any group. We conclude that a single dose of tramadol provides a better quality of analgesia than propacetamol during the first six hours after thyroidectomy, but fails to ensure optimal analgesia, since VAS pain scores failed to fall below 3 despite the use of supplemental morphine.
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In recent years, a lot of concern about the use of oral antidiabetics has been raised. Several studies indicate an excess cardiovascular morbidity and mortality associated with the use of oral antidiabetics in the treatment of non-insulin dependent diabetes mellitus. Only recently, the identification of the KATP-channels and it's pivotal role in the phenomenon of ischemic preconditioning has lead to a clear explanation of these disturbing findings. ⋯ The question has been raised what to do with oral antidiabetics during the perioperative setting with it's additional burden imposed on the cardiovascular system. In this article the historical background, the phenomenon of ischemic preconditioning, the importance of KATP-channels and the working mechanism of the oral antidiabetics are highlighted. A few thoughts on the use of oral antidiabetics in the perioperative setting are developed and clinical conclusions drawn.
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Acta Anaesthesiol Belg · Jan 2001
ReviewNonsteroidal anti-inflammatory drugs and paracetamol in children.
The cyclooxygenase enzymes produce large amounts of prostaglandins in presence of tissue injury and inflammation. Prostaglandins exert their influence on nerve membrane excitability both at the peripheral site and at the spinal dorsal horn. Their key role in peripheral tissue inflammation and central sensitization warrants their incorporation in pain management strategies for children. ⋯ The rectal route of administration is notoriously unreliable for eliciting an analgesic effect and the oral route is to be preferred. The dosage of paracetamol must take into account the pharmacokinetic properties of the drug in children. The maximum daily dosage should not be exceeded to avoid excessive production of a hepatotoxic metabolite.