Clinical pharmacy
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of patient-controlled versus conventional analgesia for postoperative pain.
Patient-controlled i.v. administration and intramuscular administration of morphine sulfate were compared in a crossover study to determine their relative effectiveness in relieving postoperative pain. Twenty adult patients scheduled for abdominal surgery were randomly assigned to one of two groups; one group received i.v. morphine sulfate for 24 hours using a patient-controlled analgesia (PCA) device, after which they were given morphine sulfate i.m. for 24 hours. The treatment order was reversed for the other group. ⋯ No significant differences in amount of narcotic used, respiratory rate, nausea and vomiting, or levels of activity or sedation were noted for the two regimens. Patients' rankings of the two treatment modes did not differ significantly, but a majority of patients indicated a preference for future use of PCA. In these postoperative patients, administration of i.v. morphine sulfate by PCA was as safe as i.m. administration and possibly more effective in relieving pain.
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Comparative Study Clinical Trial
Double-blind crossover trial of droperidol, metoclopramide, and prochlorperazine as antiemetics in cisplatin therapy.
Droperidol, metoclopramide, and prochlorperazine were compared in a double-blind crossover trial to determine their relative effectiveness in preventing and controlling the nausea and vomiting caused by cisplatin-containing chemotherapy. Twenty-five patients receiving cisplatin-containing chemotherapy for various malignancies were entered into this trial with 14 patients completing the three-drug randomization sequence. This was the patient's first exposure to cisplatin. ⋯ There was a significant difference in number of emetic episodes demonstrating antiemetic superiority of metoclopramide over both droperidol and prochlorperazine. For these 14 patients completing the trial, eight preferred metoclopramide, two preferred prochlorperazine, one preferred droperidol, and three had no preference. At the doses used in this study, the antiemetic efficacy of metoclopramide was superior to either droperidol or prochlorperazine.
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Two patients who developed intraspinal hematomas associated with anticoagulation therapy are described, and the pathology, clinical presentation, risks, evaluation and management of this rare hemorrhagic consequence, which results in spinal cord injury (SCI), are discussed. A 49-year-old man was taking warfarin sodium 7.5 mg orally every day for two weeks for thrombophlebitis. Prothrombin time (PT) was 24 sec (control = 17 sec). ⋯ Twelve days later, a laminectomy was performed to remove the T6-L1 subdural hematoma revealed by computed tomography (CT). The patient remains a T5 complete paraplegic. Unlike intracranial hemorrhage, intraspinal hemorrhage usually occurs in the epidural space, most often in the dorsal thoracic spine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Two patients who developed the neuroleptic malignant syndrome (NMS) are described, and pertinent literature is reviewed. A 30-year-old man developed NMS, apparently as a result of haloperidol treatment of chronic undifferentiated schizophrenia. Treatment with cooling blankets, acetaminophen, dantrolene sodium, and bromocriptine mesylate decreased abnormal vital signs, but catatonia continued. ⋯ Symptoms, including diffuse muscular rigidity, akinesia, and fever, develop within 24-72 hours. Neurologic symptoms may develop or worsen, and leukocytosis and elevated levels of liver enzymes occur. Death can result from respiratory or cardiovascular failure, and rhabdomyolysis can lead to acute renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Antiemetic effect of perphenazine versus prochlorperazine intravenously before cisplatin therapy.
Antiemetic effects of perphenazine and prochlorperazine, both administered by continuous i.v. infusion after a loading dose, were compared in patients receiving cisplatin. Study subjects were 6 men and 13 women for whom other antiemetic therapy had failed; each patient was studied during two courses of cisplatin therapy. Patients were randomly selected to receive either perphenazine or prochlorperazine during the first course; for the second course, each received the other antiemetic. ⋯ Few side effects were reported. Nervousness was experienced with prochlorperazine in four patients and perphenazine in one, and drowsiness occurred with prochlorperazine in four patients and perphenazine in three. Perphenazine and prochlorperazine, when given in equal doses and administered by continuous i.v. infusion after a loading dose, were equally effective in controlling nausea and vomiting associated with cisplatin therapy.