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Ketorolac, a highly persistent NSAID of environmental concern, was significantly removed from water (80% removal) through photoelectrocatalysis where titanium dioxide nanotubes prepared by Ti foil electrochemical anodization at 30 V were used as photoanodes. Fifteen milligrams per liter of ketorolac solutions in a 0.05 M Na2SO4 aqueous medium was subjected to irradiation from a 365-nm light with an intensity of 1 mWcm-2 and under an applied potential of 1.3 V (vs. Hg/Hg2SO4/sat.K2SO4) at pH 6.0. When each process (photo and electrocatalysis) was carried out separately, less than 20% drug removal was achieved as monitored through UV-vis spectrophotometry. Through scavenging experiments, direct oxidation on the photogenerated holes and oxidation by hydroxyl radical formation were found to play a key role on ketorolac's degradation. Chemical oxygen demand (COD) analyses also showed a significant COD decreased (68%) since the initial COD value was 31.3 mg O2/L and the final COD value was 10.1 mg O2/L. A 48% mineralization was also achieved, as shown by total organic carbon (TOC) analyses. These results showed that electrodes based on titania nanotubes are a promising alternative material for simultaneous photocatalytic and electrocatalytic processes in water remediation.
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Mercúrio , Nanotubos , Poluentes Químicos da Água , Água , Cetorolaco , Titânio , Oxirredução , Eletrodos , CatáliseRESUMO
Pain represents one of the leading causes of suffering and disability worldwide. Currently available drugs cannot treat all types of pain and may have adverse effects. Hence, the use of pharmacological combinations is an alternative treatment strategy. Therefore, this study aimed to evaluate the combination of resveratrol and ketorolac through isobolographic analysis. CD1 mice were used to study the antinociceptive effect of this combination using the formalin test and the study was divided into two phases. In the first phase, four individual doses of each drug were evaluated, totaling eight testing groups. From these data, the median effective doses (ED50) of each drug were calculated. In the second phase, four testing groups were used to evaluate the combination of sub-doses of both drugs and obtain the experimental ED50. To evaluate gastric damage, five groups were employed, including indomethacin, vehicle, resveratrol, ketorolac, and combined resveratrol and ketorolac groups. Stomach samples from the mice were taken after 5 h of treatment, and the area of the ulcers was determined. Resveratrol plus ketorolac elicited a reduction in nociceptive behavior during both phases of the formalin test, and isobologram analysis revealed that the theoretical and experimental ED50 values of resveratrol and ketorolac did not differ significantly, implying an additive interaction between the drugs. Additionally, the drug combination did not generate gastric ulcers, thus enhancing the desired effects without increasing the adverse effects. Consequently, these findings substantiate the efficacy of the resveratrol and ketorolac combination in the formalin test, thereby highlighting its potential as a viable alternative for alleviating pain.
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OBJECTIVE: Ketorolac-related adverse events are not yet elucidated in neonates and infants given paucity of data. The objective of this research is to determine the incidence of major bleed in postsurgical neonates and infants treated with ketorolac, and to describe characteristics of ketorolac therapy and its effect on renal function. METHODS: This retrospective review assessed postsurgical patients younger than 6 months of age, without renal and/or coagulation dysfunction, who received ketorolac for postoperative pain during the study period. Major bleed was defined as a decrease in hemoglobin by ≥ 2 g/dL in a 24-hour period and/or intracranial, intraventricular, gastrointestinal, or pulmonary hemorrhage. Renal injury was identified per pediatric-modified RIFLE (risk, injury, failure, loss, end stage renal disease) criteria. RESULTS: One hundred twenty-five patients were analyzed, having a mean dosing weight of 5.6 kg, gestational age of 37.2 weeks, and postnatal age of 3.8 months. Ketorolac therapy was most frequently 0.5 mg/kg intravenously every 6 hours with a mean of 6.7 doses administered. The primary endpoint of major bleed occurred in 2 (1.6%) 2-month-old patients of 39 weeks' gestation. Both bleeds were characterized by decrease in hemoglobin without evidence of clinically significant bleeding. One (0.8%) and 3 (2.4%) patients experienced a decrease in glomerular filtration rate and urine output, respectively. Sixty-two (49.6%) patients received a concomitant medication associated with decreased bleeding risk. CONCLUSIONS: Ketorolac appears to have low incidence of major bleeds in postsurgical patients younger than 6 months of age without renal and/or coagulation dysfunction. Larger, prospective studies are needed to confirm safety of ketorolac use in this population.
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AIMS: The aim of this study was to evaluate the analgesic effectiveness and adverse reactions of ketorolac in comparison with other drugs when administered postoperatively after third molar surgery. METHODS: PubMed and Google Scholar were utilized to search for articles comparing the efficacy and safety of ketorolac and other analgesic agents after third molar surgery. Data from papers with a lower risk of bias were recorded. The overall evaluation of analgesia onset, general and subgroup evaluation of the number of patients requiring rescue analgesic medication, general and subgroup assessment of the study medication (satisfaction on the study drugs), and the overall estimation of adverse effects were performed using the Review Manager Software 5.3 to analyse the data and obtain the meta-analysis plot. RESULTS: The subgroup evaluation of the study medication showed that patients who received ketorolac 30 mg were more satisfied than those who were given parecoxib 1 mg (odds ratio [OR] = 8.57, 95% confidence interval [CI] = 3.66-20.08, P = .00001), parecoxib 2 mg (OR = 7.17, 95% CI = 2.88-17.86, P = .0001), parecoxib 5 mg (OR = 3.03, 95% CI = 1.69-5.41, P = .0002), and parecoxib 10 mg (OR = 2.42, 95% CI = 1.36-4.32, P = .003). Moreover, patients who received ketorolac reported fewer adverse reactions compared with those who had received opioid analgesics (OR = 0.14, 95% CI = 0.32-1.76, P = .0001). CONCLUSIONS: The data from this study demonstrates that the postoperative administration of ketorolac 30 mg presents better results on patient satisfaction when compared to parecoxib 1 mg to 10 mg, and presents a similar satisfaction to parecoxib 20 mg following third molar removal.
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Cetorolaco , Dente Serotino , Analgésicos/efeitos adversos , Analgésicos Opioides/efeitos adversos , Anti-Inflamatórios não Esteroides , Método Duplo-Cego , Humanos , Cetorolaco/efeitos adversos , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Preparações Farmacêuticas , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Resumen: Introducción: Existe la creencia de que los pacientes no experimentan dolor intenso después de cirugía intracraneal. La estimulación simpática secundaria a dolor puede ocasionar hipertensión intracraneal y sangrado postoperatorio. Es controvertido el uso de opioides para analgesia postcraneotomías por temor a sus efectos colaterales que pueden enmascarar signos de alteración neurológica. En pediatría hay estudios limitados. Objetivo: Describir el nivel de control del dolor postcraneotomías al usar buprenorfina ketorolaco y ondansetrón en pacientes pediátricos. Métodos: Estudio de cohorte descriptivo. Incluimos niños de 0-17 años programados para cirugía intracraneal electiva. Para el control del dolor se administró buprenorfina, ketorolaco y ondansetrón en infusión por 30 horas. Se investigó dolor al iniciar la infusión a las cuatro, ocho, 12, 24 y 30 horas; variables hemodinámicas y grado de sedación. Resultados: 109 pacientes fueron incluidos. Se observó adecuado control del dolor en 71.56%, 28.4% tuvo control insuficiente con una diferencia estadísticamente significativa (p < 0.001). Hubo sedación moderada en 5.6% iniciando la infusión y a las 24 horas (4.5%) sin repercusión hemodinámica. Se detectó náusea en 8.2% y vómito en 6.64%; no se presentó sedación profunda, ni depresión respiratoria. Conclusiones: Estos hallazgos sugieren que es una opción efectiva para tratar el dolor postcraneotomías en pediatría.
Abstract: Introduction: There is still a belief that patients do not experience intense pain after intracranial surgery. Sympathetic stimulation associated with pain can lead to elevated intracranial pressure and postoperative haemorrhage. There is controversy about the use of opioids for postoperative analgesia in craniotomies, owing to fear of its side effects, which can mask signs of neurological alteration. There are limited studies in the pediatric patient for post-craniotomy analgesia. Objective: To describe the postcraneotomies pain control level, using buprenorphine in partnership with ketorolac and ondansetron in pediatric patients. Methods: Descriptive cohort study. For postoperative pain control, patients were given continuous infusion buprenorphine, ketorolac and ondansetron for 30 hours. The main variables to investigate were pain at beginning of infusion, at four, eight, 12, 24 and 30 hours, hemodynamic variables and depth of sedation. Results: 109 patients were included. Adequate control of pain was observed in 71.56% of patients, whereas in 28.4% insufficient control was found, with a statistically significant difference (p < 0.001). There was moderate sedation in 5.6% of the patients at the start of infusion and at 24 hours (4.5%), without significant impact on hemodynamic variables. Nausea was found in 8.2% and vomiting in 6.64%. No deep sedation, or respiratory depression was presented. Conclusions: These findings suggest that is an effective option to treat postcraneotomy pain in pediatric patients.
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Resumen: Introducción: La analgesia preventiva es la administración de un fármaco o realización de una intervención capaz de inhibir o bloquear la respuesta dolorosa con la finalidad de prevenir el dolor asociado a un procedimiento quirúrgico. Objetivo: Identificar si existen diferencias en el control del dolor postoperatorio utilizando analgesia preventiva versus analgesia postoperatoria, manejado con paracetamol + ketorolaco en pacientes sometidos a colecistectomía laparoscópica electiva. Material y métodos: Ensayo clínico controlado, comparativo, aleatorizado, longitudinal, unicéntrico, prospectivo, homodémico, doble ciego; con 70 pacientes divididos en dos grupos. En el grupo 1 que recibió analgesia preventiva se usó paracetamol + ketorolaco y en el grupo 2 se utilizó el mismo esquema de manera postquirúrgica inmediata. Se midió tensión arterial, frecuencia cardíaca, escala verbal numérica del dolor y presencia de efectos secundarios de los fármacos en distintos momentos. Prueba estadística T de Student con significancia estadística de p < 0.05. Resultados: A los 60 minutos la tensión arterial diastólica en el grupo 1 tuvo diferencia de medias -4.20 con p = 0.027 y la escala verbal numérica presentó diferencia de medias de -0.71 y p = 0.002. A las cuatro horas la tensión arterial diastólica mostró diferencia de medias de -3.5 y p = 0.033. Las náuseas se constataron en 2.9% para el grupo 1 y 8.6% para el grupo 2. Conclusiones: Existe una mejor respuesta al dolor en aquellos pacientes que reciben un esquema de analgesia preventiva en comparación a los que se les administra un esquema de analgesia postquirúrgica inmediata.
Abstract: Introduction: Preventive analgesia is the administration of a drug or performance of an intervention capable of inhibiting or blocking the painful response in order to prevent the pain associated with a surgical procedure. Objective: To identify whether there are differences in postoperative pain control using preventive analgesia versus postoperative analgesia, managed with paracetamol + ketorolac in patients undergoing elective laparoscopic cholecystectomy. Material and methods: Controlled clinical trial, randomized, longitudinal, unicentric, prolective, homodemic, double blind; 70 patients divided into two groups. group 1 received preventive analgesia using paracetamol + ketorolac and group 2 same scheme in an immediate postsurgical manner. Bloodpressure, heartrate, numerical verbal scale of pain and presence of side effects of drugs at different times were measured. Student's t-test with statistical significance of p < 0.05. Results: At 60 minutes the diastolic blood pressure in group 1 had difference of means -4.20 with p = 0.027 and numerical verbal scale presented difference of means of -0.71 and p = 0.002. At four hours diastolic bloodpressure showed difference of means of -3.5 and p = 0.033. Nausea was reported in 2.9% for group 1 and 8.6% for group 2. Conclusions: There is a better response to pain in those patients who receive a preventive analgesia scheme compared to those who are administered an immediate post-surgical analgesia scheme.
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Although nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the main types of drugs used to treat pain, they have several adverse effects, and such effects can be reduced by combining two analgesic drugs. The aim of this study was to evaluate the nociceptive activity of methyleugenol combined with either diclofenac or ketorolac, and determine certain parameters of pharmacokinetics. For the isobolographic analysis, the experimental effective dose 30 (ED30) was calculated for the drugs applied individually. With these effective doses, the peak plasma concentration (Cmax) was found and the other parameters of pharmacokinetics were established. Methyleugenol plus diclofenac and methyleugenol plus ketorolac decreased licking behavior in a dose-dependent manner in phase II, with an efficacy of 32.9 ± 9.3 and 39.8 ± 9.6%, respectively. According to the isobolographic analysis, the experimental and theoretical ED30 values were similar for methyleugenol plus diclofenac, suggesting an additive effect, but significantly different for methyleugenol plus ketorolac (3.6 ± 0.5 vs. 7.7 ± 0.6 mg/kg, respectively), indicating a probable synergistic interaction. Regarding pharmacokinetics, the only parameter showing a significant difference was Cmax for the methyleugenol plus diclofenac combination. Even with this difference, the combinations studied may be advantageous for treating inflammatory pain, especially for the combination methyleugenol plus ketorolac.
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Analgésicos , Diclofenaco , Eugenol/análogos & derivados , Cetorolaco , Analgésicos/farmacocinética , Analgésicos/farmacologia , Animais , Diclofenaco/agonistas , Diclofenaco/farmacocinética , Diclofenaco/farmacologia , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Eugenol/agonistas , Eugenol/farmacocinética , Eugenol/farmacologia , Cetorolaco/agonistas , Cetorolaco/farmacocinética , Cetorolaco/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos ICRRESUMO
ABSTRACT Purpose: To evaluate the rate of cystoid macular edema development among cataract surgery patients on four different therapeutic regimens. Methods: The present study is a retrospective analysis of 5,380 eyes following uncomplicated phacoemulsification at Wake Forest University. The study period went from July 2007 to December 2012. Patients received one of four regimens, as follows: postoperative generic ketorolac 0.4% and prednisolone 1%, postoperative name-brand ketorolac 0.45% and prednisolone 1%, postoperative bromfenac 0.09% and prednisolone 1%, preoperative and postoperative bromfenac 0.09% alone. A statistical analysis was performed to assess the differences in rate of cystoid macular edema development among the four different therapeutic regimens. The diagnosis of cystoid macular edema required worsening of vision and evidence of increased macular thickness on optical coherence tomography. Results: The overall rate of cystoid macular edema was 0.82%. Treatment by postoperative generic ketorolac 0.45% and prednisolone 1% demonstrated the highest rate of cystoid macular edema development (2.20% of the cases). Postoperative name-brand ketorolac 0.45% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.90% of the cases). Postoperative administration of bromfenac 0.09% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.44% of the cases). Preoperative and postoperative bromfenac 0.09% alone resulted in the lowest rate of cystoid macular edema development (0.09% of the cases). The rate of cystoid macular edema was significantly lower when bromfenac was used alone vs. either regimen where ketorolac and prednisolone were used (OR 0.043, 95% CI 0.002 to 0.312; p<0.001). Conclusions: Post-cataract surgery cystoid macular edema developed less frequently following topical non-steroidal anti-inflammatory drugs regimen compared to the other therapies evaluated. Bromfenac, without corticosteroids, achieved lower rates of cystoid macular edema vs. various combinations of non-steroidal anti-inflammatory drugs with corticosteroids.
RESUMO Objetivo: Avaliar a taxa de desenvolvimento do edema macular cistóide em pacientes submetidos à cirurgia de catarata em quatro esquemas terapêuticos diferentes. Métodos: O presente estudo é uma análise retrospectiva de 5.380 olhos após facoemulsificação não complicada na Wake Forest University. O período do estudo foi entre julho de 2007 e dezembro de 2012. Os pacientes receberam um dos quatro esquemas: cetorolaco genérico pós-operatório 0,4% e prednisolona 1%, cetorolaco 0,45% pós-operatório e prednisolona 1%, bromfenac 0,09% e a prednisolona 1% pós-operatório, bromfenaco 0,09% no pré-operatório e isoladamente no pós-operatório. Uma análise estatística foi realizada para avaliar as diferenças na taxa de desenvolvimento do edema macular cistóide entre os quatro diferentes regimes terapêuticos. O diagnóstico de edema macular cistóide exigiu uma piora da visão e uma evidência de aumento da espessura macular na tomografia de coerência óptica. Resultados: A taxa global de edema macular cistóide foi de 0,82%. O tratamento com cetorolaco genérico pós-operatório 0,45% e prednisolona 1% demonstrou a maior taxa de desenvolvimento de edema macular cistóide (2,20% dos casos). O cetorolaco 0,45% e a prednisolona 1% no pós-operatório exibiram taxas intermediárias de desenvolvimento de edema macular cistóide (0,90% dos casos). A administração de bromofenac 0,09% e de prednisolona 1% no pós-operatório apresentou taxas intermediárias de desenvolvimento de edema macular cistóide (0,44% dos casos). O bromfenac 0,09% no pré e pós-operatório isoladamente resultou na menor taxa de desenvolvimento de edema macular cistóide (0,09% dos casos). A taxa de edema macular cistóide foi significativamente menor quando o bromfenac foi utilizado isoladamente em relação ao esquema onde cetorolaco e a prednisolona foram usados (OR 0,043, 95% CI 0,002 a 0,312; p<0,001). Conclusões: O edema macular cistóide pós-cirurgia de catarata desenvolveu-se com menor frequência após o tratamento tópico de medicamentos anti-inflamatórios não esteroidais, comparado às outras terapias avaliadas. Bromfenac, sem corticosteróides, alcançou taxas mais baixas de edema macular cistóide vs. Várias combinações em comparação com as várias combinações de drogas anti-inflamatórias não esteroidais com corticosteróides.
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Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Benzofenonas/uso terapêutico , Bromobenzenos/uso terapêutico , Prednisolona/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Edema Macular/prevenção & controle , Facoemulsificação/efeitos adversos , Catarata , Edema Macular/etiologia , Estudos Retrospectivos , Quimioterapia CombinadaRESUMO
OBJECTIVE: To conduct a comprehensive systematic meta-analysis investigating the association of nonsteroidal anti-inflammatory drugs (NSAIDs) and their subtypes with skin cancer (SC) and its subclasses (basal cell carcinoma BCC; squamous cell carcinoma SCC; melanoma; nonmelanoma skin cancer NMSC) in general, American and European populations. METHODS: PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure and ClinicalTrials.gov were searched up to 24 February 2019. Pooled effect sizes and 95% confidence intervals were used to estimate associations. RESULTS: Results based on 26 original studies including 223,619 cases and 1,398,507 controls showed both NSAIDs and nonselective Cyclooxygenase (COX) inhibitors to be statistically significantly associated with a reduced risk of SC, BCC, SCC and NMSC but not with melanoma. Conversely, no association was observed between selective Cyclooxygenase 2 (COX-2) inhibitors and SC or its subclasses. Further subgroup analysis showed that the results analyzed for American populations were almost the same as those for the general population. For European populations, neither NSAIDs nor its subtypes correlated significantly with susceptibility to SC or its subclasses. CONCLUSIONS: The use of NSAIDs might reduce the risk of SC, but many factors including study population, drug subtype, and disease subclass affect the significance of the association.
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Anti-Inflamatórios não Esteroides/uso terapêutico , Neoplasias Cutâneas/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados Unidos/epidemiologiaRESUMO
Purpose: To compare management of postoperative pain after corneal collagen crosslinking (CXL) with oral gabapentin or ketorolac. Methods: Prospective interventional comparative case series in a single center. Patients undergoing epithelium-off (epi-off) or epithelium-on (epi-on) techniques performed by a single surgeon for progressive keratoconus were enrolled and randomly assigned to the ketorolac (10-mg tablets every 8 h) or the gabapentin (300-mg capsules every 8 h) group and instructed to take the medication for the first 3 postoperative days. Using a numeric scale of pain, scores were assessed for current pain (at the time of applying the questionnaire), and average pain over the preceding 24 h. Eye symptoms and systemic adverse events related to oral medication were also assessed. Results: Thirty-seven patients were included, with 22 (10 epi-on and 12 epi-off) assigned to the ketorolac group and 15 (7 epi-on and 8 epi-off) to the gabapentin group. No statistically significant differences were noted on the pain scale between groups at any point of the study, in the median pain scores of patients at the time of applying the questionnaire, nor in the severity of pain during the 24-h period before the assessment. Also, no differences were found among groups for the eye symptoms and the systemic adverse events. The median regression analysis showed no effect of the type of surgery or gender in the severity of pain. Conclusions: Both oral ketorolac and oral gabapentin can be used with similar results for pain and symptomatic control after epi-on or epi-off CXL procedures.
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Córnea/metabolismo , Gabapentina/administração & dosagem , Ceratocone/cirurgia , Cetorolaco/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Colágeno/metabolismo , Reagentes de Ligações Cruzadas/administração & dosagem , Feminino , Gabapentina/efeitos adversos , Humanos , Cetorolaco/efeitos adversos , Masculino , Medição da Dor , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To analyze, using optical coherence tomography, the macular thickness values of patient groups using nonsteroidal anti-inflammatory drug (NSAID) eye drops or artificial tears during uncomplicated cataract surgery. METHODS: A total of 77 eyes from 42 patients were analyzed. The patients were divided into three groups, each using one of the following ophthalmic sterile suspensions: nepafenac (21 eyes), propylene glycol (24 eyes), or ketorolac tromethamine (32 eyes). RESULTS: The mean macular thicknesses of the nepafenac group, preoperatively as well as at 1, 7, and 45 days postoperatively, were 216.42, 216.61, 222.47, and 218.28, respectively; those of the propylene glycol control group were 218.29, 214.50, 219.37, and 228.45, respectively; and those of the ketorolac tromethamine group were 217.46, 220.71, 225.25, and 228.46, respectively. There were no significant differences between groups at any time, with p-values of 0.971, 0.6742, 0.6711, and 0.327, respectively. CONCLUSION: During the study period, no significant differences in macular thickness were observed between the patient groups using two types of NSAIDs or between those groups and the control group that used propylene glycol, indicating that neither drug was superior to the other or the placebo. However, a slight macular thickening, without reduction of visual acuity, was observed in all groups.
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The aim of the present study was to determine whether tizanidine, an alpha2-adrenoceptor agonist, is able to increase the anti-inflammatory and anti-nociceptive effects of naproxen and ketorolac with a low incidence of gastric injury and spontaneous activity in rats. The anti-inflammatory effect was assayed in a carrageenan test, and oral administration of tizanidine (ED40 =0.94±0.2mg/kg), naproxen (ED40=3.18±0.4mg/kg), and ketorolac (ED40=16.4±1.9mg/kg) showed a dose-dependent effect on inflammation. The anti-nociceptive effect was assayed in the formalin test, and administration of tizanidine (ED40=0.39±0.06mg/kg, p.o.), naproxen (ED40=33.9±3.9mg/kg, p.o.) or ketorolac (ED40=6.49±1mg/kg, p.o.) each showed a dose-dependent anti-nociceptive effect. The effects of combinations of tizanidine/naproxen and tizanidine/ketorolac were determined considering their ED40 at a rate of 1:1. Additionally, the tizanidine/naproxen and tizanidine/ketorolac combinations showed anti-inflammatory and anti-nociceptive effects. The tizanidine/ketorolac combination was more potent than tizanidine/naproxen, in both inflammatory (interaction index=0.03 tizanidine/ketorolac and 0.07 tizanidine/naproxen) and nociceptive (interaction index=0.005 tizanidine/ketorolac and 0.01 tizanidine/naproxen) processes. In both cases, tizanidine improved naproxen and ketorolac gastrointestinal tolerability by 50%. Furthermore, co-administration of tizanidine with naproxen or ketorolac did not modify the spontaneous activity in the same way as individual tizanidine administration. Considering that tizanidine increases the anti-inflammatory and anti-nociceptive effects of naproxen or ketorolac, with an increase in gastric tolerability, tizanidine could provide therapeutic advantages in the clinical treatment of inflammation and pain.
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Clonidina/análogos & derivados , Cetorolaco/efeitos adversos , Cetorolaco/farmacologia , Naproxeno/efeitos adversos , Naproxeno/farmacologia , Analgésicos/efeitos adversos , Analgésicos/farmacologia , Animais , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/farmacologia , Clonidina/farmacologia , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Masculino , Ratos , Ratos Wistar , Estômago/efeitos dos fármacosRESUMO
BACKGROUND: Ureteric colic is the most common symptom of lithiasis. It is caused by the presence of stones accumulated in the renal papillae. These stones often migrate down the ureter, causing a ureteric colic, characterized by a severe pain in the lumbar region. The aim of this study was to compare the use of ketorolac and nifedipine vs. ketorolac and tamsulosin for the medical treatment of pain caused by stones in the lower ureter. METHODS: Longitudinal study of 150 patients of 21-years or older with stones in the lower third of the ureter. 50% received ketorolac and nifedipine and the other 50%, ketorolac and tamsulosin. The Numeric Pain Rating Scale (NPRS) was used for the assessment of pain at admission and 4 and 12 hours after the treatment was administered. We used descriptive and inferential statistics (Mann-Whitney-Wilcoxon, chi-squared and Poisson regression). RESULTS: Mean age was 38.17 years; 54.7% were male and 45.3% female. NPRS mean was 9.69 (initially), 7.42 (at 4 hours) and 2.05 (at 12 hours). There were no significant differences in the initial measurement of pain between groups (p < 0.005); four and 12 hours later the pain decreased more in patients managed with ketorolac and nifedipine, p = 0.0041. There were no complications nor side effects in both treatments. CONCLUSION: The use of ketorolac and nifedipine is more effective than the use of ketorolac and tamsulosin for the management of pain caused by lower ureteral colic during the first 12 hours of treatment.
Introducción: el cólico renoureteral es la manifestación más común de la litiasis. Se trata de la presencia de cálculos en las papilas renales que frecuentemente migran hacia el uréter, ocasionando un cólico renoureteral, caracterizado por un dolor intenso en la región lumbar o en sus flancos. Se buscó comparar el uso del ketorolaco y nifedipino frente a ketorolaco y tamsulosina para el manejo del dolor ocasionado por litiasis en el tercio inferior del uréter. Métodos: estudio longitudinal en 150 pacientes mayores de 21 años con litiasis en tercio inferior del uréter. Al 50% se le administró ketorolaco y nifedipino y al otro 50% ketorolaco y tamsulosina. Se utilizó la escala numérica de dolor (END) al ingreso, a las 4 y a las 12 horas. La estadística fue descriptiva e inferencial (U de Mann-Whitney-Wilcoxon, chi cuadrada y regresión de Poisson). Resultados: la edad promedio fue 38.17 años y 54.7% de los pacientes fueron hombres. Inicialmente la END tuvo una media de 9.69, de 7.42 a las 4 horas y de 2.05 a las 12 horas. En la medición inicial del dolor no hubo diferencias significativas entre ambos grupos (p > 0.005); 4 y 12 horas después el dolor disminuyó más en los pacientes manejados con ketorolaco y nifedipino: p = 0.0041 y p = 0.000, respectivamente. No hubo complicaciones ni efectos secundarios en ambos tratamientos. Conclusión: la mancuerna ketorolaco y nifedipino es más efectiva que la del ketorolaco y la tamsulosina para el manejo del dolor del cólico renoureteral inferior durante las primeras 12 horas de tratamiento.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Serviço Hospitalar de Emergência , Cetorolaco/uso terapêutico , Nifedipino/uso terapêutico , Cólica Renal/tratamento farmacológico , Sulfonamidas/uso terapêutico , Agentes Urológicos/uso terapêutico , Adulto , Idoso , Quimioterapia Combinada , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Cólica Renal/diagnóstico , Tansulosina , Resultado do TratamentoRESUMO
ABSTRACT Drug delivery to treat ocular disorders locally is a challenging endeavor. Traditional ocular dosage form - eye drops - exhibits poor availability, consequently inefficient therapeutic response. The objective of the study was to formulate and characterize a ketorolac tromethamine ocular system with a prolonged release pattern based on liposomes as a vesicular carrier and to design once daily liquid preparation realizing the thermal in situ gelation principle. Liposomes were prepared by film hydration method. The influence of cholesterol concentration, pH and volume of hydration medium, and type and concentration of charging imparting agents were studied. Liposomes were characterized via, morphological examination, vesicular size, and encapsulation efficiency, and in vitro release performance, moreover its stability was assessed. The results obtained highlighted that liposomes showed a closed vesicular multi-lamellar structure. Ketorolac was successfully encapsulated within the liposomal structure in a cholesterol and charge inducing agent concentration-dependent behaviour. The dispersion of liposomes within thermosensitive Poloxamer in situ gel was able to retard the release of the drug by diffusion providing a controlled prolonged delivery. The liposomal formulations were physically stable for six months. Ketorolac tromethamine in situ liposomal gel representing an efficient alternative in terms of ocular retention and patient compliance when compared with conventional eye drops.
Assuntos
Cetorolaco de Trometamina/farmacocinética , Reatividade-Estabilidade , Composição de Medicamentos/classificação , Lipossomos/antagonistas & inibidores , Trometamina/antagonistas & inibidores , Anormalidades do Olho/complicações , Dermatopatias Vesiculobolhosas , Administração OftálmicaRESUMO
Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria®) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients' quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients' expectations regarding visual recovery are also increasing.
RESUMO
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common type of medication used in the treatment of acute pain. Ketorolac trometamol (KT) is a nonnarcotic, peripherally acting nonsteroidal anti-inflammatory drug with analgesic effects comparable to certain opioids. OBJECTIVE: The aim of this study was to compare the efficacy of KT and naproxen (NA) in the treatment of acute low back pain (LBP) of moderate-to-severe intensity. PATIENTS AND METHODS: In this 10-day, Phase III, randomized, double-blind, double-dummy, noninferiority trial, participants with acute LBP of moderate-to-severe intensity as determined through a visual analog scale (VAS) were randomly assigned in a 1:1 ratio to receive sublingual KT 10 mg three times daily or oral NA 250 mg three times daily. From the second to the fifth day of treatment, if patient had VAS >40 mm, increased dosage to four times per day was allowed. The primary end point was the reduction in LBP as measured by VAS. We also performed a post hoc superiority analysis. RESULTS: KT was not inferior to NA for the reduction in LBP over 5 days of use as measured by VAS scores (P=0.608 for equality of variance; P=0.321 for equality of means) and by the Roland-Morris Disability Questionnaire (P=0.180 for equality of variance test; P=0.446 for equality of means) using 95% confidence intervals. The percentage of participants with improved pain relief 60 minutes after receiving the first dose was higher in the KT group (24.2%) than in the NA group (6.5%; P=0.049). The most common adverse effects were heartburn, nausea, and vomiting. CONCLUSION: KT is not inferior in efficacy and delivers faster pain relief than NA.
Assuntos
Cetorolaco/administração & dosagem , Dor Lombar/tratamento farmacológico , Naproxeno/administração & dosagem , Trometamina/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/química , Anti-Inflamatórios não Esteroides/metabolismo , Método Duplo-Cego , Humanos , Cetorolaco/química , Cetorolaco/metabolismo , Naproxeno/química , Naproxeno/metabolismo , Trometamina/química , Trometamina/metabolismoRESUMO
This double-blind, split-mouth, and randomized study was aimed to compare the efficacy of dexamethasone and ketorolac tromethamine, through the evaluation of pain, edema, and limitation of mouth opening. Thirty-four individuals aged 18-26 years, having bilateral mandibular third molars, in a similar position, were selected. Two different surgical procedures were performed on the same individual by the single surgeon. For an extraction, the individual received 1 capsule of 10 mg ketorolac tromethamine 1 h before surgery and every 8 h for 2 days. For the extraction of the contralateral side, the individual received 1 capsule of 8 mg dexamethasone 1 h before surgery and 1 placebo capsule every 8 h for 2 days. Sodium metamizol, 500 mg, was given as rescue medication in postoperative. Pain was assessed by the Visual Box Scale-11 points (BS-11) at 24 h postoperative. Edema (metric measurement) and the maximum mouth opening (interincisal) were recorded in the pre-operative, 24 h, 48 h, 72 h and 7 days postoperatively. The results showed that both therapeutic treatments used were effective in the postoperative, and there were no statistically significant differences between the groups for the pain and edema variables. However, for the limitation of mouth opening, 24 h and 7 days postoperatively, the dexamethasone group had a lower limitation of mouth opening, behaving better than the ketorolac for this variable in these periods. Due also to the higher margin of safety, the use of dexamethasone as a single dose becomes a more suitable alternative for use in routine surgical extractions of third molars.
Assuntos
Anti-Inflamatórios/uso terapêutico , Dexametasona/uso terapêutico , Cetorolaco de Trometamina/uso terapêutico , Dente Serotino/cirurgia , Extração Dentária , Adolescente , Adulto , Dipirona/uso terapêutico , Método Duplo-Cego , Esquema de Medicação , Edema/etiologia , Feminino , Humanos , Masculino , Pré-Medicação , Resultado do Tratamento , Trismo/etiologia , Escala Visual Analógica , Adulto JovemRESUMO
La Asociación Internacional para el Estudio del Dolor (IASP) define el dolor como una experiencia sensorial y emocional desagradable con daño tisular actual o potencial descrito en términos de dicho daño. El objetivo del presente estudio fue analizar la eficacia y seguridad de la combinación de metamizol - tramadol en comparación con el metamizol - ketorolaco en el manejo del dolor postoperatorio de colecistectomía laparoscópica del Hospital Obrero N° 2. Se realizó un estudio analítico, longitudinal, ensayo clínico aleatorizado. El análisis de los datos fue no paramétrico: las variables ordinales y nominales con tablas de frecuencia; variables continuas y discretas con medidas de posición, Escala Visual Analgésica (EVA) prueba de hipótesis U de Mann-Whitney mediante el programa SPSS® versión 22.5 para Windows. Los resultados mostraron que es eficaz y seguro la utilización de la asociación de esquema 1 (metamizol - tramadol) en comparación al esquema 2 (metamizol - ketorolaco) debido a que la EVA del dolor es significativa (p < 0,05) prueba de U de Mann-Whitney.Además, ambos esquemas de tratamiento tienen una conformidad analgésica satisfactoria. Sin embargo, tienen efectos adversos similares en ambos esquemas de tratamiento. Por lo tanto se acepta la hipótesis alternativa.
The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience with actual or potential tissue damage described in terms of such damage. The objetive of this study was to analyze the efficacy and safety of the combination of metamizol - tramadol compared to metamizol - ketorolac in postoperative pain management in laparoscopic cholecystectomy Hospital Obrero No. 2. An analytical, longitudinal study, clinical trial randomized.The analysis was nonparametric data: ordinal and nominal variables with frequency tables; continuous and discrete variables with position measurements,Visual Analgesic Scale (EVA) hypothesis test U Mann-Whitney through the program SPSS® version 22.5 for Windows. The results showed that it is effective and safe use of the association scheme 1 (metamizol - tramadol) compared to scheme 2 (metamizol - ketorolac) EVA because the pain is significant (p <0.05) U test Mann-Whitney. In addition, both schemes have a satisfactory analgesic treatment compliance. However, they have similar adverse effects in both treatment regimens. Therefore the alternative hypothesis is accepted.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Dor Pós-Operatória/tratamento farmacológico , Dipirona/administração & dosagem , Colecistectomia Laparoscópica/métodosRESUMO
O objetivo deste estudo foi avaliar o uso do cetorolaco de trometamina 10mg sublingual 30 minutos antes do procedimento de biopulpectomia em pacientes com pulpite irreversível com relação à dor antes do procedimento e nas 48 horas subsequentes, a quantidade de medicação consumida no pós-operatório e tempo esperado para sua utilização. Também foi avaliada a influência da anestesia intrapulpar, o uso da automedicação analgésica antes da procura pelo atendimento e diferença entre gêneros sobre os níveis de dor pré e pós-operatória. Propôs-se avaliar também a necessidade da presença do antibiótico na medicação intracanal, comparando o Otosporin® com hidrocortisona. Participaram da pesquisa 608 pacientes que procuraram o Setor de Urgência Odontológica da Faculdade de Odontologia de Bauru ou o Setor Odontológico do Pronto Socorro Central da Prefeitura Municipal de Bauru, sendo que 34 completaram de forma adequada o protocolo previsto. Foram divididos em 4 grupos que receberam cetorolaco ou placebo como medicação pré-operatória e Otosporin® ou hidrocortisona como medicação intracanal. Foram anotados os valores de intensidade de dor, em uma escala visual analógica, antes da medicação pré-operatória, antes do atendimento, após o atendimento, 1, 2, 4, 12, 24, 48 horas após e quando houve necessidade de medicação pós-operatória para alívio da dor. Também foi anotado se o paciente havia se automedicado e qual a droga utilizada, se houve necessidade de anestesia intrapulpar, a quantidade de medicação consumida pelo paciente no pós-operatório e o tempo esperado para seu consumo. Dos resultados observou-se que os pacientes que receberam cetorolaco como medicação pré-operatória tiveram uma redução significativa da dor em 30 minutos, quando comparado ao placebo. Foi observado que o tempo necessário para a ingestão de medicamentos pós-operatórios não demonstrou diferença significativa entre os grupos, assim como na quantidade de medicação ingerida. O tempo decorrido entre a primeira e a última dose de medicação pós-operatória também não demonstrou diferença estatística. Com relação a anestesia intrapulpar, 78% dos pacientes necessitaram desta técnica, mas devido ao pequeno tamanho da amostra obtida, não foi possível correlacionar o seu uso com a utilização da medicação pós-operatória. Para os pacientes que se automedicaram previamente, não houve diferença significativa em relação à dor inicial. Quando os gêneros foram comparados, não foi possível observar uma diferença estatística significante entre eles com relação aos parâmetros estudados. Também foram descritos no trabalho os motivos de não inclusão dos 574 pacientes que foram abordados durante a realização deste estudo. Com base nos resultados, conclui-se que o cetorolaco diminuiu expressivamente o nível de dor durante a espera pelo atendimento, porém com relação ao tempo esperado pelo paciente para tomar a primeira dose de medicação pós-operatória, a última dose, a quantidade de comprimidos e a frequência de ingestão não demonstrou a mesma diferença. Também não houve diferença no nível de dor inicial entre os pacientes que se automedicaram e os que não fizeram uso dessa prática. Devido ao pequeno número da amostra, não foi possível encontrar uma correlação entre o uso da técnica anestésica intrapulpar e medicação pós-operatória, sugerindo mais estudos futuros.(AU)
The aim of this study was to evaluate the use of ketorolac tromethamine (10mg sublingual taken 30 minutes before pulpectomy in patients with irreversible pulpitis) in pain reduction immediately before the procedure and the 48 subsequent hours, postoperative consumption of analgesic drugs and time for its use. The influence of intrapulpal anesthesia, the use of analgesic self-medication prior to the demand for care and gender difference on the levels of pre- and postoperative pain was also evaluated. It was also proposed assess the need for antibiotic presence in the intracanal medicament, comparing Otosporin® with hydrocortisone. A total of 608 patients who presented to Dental Urgency Sector from Dental School of Bauru (USP) or Emergency Dental Sector from Bauru City Hall were invited to participate, and 34 completed properly planned protocol. They were distributed in 4 groups that received either ketorolac or placebo as preoperative medication and Otosporin® or hydrocortisone as intracanal medication. The rates of pain intensity were recorded by means of a visual analogue scale before pretreatment medication, immediately before the appointment, 1, 2, 4, 12, 24, 48 hours after the appointment, and when there was taken post medication for postoperative pain relief. It was also recorded if the patient had self medicated and which the drug used and, if there was need intrapulpal anesthesia, amount of ketorolac and rescue medication (paracetamol 750mg) consumed by the patient postoperative time and the waitng time for consumption. The results showed that patients receiving Ketorolac as preoperative medication had a significant reduction of pain in 30 minutes compared to placebo. It was observed that the time required for the intake of postoperative drug showed no significant difference between groups, as well as the amount of medication intake. The time elapsed between the first and last dose of postoperative medication also showed no statistical difference. Concerning intrapulpal anesthesia, 78% of patients required for this technique, but because of the small sample size obtained it was impossible to correlate their use with the use of postoperative medication. For patients who practiced self medication previously, there was no significant difference with respect to initial pain. When genders were compared, it was not possible to observe a statistically significant difference between them regarding the parameters studied. Were also described in the study the reasons of non-inclusion of 574 patients that were addressed during this study. Based on the results, it is concluded that ketorolac significantly decreased the level of pain during the waiting time, but with respect to the time length for the patient to take the first dose of postoperative medication, the last dose, the number of tablets and taken frequency did not show the same difference. There was no difference in the initial level of pain among patients who practiced self medication and those who did not use this practice. Due to the small sample size, it was not possible to find a correlation between the use of the anesthetic technique intrapulpal and postoperative medication, suggesting more future studies.(AU)
Assuntos
Humanos , Masculino , Feminino , Anestesia Dentária/métodos , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Hidrocortisona/uso terapêutico , Cetorolaco de Trometamina/uso terapêutico , Pulpectomia/métodos , Pulpite/tratamento farmacológico , Irrigantes do Canal Radicular/uso terapêutico , Odontalgia/tratamento farmacológico , Dor Aguda/tratamento farmacológico , Combinação de Medicamentos , Neomicina/uso terapêutico , Medição da Dor , Polimixina B/uso terapêutico , Cuidados Pré-Operatórios , Fatores de Tempo , Resultado do TratamentoRESUMO
AIM: Assessing the efficacy of drug in controlling pain intensity after surgical removal of impacted mandibular third molar teeth and to compare the effects. MATERIAL AND METHODS: A double-blind, randomized, controlled clinical trial was conducted. 40 patients were randomly selected and divided into two equal groups. Group A received 50 mg of tramadol orally and Group B received 10 mg of ketorolac orally. In both groups dose was repeated for next 24 hrs. Visual analogue scale was used for the collection of pain intensity from the patients. RESULTS: The results revealed, in Group A, the analgesia started within 1 hour and reached the maximum analgesic effect in 4 hours, pain intensity was 1.8 out of 10, on visual analog scale. In Group B, analgesia started within 1hour and showed it's maximum analgesic effect. The pain intensity was 2.5 on visual analog scale. The analgesic effect of 50 mg tramadol lasted up to 6 hours and that of ketorolac lasted for 5 hour. CONCLUSION: The study shows that 50mg tramadol is a suitable and safe analgesic for the relief of post-extraction pain and is more effective than 10mg ketorolac with prolonged analgesia and minimal side effects, we recommend studies with randomized clinical trials with larger sample size are needed it in clinical practice.