scholarly journals Effects of Reduction of the Caudal Morphine Dose in Paediatric Circumcision on Quality of Postoperative Analgesia and Morphine-Related Side-Effects

2007 ◽  
Vol 35 (5) ◽  
pp. 743-747 ◽  
Author(s):  
M. Cesur ◽  
H. A. Alici ◽  
A. F. Erdem ◽  
T. Yapanoglu ◽  
F. Silbir
Keyword(s):  
Side Effects ◽  
Epidural Morphine ◽  
Low Dose ◽  
Low Doses ◽  
Respiratory Complications ◽  
Rescue Analgesia ◽  
Morphine Dose ◽  
To Receive ◽  
Caudal Epidural

This study compared the efficacy and adverse effects of three low doses of morphine (10, 15 and 30 μg.kg1) for caudal epidural analgesia in children undergoing circumcision. A total of 135 boys undergoing outpatient circumcision were randomly assigned to receive 10, 15 or 30 μg.kg1 of caudal morphine. Anaesthesia was induced and maintained with propofol. After induction, the morphine was added to 0.5 ml.kg1 1% lignocaine solution with adrenaline 5μg.ml1 and injected caudally. Anaesthesia quality, postoperative pain and adverse events in a 24-hour period were evaluated. Paracetamol (20 mg. kg’ orally) was used as rescue analgesia as required. No patient required paracetamol in the first eight hours after the caudal injections. In the first 24 hours postoperatively no further analgesia was required in 66.7%, 77.8% and 91.1% of the patients in the 10, 15 and 30 μg.kg1 groups, respectively (P=0.01 for 10 vs. 30 groups). All patients had excellent analgesia. No respiratory complications were observed. Nausea-vomiting occurred in 13.3%, 20% and 46.7% of the patients in the 10, 15 and 30 μg.kg1 groups (P=0.002 for 10 vs. 30 and 0.044 for 15 vs. 30). Pruritus occurred in 8.9%, 11% and 15.6% in the 10, 15 and 30 μg.kg1 groups but was localised and did not require treatment. This study was not powered to assess concerns that low dose epidural morphine may rarely be associated with delayed apnoea and is therefore considered unsuitable for outpatient use in many centres. Increases in caudal morphine dose above 10 μxg. kg1 produce some ‘paracetamol sparing’ but no improvement in analgesia, some pruritus and a significant increase in nausea and vomiting.

Comparison of two high doses of subcutaneous buprenorphine in cats undergoing ovariohysterectomy

2019 ◽  
Vol 24 (10) ◽  
pp. 504-514
Author(s):  
Rosa Leedham ◽  
Kate L White ◽  
David Yates ◽  
Lauren Brown
Keyword(s):  
Clinical Study ◽  
Acute Pain ◽  
Pain Scale ◽  
Rescue Analgesia ◽  
Physiological Variables ◽  
Blinded Observer ◽  
High Doses ◽  
Induction Of Anaesthesia ◽  
To Receive

Objectives: The aim of the study was to evaluate the analgesia and recovery effects of two doses (0.12 mg/kg and 0.24 mg/kg) of subcutaneous buprenorphine in cats undergoing ovariohysterectomy. Methods: This was an assessor-blinded, randomised, clinical study. A total of 83 cats were recruited and randomly allocated to receive 0.12 mg/kg buprenorphine or 0.24 mg/kg buprenorphine subcutaneously, followed 30 minutes later by 40 μg/kg medetomidine intramuscularly. Anaesthesia was induced with intravenous alfaxalone to effect and maintained with isoflurane in oxygen. All cats received meloxicam before surgery. Temperament score, quality of sedation, induction of anaesthesia, dose of alfaxalone and recovery were scored using simple descriptive scales. Atipamazole was administered following surgery. Physiological variables during anaesthesia were recorded. Cats were assessed postoperatively by the same blinded observer at 2, 4 and 24 hours using a modified Colorado Feline Acute Pain scale. The presence or absence of mydriasis was noted. Results: No significant differences were identified between groups. Three cats in the 0.12 mg/kg group and four in the 0.24 mg/kg group required rescue analgesia. Mydriasis persisting for at least 24 hours was evident in 75 cats. Conclusions and relevance: No differences in analgesia were detected between groups with these protocols; mydriasis was common in both groups.

Comparison of the Effects of Low Dose Methylprednisolone and Metoclopramide on Nausea and Vomiting and Respiratory Complications after Adenotonsillectomy

2021 ◽  
Vol 15 (9) ◽  
pp. 2753-2756
Author(s):  
Shahid Adalat Chaudhry ◽  
Madiha Zafar ◽  
Usman Zeeshan ◽  
Mubashar Iqbal ◽  
Arooj Fatima ◽  
...  
Keyword(s):  
Side Effects ◽  
Pain Score ◽  
Low Dose ◽  
Operative Time ◽  
Oral Intake ◽  
Respiratory Complications ◽  
Group I ◽  
Male Patients ◽  
Group Ii ◽  
Mean Time

Objective: The aim of this study is to compare the effects of low dose methylprednisolone and metoclopramide on nausea, vomiting and respiratory complications after adenotonsillectomy. Study Design: Retrospective study Place and Duration: The study was conducted in Divisional Headquarter Teaching Hospital, Mirpur AJK for duration of six months from December 2020 to May 2021. Methods: Total 150 patients of both genders underwent adenotonsillectomy presented in this study. Patients were aged between 3-15 years. Detailed demographics of enrolled cases age, sex and weight were recorded after taking informed written consent. Patients were equally divided into two groups. Group I had 75 patients and received 1 mg/kg IV methylpredinosolone and group II received 0.15 mg/kg metoclopramide among 75 patients. Post-operative effects on PONV were assessed and compared among both groups in terms of oral intake time, vomiting episodes, respiratory complications and side effects. Mean pain score was calculated by VAS. Complete data was analyzed by SPSS 23.0 version. Results: There were 40 (53.3%) females and 35 (46.7%) males in group I with mean age 9.43±1.44 years while in group II 42 (56%) were females and 33 (44%) were male patients with mean age 8.04±3.36 years. Mean weight of the patients in group I was 23.08±4.61 kg and in group II mean body weight was 22.11±6.84 kg. Mean operative time in group I was 27.41±8.53 min and in group II mean time was 28.17±6.34 min. Post-operative frequency of vomiting and nausea was lower in group I 14 (18.7%) and 16 (21.3%) as compared to group II 21 (28%) and 24 (34%). Low pain score was found in group I 1.71±6.11 as compared to group II 3.02±4.09. Time to oral intake was higher in group II 2.98±3.48 hours as compared to group I 1.09±7.51 hours. Rate of respiratory complications and side effects were significantly higher in group II. Conclusion: We concluded in this study that the use of methylpredinosolone was effective among patients those underwent for adenotonsillectomy in terms of post-operative frequency of PONV, pain, respiratory complications and side effects. Except this low dose of methylpredinosolone were effective in earlier tolerance of oral intake. Keywords: Adenotonsillectomy, Metoclopramide, Methylpredinosolone, Oral Intake

Effect of oral contraceptives on the production and composition of human milk

1977 ◽  
Vol 9 (S4) ◽  
pp. 123-133 ◽  
Author(s):  
A. N. Gupta ◽  
V. S. Mathur ◽  
S. K. Garg
Keyword(s):  
Side Effects ◽  
Human Milk ◽  
Oral Contraceptives ◽  
Low Dose ◽  
Lactating Women ◽  
Endocrine Profile ◽  
Quality Of Milk ◽  
Drop Outs ◽  
Selection Of

SummaryOne hundred and thirty six lactating women were studied, 42 controls and 94 taking oral contraceptives. Combination pills of oestrogen and progestogen (Primovlar and Minovlar) and a low dose progestogen pill (Norgestrel) were used. The selection of a particular formulation was based on the endocrine profile of an individual; this reduced drop-outs due to side effects.The change in the quantity of milk was assessed by test-feeding followed by manual expression. Milk was also analysed quantitatively. Significant reduction in the milk yield was found with the Primovlar and Minovlar groups but no change was observed with Norgestrel. No change in the quality of milk was found for any of the three groups.

A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of a low-dose 7-day buprenorphine transdermal patch in osteoarthritis patients naïve to potent opioids

2010 ◽  
Vol 1 (3) ◽  
pp. 122-141 ◽  
Author(s):  
Harald Breivik ◽  
Tone Marte Ljosaa ◽  
Kristian Stengaard-Pedersen ◽  
Jan Persson ◽  
Hannu Aro ◽  
...  
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Low Dose ◽  
Rating Scale ◽  
Secondary Outcome ◽  
Double Blind Study ◽  
Double Blind ◽  
Skin Reactions ◽  
Local Skin

AbstractObjectivePatients with osteoarthritis (OA) pain often have insufficient pain relief from non-opioid analgesics. The aim of this trial was to study efficacy and tolerability of a low dose 7-day buprenorphine transdermal delivery system, added to a NSAID or coxib regimen, in opioid-naïve patients with moderate to severe OA pain.MethodsA 6 months randomised, double-blind, parallel-group study at 19 centres in Denmark, Finland, Norway, and Sweden, in which OA patients (>40 years) with at least moderate radiographic OA changes and at least moderate pain in a hip and/or knee while on a NSAID or a coxib were randomised to a 7-day buprenorphine patch (n = 100) or an identical placebo patch (n = 99). The initial patch delivered buprenorphine 5 μg/h. This was titrated to 10 or 20 μg/h, as needed. Rescue analgesic was paracetamol 0.5–4 g daily. Statistical analysis of outcome data was mainly with a general linear model, with treatment as factor, the primary joint of osteoarthritis, baseline scores, and season as covariates.ResultsMost patients had OA-radiographic grade II (moderate) or grade III (severe), only 8 in each group had very severe OA (grade IV). The median buprenorphine dose was 10 μg/h. 31 buprenorphine-treated patients and 2 placebo-treated patients withdrew because of side effects. Lack of effect caused 12 placebo-treated and 7 buprenorphine-treated patients to withdraw. The differences in effects between treatments: Daytime pain on movement, recorded every evening on a 0–10 numeric rating scale decreased significantly more (P = 0.029) in the buprenorphine group. Patients’ Global Impression of Change at the end of the double blind period was significantly improved in the buprenorphine group (P = 0.017). The chosen primary effect outcome measure, the Western Ontario and McMaster Universities (WOMAC) OA Index for Pain (P = 0.061), and secondary outcome measures, the WOMAC OA score for functional abilities (P = 0.055), and the WOMAC total score (P = 0.059) indicated more effects from buprenorphine than placebo, but these differences were not statistically significant. In a post-hoc, subgroup analysis with the 16 patients with radiographic grad IV (very severe) excluded, WOMAC OA Index for Pain was significantly (P = 0.039) reduced by buprenorphine, compared with placebo. WOMAC OA score for stiffness and the amount of rescue medication taken did not differ. Sleep disturbance, quality of sleep, and quality of life improved in both groups. Side effects: Typical opioid side effects caused withdrawal at a median of 11 days before completing the 168 days double blind trial in 1/3 of the buprenorphine group. Mostly mild local skin reactions occurred equally often (1/3) in both groups.ConclusionsAlthough the 24 hours WOMAC OsteoArthritis Index of pain was not statistically significantly superior to placebo, day-time movement-related pain and patients’ global impression of improvement at the end of the 6-months double blind treatment period were significantly better in patients treated with buprenorphine compared with placebo. Opioid side effects caused 1/3 of the buprenorphine-patients to withdraw before the end of the 6-months double blind study period.ImplicationsA low dose 7-days buprenorphine patch at 5–20 μg/h is a possible means of pain relief in about 2/3 of elderly osteoarthritis patients, in whom pain is opioid-sensitive, surgery is not possible, NSAIDs and coxibs are not recommended, and paracetamol in tolerable doses is not effective enough. Vigilant focus on and management of opioid side effects are essential.

Preservation of Cheese and Plain Yogurt by Low-dose Irradiation

1980 ◽  
Vol 43 (2) ◽  
pp. 114-118 ◽  
Author(s):  
S. YÜCEER ◽  
G. GÜNDÜZ
Keyword(s):  
Side Effects ◽  
Shelf Life ◽  
Total Dose ◽  
Room Temperature ◽  
Low Dose ◽  
Sorbic Acid ◽  
Low Doses ◽  
Dose Irradiation ◽  
Refrigerator Temperature ◽  
Number Of Bacteria

Irradiation preservation of Turkish kashar cheese and plain yogurt was studied using very low doses of Co-60 radiation. No side effects were observed below 0.15 Mrad. The number of bacteria killed was directly related to total dose up to 0.02 Mrad, then the effectiveness of the dose decreased. Coating cheese samples with a sorbic acid solution helped in reducing the number of bacteria by about 10–12% in irradiated samples. The shelf-life of irradiated samples stored at refrigerator temperature was almost the same as that of ones coated with sorbic acid but stored at room temperature. Mold formation in irradiated samples took three to four times longer than in nonirradiated ones. With plain yogurt the effect of total dose seemed to be the same as in cheese. Irradiation increased the shelf-life of yogurt three- to four-fold. Preservation by irradiation combined with refrigeration increased the shelf-life about five-fold.

Impact of radiotherapy practice structure on prostate cancer treatment and outcomes.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 47-47
Author(s):  
Karen Elizabeth Hoffman ◽  
Jinhai Huo ◽  
Sharon Hermes Giordano ◽  
Benjamin D. Smith
Keyword(s):  
Prostate Cancer ◽  
Quality Of Care ◽  
Side Effects ◽  
Categorical Variables ◽  
Treatment Toxicity ◽  
Image Guided ◽  
Intensity Modulated ◽  
Radiation Oncologists ◽  
To Receive

47 Background: Traditionally men with prostate cancer were treated in clinics created, managed and overseen by radiation oncologists. Urology-owned “integrated” practices emerged in the 2000s. Proponents of integrated (INT) practices argue they improve quality-of-care by fostering multidisciplinary care while detractors argue they decrease quality-of care because they employ only one or two radiation oncologists which limits quality-assurance peer review. We compared radiation techniques and treatment toxicity for men who received radiation therapy (RT) in INT and non-INT practices. Methods: Men 66 years and older diagnosed with prostate cancer from 2006 to 2009 were obtained from the Texas Cancer Registry. Cancer-directed therapy, comorbid medical conditions and late treatment toxicity (diagnosis or procedure codes for toxicity 12 or more months after diagnosis) were determined from linked Medicare claims. Practice type was classified based on practice location of the treating radiation oncologist. Chi-square statistics compared categorical variables. Cox proportional hazards models evaluated predictors of toxicity. Results: External beam RT (> 20 fractions) was administered to 781 men in INT and 3,257 men in non-INT practices. Median follow up was 44 months. Men treated in INT practices lived in counties with higher income (p<0.001). There was no difference in patient age (p=0.55) or comorbidity (p=0.88) between practice types. Men treated in INT practices were more likely to receive intensity-modulated RT (98% vs. 82%, p<0.001) and image-guided RT (73% vs. 23%, p<0.001). Androgen deprivation therapy use was similar between practice types (p=0.36). Adjusting for patient and tumor characteristics, there was no difference in risk of late gastrointestinal (p=0.52), urinary (incontinence, p=0.10; other p=0.28), or erectile (p=0.28) toxicity between practice types. Conclusions: Men treated in INT practices were more likely to receive intensity-modulated RT and image-guided RT for their prostate cancer. Risk of late gastrointestinal, urinary and sexual side effects for men who received radiotherapy in INT practices was similar to risk of late side effects for men who received radiotherapy in non-INT practices.

scholarly journals Evaluation of Dexmedetomidine Co-Administered with Neostigmine and Bupivacaine for Postoperative Epidural Analgesia in Lower Limb Orthopaedic Surgeries – A Study from Maharashtra, India

2021 ◽  
Vol 10 (32) ◽  
pp. 2634-2639
Author(s):  
Parag Yashawant Dongre ◽  
Aruna Vijay Chandak ◽  
Amol P. Singam
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Lower Limb ◽  
Rescue Analgesia ◽  
Post Surgery ◽  
Group I ◽  
Post Operative Pain ◽  
Key Words Epidural ◽  
Spinal Epidural

BACKGROUND Addition of adjuvants to the neuro axial blocked helps prolongate the duration and quality of analgesia and anaesthesia. The safety and efficacy of drugs dexmedetomidine and neostigmine have been less commonly studied. We wanted to compare post-operative analgesia, haemodynamics, and side effects if any in this study. METHODS Combined spinal - epidural anaesthesia was performed in 60 patients who underwent lower limb surgeries of less than 2 hrs. The patients were given the drug epidurally post-surgery. Group I, II and III were given 10 ml of 0.25 % bupivacaine alone, with 1 microgram per kg of neostigmine and with 0.5 milligram per kg of dexmedetomidine and 1 microgram per kg of neostigmine, respectively. 50 mg tramadol intravenous was kept as rescue analgesic. Parameters which predict haemodynamics, assessment of pain, period of analgesia, demand for rescue analgesia and the chances of side effects were noted over the next ten hrs. RESULTS To conclude, epidural analgesia is the most preferred analgesia these days in management of lower limb orthopaedic surgery’s post-operative pain. When bupivacaine was combined with neostigmine and dexmedetomidine as a neuraxial adjuvant, it prolonged the post-operative analgesia significantly without increasing the side effects of those drugs. The combination of two drugs proved better than the use of single drug alone. CONCLUSIONS Combination of neostigmine and dexmedetomidine when used as a neuraxial adjuvant, significantly prolonged the duration of post-operative analgesia by 274.13 4.539 in lower limb orthopaedic cases compared to neostigmine alone that was 176.23 ± 3.441. KEY WORDS Epidural, Neostigmine, Dexmedetomidine, Orthopaedic Surgeries, Post-Operative Analgesia

Pegfilgrastim in Congenital Neutropenia: An Observational Survey from the French SCN Registry.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3308-3308
Author(s):  
B. Beaupain ◽  
T. Leblanc ◽  
O. Reman ◽  
J.P. Vannier ◽  
O. Hermine ◽  
...  
Keyword(s):  
Side Effects ◽  
Severe Infection ◽  
Congenital Neutropenia ◽  
Pharmacokinetic Characteristic ◽  
Life Improvement ◽  
Chronic Skin ◽  
To Receive ◽  
Better Than

Abstract PegFilgrastim is registered in France since 2002. Its pharmacokinetic characteristic allows the possibility to limit the number of injections in patients with congenital neutropenia receiving long term G-CSF therapy. To date, no report has been issued about the outcome of patients with congenital neutropenia receiving this drug. At the cut-off date of July 31th, 2007, 339 patients with congenital neutropenia had been included in the French Severe chronic neutropenia (Severe congenital neutropenia n=142, WHIM n=16, Cyclic n=75; GSDIb n=16 SDS n=90). Eight patients (SCN n=4, Cyclic n=3 and GSDIb n=1) had been identified to receive PegFilgrastim. Median age at PegFilgrastim onset was 18.2 years (min 6.1-max 37.6). In 7 cases, PegFilgrastim was given in the continuation of Filgrastim (n=3) or Lenograstim(4), with a median delay of 13 years after G-CSF onset and in one case, PegFilgrastim was the initial prescription of cytokine. Dose of PegFilgrastim was usually a vial per injection, except in one child (1/2vials) resulting in a dose per injection between 90 and 286 μg/kg per injection. The rhythm of PegFilgrastim injection varied from 1 injection every 7 days until 1 injection every 14 days, with discontinuation period. The median duration (between onset of PegFilgrastim and the last dose) was 0.7 year (min 0.3–2.7). The efficiency measured by ANC criteria appears to better than G-CSF (fig 1: baseline Median ANC 156/mm3, Under G-CSF 501/mm3, Under PegFilgrastim 1901/mm3/ Kruskall Wallis test p=0.02). Severe infection was never reported under PegFilgrastim, but neither in the previous G-CSF therapeutic periods for the 7 patients. More frequent ENT infection was observed in one patient who consider the PegFilgrastim as less efficient than G-CSF. The side effects appeared to be more frequent compare to the G-CSF therapy. Bone pains were reported in 7 patients, anemia and thrombocytopenia (WHO gr II) in one, urticarian chronic skin rash in 3. Finally, at the last update, 7 patients had withdrawn PegFilgrastim, and had resumed G-CSF therapy. Only one patient is still receiving PegFilgrastim. In conclusion, PegFilgrastim appeared efficient in Congenital neutropenia, but more frequent short term side effects were observed compare to standard G-CSF therapy, resulting in a limited quality of life improvement, leading to drug withdrawn in most of the patients. Figure 1: Median ANC by diagnosis Figure 1:. Median ANC by diagnosis

The Antiemetic Efficacy of Methylprednisolone Compared with Metoclopramide in Outpatients Receiving Adjuvant CMF Chemotherapy for Breast Cancer: A Randomized Trial

1985 ◽  
Vol 71 (5) ◽  
pp. 459-462 ◽  
Author(s):  
Elisabetta Campora ◽  
Silvana Chiara ◽  
Paolo Bruzzi ◽  
Pietro Scarsi ◽  
Riccardo Rosso
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Randomized Trial ◽  
Breast Cancer Patients ◽  
Complete Protection ◽  
Antiemetic Drug ◽  
Antiemetic Efficacy ◽  
Gastrointestinal Side Effects ◽  
To Receive

A randomized trial was performed comparing the antiemetic efficacy of methylprednisolone (MPN) and metoclopramide (MCP) in 60 breast cancer patients eligible for outpatient adjuvant chemotherapy with cyclophosphamide, methotrexate, and 5-FU (CMF). At the time of their first chemotherapy course patients were randomized to receive either MPN 375 mg or MCP 1 mg/kg both administered in 3 equal doses, IV just prior to chemotherapy and then IM 6 and 12 hours after treatment. Patients receiving MPN experienced significantly less nausea (p < 0.0005) and vomiting (p < 0.0005) and antiemetic protection was maintained in patients receiving multiple chemotherapy courses. Complete protection (0 emesis) was observed in 58 % of patients receiving MPN as compared with 20 % of patients treated with MCP (p < 0.005). The most frequent side effects were facial flush in 38 % of patients and somnolence in 15 % of patients receiving MPN and MCP, respectively. Complete protection from CMF-induced gastrointestinal side effects was observed in two-thirds of our patients receiving antiemetic MPN treatment. In these patients administration of the maximum cumulative CMF dose was possible without impairing their quality of life. MPN, at the dose and schedule reported, is an affective antiemetic drug suitable for use in breast cancer outpatients receiving adjuvant CMF therapy.

Quality of Life Outcomes Associated with Variable Posttransplant Prednisone Dosing Regimens

1996 ◽  
Vol 6 (2) ◽  
pp. 64-68 ◽  
Author(s):  
Donna K Hathaway ◽  
Rebecca P Winsett ◽  
E Jean Milstead ◽  
Mona N Wicks ◽  
A Osama Gaber
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Low Dose ◽  
Standard Dose ◽  
Graft Function ◽  
Transplant Recipients ◽  
Life Outcomes ◽  
Dosing Regimens ◽  
Dose Prednisone

Prednisone tapering has become more common in the management of transplant recipients. Benefits of this practice, however, must be weighed against the risks. This study identified outcomes associated with variable low dose prednisone protocols. The study sample included 98 kidney and kidney-pancreas transplant recipients 1 year after transplant. Graft function, side effects of steroid therapy, and quality of life were recorded on patients receiving 0 (n=5), 1 to 5 (n=4), 5 to 7.5 (n=5), 7.5 to 10 (n=21), and greater than 10 mg/d prednisone (n=63). Despite the fact that patients were assigned to the low dose groups because they were at risk for or already experiencing steroid induced side effects, the low dose groups presented side effect and quality of life profiles similar to or better than those of the standard dose group.

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