Ketorolac vs. tramadol for pain management after abdominal surgery in children

Background Tramadol is a pure analgesic widely used forpostoperative treatment and well tolerated by children. Howevet;it has only a 50% efficacy. Ketorolac, a non􀁙steroid anri􀁙inflammation drug (NSAID), is widely used in adults and has upto 85% clinical efficacy. Data supporting the use of ketorolac inchildren has been limited.Objective To compare the clinical efficacies of intravenousketorolac and tramadol for moderate􀁙to􀁙severe pain managementafter abdominal surgery in children.Methods A double􀁙blind controlled trial was conducted in Moh.Hoesin Hospital, Palembang, from January to June 2012. Subjectswere postoperative children aged 1 􀁙 7 years who met the inclusioncriteria. T hey were randomized into two groups who receivedeither intravenous ketorolac or tramadol. Subjects assessedtheir pain level using the Face, Legs, Anns, Cry and Consolability(FLACC) pain scale. T he FLACC scores ::::;3 were considered toindicate clinical success of the intervention. Data were analyzedby T􀁙test, Chi􀁙square test, and Fischer's exact test.Results Of the 60 subjects who underwent abdominal surgery withgeneral anesthesia, 31 (52%) were boys and 29 (48%) were girls.Subjects' mean age and body weight were 3.7 (SD 1.82) years and12.6 (SD 2.85) kg, respectively. Mean duration of surgery was 71.7(SD 21.11) minutes and mean post􀁙operative FLACC score was6.6 (SD 0.5). Eight subjects dropped out of the study. Efficacies ofketorolac and tramadol were not significantly different at 21/26 and17/26, respectively (P=OJ5). In addition, there was no significantdifference in the number of patients experiencing a >3 FLACCscore decline between ketorolac and tramadol groups (P=0.61).Conclusion T here is no significant difference in the efficaciesof intravenous ketorolac and tramadol for moderate􀁙to􀁙severepain management after abdominal surgery in children. [PaediatrIndones.2014;54:118.21.].

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The Use of Milrinone Versus Conventional Treatment for the Management of Life-Threatening Bronchial Asthma

The Open Anesthesia Journal ◽

10.2174/2589645801913010012 ◽

2019 ◽

Vol 13 (1) ◽

pp. 12-17 ◽

Cited By ~ 2

Author(s):

Amr Sobhy ◽

Doaa M. K. Eldin ◽

Hany V. Zaki

Keyword(s):

Bronchial Asthma ◽

Conventional Treatment ◽

Controlled Trial ◽

Blood Gases ◽

Categorical Variables ◽

Chi Square ◽

Arterial Blood ◽

Number Of Patients ◽

Significant Difference ◽

Life Threatening

Background and Aims: In our study, we investigated the effectiveness of intravenous milrinone in life-threatening bronchial asthma as compared to conventional treatment. Methods: Fifty patients aged 18-50 years, presenting with life-threatening asthma were enrolled in a Randomised Controlled Trial (RCT). They were randomly allocated into Group C (25 patients): who received the standard pharmacotherapy and placebo, and Group M (25 patients): who in addition to the standard therapy, received 25 μg milrinone as an initial slow IV bolus diluted in 10 ml of normal saline. The following data were recorded: PEFR (Peak Expiratory Flow Rate) expressed as a percentage of the patient’s previous value, Respiratory Rate (RR), MABP (Mean Arterial Blood Pressure), arterial blood gases, and the number of patients requiring mechanical ventilation. Differences between groups were tested using Analysis of Variance (ANOVA) for quantitative variables with post hoc using the Least Significant Difference (LSD) test, and Chi square test for categorical variables. Results: Group M showed marked improvement in PEFR that was highly significant (P < 0.001) 10 min after injection and significant after one hour from the start of treatment in comparison to Group C. There was also an improvement in RR and PO2 that was significant in group M. Milrinone was associated with a reduction in MABP only after 10 min from injection, and showed a statistically significant decrease in the number of patients requiring mechanical ventilator support (P ˂ 0.05). Conclusion: Milronine is a promising agent as a rescue drug in the treatment of life-threatening bronchial asthma.

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Randomized controlled trial of erdosteine for acute cough in children with colds

Paediatrica Indonesiana ◽

10.14238/pi51.2.2011.111-5 ◽

2011 ◽

Vol 51 (2) ◽

pp. 111

Author(s):

Yenny Yenny ◽

Roni Naning ◽

Amalia Setyati

Keyword(s):

Randomized Controlled Trial ◽

Clinical Improvement ◽

Common Cold ◽

Controlled Trial ◽

Research Subjects ◽

Acute Cough ◽

Chi Square ◽

Double Blind ◽

Randomized Controlled ◽

Significant Difference

Background T h e prevalence of the common cold in children is high, v.ith 30% of cases exhibiting an acute cough, the most common complaint by parents. Erdosteine, a recently developed cough medicine, is available for children. Erdosteine has been reported to increase mucodliary clearance, act as an antioxidant and prevent bacterial adhesion.Objective To assess the clinical improvement in acute cough in children \\lith a common cold taking erdosteine vs. a placebo.Methods We conducted a double􀀾blind, randomized, controlled trial at the Public Health Center of Gedongtengen, Yogyakarta with 140 children selected by a consecutive sampling method. Research subjects were randomized by computer program into two treatment groups, those receiving erdosteine therapy and those receiving a placebo. Both groups were monitored for 6 days. A scoring system was used to assess the improvement of acute cough symptoms and analyzed by Chi-square test.Results No significant differences in basic characteristics, cough severity, or environment were found among the 140 children with common cold in the two groups. After 6 days of treatment, no significant difference in clinical improvement of acute cough was found between the erdosteine (65 subjects improved out of 70) and placebo groups (62/70),92.5% and 88.6%, respectively (P=0.382).Conclusion Erdosteine was not more effective than the placebo for treatment of acute cough in children with common cold.

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A prospective double-blind randomized controlled trial of the effect of topical bupivacaine on post-operative pain in bilateral nasal surgery with bilateral nasal packs inserted

The Journal of Laryngology & Otology ◽

10.1258/0022215054020322 ◽

2005 ◽

Vol 119 (4) ◽

pp. 284-288 ◽

Cited By ~ 18

Author(s):

Malcolm A Buchanan ◽

Graham R Dunn ◽

Gillian M MacDougall

Keyword(s):

Randomized Controlled Trial ◽

Local Anaesthetic ◽

Controlled Trial ◽

Nasal Surgery ◽

Double Blind ◽

Control Power ◽

Randomized Controlled ◽

Post Operative Pain ◽

Number Of Patients ◽

Significant Difference

To ascertain whether local anaesthetic use is of clinical benefit in nasal surgery, a prospective double-blind randomized controlled trial of topical bupivacaine on post-operative pain in patients packed after bilateral nasal surgery was carried out. Each patient received a bupivacaine-soaked and a saline-soaked Merocel pack, thereby acting as their own control. Power analysis ascertained the number of patients required to enter the trial to detect a statistically significant difference in pain. Fifty-seven patients completed the trial. Visual analogue scales determined the level of post-operative pain at different time points in each nostril. Less pain was demonstrated in nostrils containing bupivacaine-soaked packs compared with saline-soaked packs at two hours (p < 0.0001), four hours (p = 0.0183) and six hours (p = 0.0476) post-operatively. Although not statistically significant, less pain was noted on pack removal on the local anaesthetic sides. These results provide clinical-based evidence for the use of bupivacaine as a local anaesthetic in reducing pain following nasal surgery with packing.

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The addition of omeprazole to ondansetron for treating chemotherapy-induced nausea and vomiting in pediatric cancer patients

Paediatrica Indonesiana ◽

10.14238/pi1.1.2018.42-7 ◽

2018 ◽

Vol 1 (1) ◽

pp. 42

Author(s):

Perjuangan Dapot Hamonangan Simbolon ◽

Selvi Nafianti ◽

Pertin Sianturi ◽

Bidasari Lubis ◽

Aznan Lelo

Keyword(s):

Placebo Group ◽

Cancer Patients ◽

Pediatric Cancer ◽

Controlled Trial ◽

Complete Response ◽

Nausea And Vomiting ◽

Chi Square ◽

Double Blind ◽

Significant Difference ◽

Pediatric Cancer Patients

Background Chemotherapy-induced nausea and vomiting are some of the most disturbing side effects in pediatric cancer patients. The standard recommendation is the use of 5-hydroxytryptamine 3 receptor antagonist, such as ondansetron, to treat these symptoms. Despite this treatment, more than 50% of patients still experience nausea and vomiting.Objective To evaluate the effect of the addition of omeprazole to ondansetron in the treatment of chemotherapy-induced nausea and vomiting.Methods A double-blind, randomized, controlled trial was conducted at Haji Adam Malik Hospital, Medan, North Sumatera, from March to May 2016. Subjects were children aged 1 to 18 years, diagnosed with cancer, and who received intravenous chemotherapy. Patients were randomized to receive either a single dose of ondansetron (0.5 mg/kg) plus placebo or ondansetron (0.5 mg/kg) plus omeprazole (0.5 mg/kg). The severity of nausea and vomiting were measured using the Rhodes index of nausea, vomiting, and retching during the 24 hours after initiation of emetogenic chemotherapy. The primary outcome of efficacy was the proportion of patients who achieved complete response (lack of nausea/vomiting). Statistical analysis was performed by Chi-square and Fischer’s exact tests.Results Seventy eligible pediatric patients were randomized into two groups: 32 subjects in the ondansetron + placebo group and 38 others in the ondansetron + omeprazole group. The therapy failed in 50% (16/32) of the ondansetron + placebo group and 18.4% (7/38) of the ondansetron + omeprazole group. There was a significant difference in the clinical response between groups (P=0.01).Conclusion The addition of omeprazole to ondansetron for the treatment of chemotherapy-induced nausea and vomiting is more effective than administration of ondansetron alone.

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Comparing the Effects of Cumin, Peppermint, and Milk of Magnesia on Gastrointestinal Complications after Caesarean Section

Global Journal of Health Science ◽

10.5539/gjhs.v8n12p78 ◽

2016 ◽

Vol 8 (12) ◽

pp. 78 ◽

Cited By ~ 1

Author(s):

Maryam Tofighi Niaki ◽

Zoleykha Atarod ◽

Shabnam Omidvar ◽

Mandana Zafari ◽

Azar Aghamohammadi ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Controlled Trial ◽

Chi Square ◽

Double Blind ◽

Gastrointestinal Complications ◽

Gynecology And Obstetrics ◽

Emergency Cesarean ◽

Gastrointestinal Problems ◽

Significant Difference

CONTEXT: Gastrointestinal problems are common after Cesarean section. During the past three decades, there has been an increasing trend in the use of herbal plants in the treatment of various medical conditions.AIMS: This study aimed to compare the effects of cumin, peppermint with magnesium hydroxide (milk of magnesia; MOM) on gastrointestinal complications of Caesarean section.SETTINGS & DESIGN: This randomized double-blind controlled trial was conducted in the Gynecology and Obstetrics Department of Imam Hospital (affiliated to Mazandaran University of Medical Sciences, Sari, Iran) during November 2013-August 2014. The project was approved by the Research Ethics Committee of Islamic Azad Medical University, Sari Branch (Iran).MATERIAL & METHODS: A total of 83 patients undergoing non-emergency Cesarean delivery in Imam Hospital were randomly selected. Patients with underlying diseases, history of gastrointestinal problems, fever, intestinal adhesion, longer-than-usual Cesarean section, and lack of cooperation were excluded. The subjects were informed about the study objectives and procedure and asked to provide written informed consent. They were then randomly assigned into three groups of cumin, peppermint, MOM. Gastrointestinal complications were assessed 20, 40, 60, and 120 minutes after drug administration.STATISTICAL ANALYSIS USED: The collected data were analyzed using Fisher’s exact and chi-square tests in SPSS for Windows 18.0.RESULTS: There was no significant difference between three groups according to incidence of gastrointestinal side effects after Cesarean section at the mentioned intervals.CONCLUSIONS: Cumin and peppermint were as effective as MOM.

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Oxycodone 5 Miligram is More Effective Than Ketorolac 30 Miligram in Suppressing Cortisol Levels During General Anesthesia

Journal of Anesthesiology and Clinical Research ◽

10.37275/jacr.v2i1.145 ◽

2021 ◽

Vol 2 (1) ◽

pp. 148-158

Author(s):

Kelvin ◽

Rizal Zainal ◽

Irwanto FH ◽

Erial Bahar

Keyword(s):

General Anesthesia ◽

Sample Size ◽

Intravenous Administration ◽

Elective Surgery ◽

Controlled Trial ◽

Post Intervention ◽

Chi Square ◽

Double Blind ◽

Significant Difference ◽

Cortisol Levels

Background: Preemptive analgesia is a developing clinical concept, which involves administering analgesics before pain stimulation occurs, to prevent the sensitization of the nervous system to further stimuli that can cause pain. Ketorolac has strong analgesic properties oxycodone is a semisynthetic opioid that is synthesized from the alkaloid thebaine opiate. Pain could induce stress hormone such as cortisol. Study to compare ketorolac and oxycodone with cortisol has not been investigated. This study aimed to assess intravenous administration of ketorolac 30 mg compared with intravenous 5 mg oxycodone for pain as measured by cortisol levels post-intervention in surgery performed under general anesthesia. Method: A study randomized controlled trial in double-blind form for patients at dr. Mohammad Hoesin Palembang, who will undergo elective surgery with general anesthesia at the Central Surgical Installation building, with the period September-October 2020. There are 24 study samples, to anticipate dropouts, an added sample size is 10%, so the sample size is 26 for each treatment group. The selection of subjects according to the purpose of the study was carried out by simple random. Data analysis using SPSS ver 22.0 software. Data were analyzed using Independent T-Test, Mann Whitney, and Chi-Square Test. Result: The results showed, there was a significant difference in the effectiveness of intravenous administration of ketorolac 30 mg and intravenous oxycodone 5 mg on pain as measured by cortisol levels in patients undergoing general anesthesia at dr. Mohammad Hoesin Palembang (p = 0.013). The value of cortisol levels in pre- operative patients who will be given general anesthesia at dr. There was no statistically significant difference between Mohammad Hoesin in the two groups (p = 0.107). The value of cortisol levels in preoperative patients who were given ketorolac 30 mg intravenously at dr. Mohammad Hoesin was 9.90 ± 4.2. The value of cortisol levels in postoperative patients who were given ketorolac 30 mg intravenously at dr. Mohammad Hoesin was 17.75 ± 6.08. The value of preoperative cortisol levels for patients who were given oxycodone 5 mg intravenously at dr. Mohammad Hoesin was 12.03 ± 5.10. The value of postoperative cortisol levels for patients who were given oxycodone 5 mg intravenously at dr. Mohammad Hoesin is 14.50 ± 4.75. Conclusion: There was a significant difference in the effectiveness of intravenous administration of ketorolac 30 mg and oxycodone 5 mg intravenously on BSS levels (p = 0.005) and VAS scores (p = 0.001) who underwent general anesthesia at dr. Mohammad Hoesin Palembang.

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The Effects of Quetiapine on Craving and Withdrawal Symptoms in Methamphetamine Abuse: A Randomized, Double-Blind, Placebo-Controlled Trial

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v10i4.29374 ◽

2020 ◽

Vol 10 (4) ◽

pp. 29374.1-29374.7

Author(s):

Najme Sadat Javdan ◽

◽

Amir Ghaderi ◽

Hamid Reza Banafshe ◽

◽

...

Keyword(s):

Controlled Trial ◽

Withdrawal Symptoms ◽

Chi Square ◽

Double Blind ◽

Methamphetamine Abuse ◽

Beneficial Effects ◽

Amphetamine Withdrawal ◽

Significant Difference ◽

Chi Square Test ◽

To Receive

Background: Patients with Methamphetamine Abuse (MA) are susceptible to many complications like craving, and withdrawal symptoms. These trials were designed to evaluate the effect of quetiapine administration on craving and withdrawal symptoms in MA abuse. Methods: This trial was conducted on 60 people with MA abuse to receive either 100 mg quetiapine (n=30), or placebo (n=30) every day for 2 months. The Desire for Drug Questionnaire (DDQ) and Amphetamine Withdrawal Questionnaire (AWQ) scores were evaluated at baseline and after 2 months’ intervention. For data analysis, t test, and the Chi-square test were applied in SPSS v. 18. Results: Quetiapine significantly decreased DDQ (P=0.002) and AWQ symptoms (P=0.001) compared to the placebo. Furthermore, there was a significant difference among groups in terms of the frequency of negative urine tests (P<0.001). Conclusion: This trial showed that administration of quetiapine supplements for 2 months in individuals with MA abuse had beneficial effects on craving and withdrawal syndrome.

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Premedication with Oral Alprazolam and Melatonin Combination: A Comparison with Either Alone—A Randomized Controlled Factorial Trial

BioMed Research International ◽

10.1155/2014/356964 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Krishna Pokharel ◽

Mukesh Tripathi ◽

Pramod Kumar Gupta ◽

Balkrishna Bhattarai ◽

Sindhu Khatiwada ◽

...

Keyword(s):

Repeated Measures ◽

Controlled Trial ◽

Visual Analogue Score ◽

Sedation Score ◽

Combination Drug ◽

Chi Square ◽

Double Blind ◽

Amnesic Effect ◽

Time Points ◽

Number Of Patients

We assessed if the addition of melatonin to alprazolam has superior premedication effects compared to either drug alone. A prospective, double blind placebo controlled trial randomly assigned 80 adult patients (ASA 1&2) with a Visual Analogue Score (VAS) for anxiety ≥3 to receive a tablet containing a combination of alprazolam 0.5 mg and melatonin 3 mg, alprazolam 0.5 mg, melatonin 3 mg, or placebo orally 90 min before a standard anesthetic. Primary end points were change in anxiety and sedation score at 15, 30, and 60 min after premedication, and number of patients with loss of memory for the five pictures shown at various time points when assessed after 24 h. One-way ANOVA, Friedman repeated measures analysis of variance, Kruskal Wallis and chi square tests were used as relevant. Combination drug produced the maximum reduction in anxiety VAS (3 (1.0–4.3)) from baseline at 60 min (P<0.05). Sedation scores at various time points and number of patients not recognizing the picture shown at 60 min after premedication were comparable between combination drug and alprazolam alone. Addition of melatonin to alprazolam had superior anxiolysis compared with either drugs alone or placebo. Adding melatonin neither worsened sedation score nor the amnesic effect of alprazolam alone. This study was registered, approved, and released from ClinicalTrials.gov. Identifier number:NCT01486615.

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Perbandingan Aromaterapi Pepermin dengan Ondansetron Intravena sebagai Terapi Rescue Mual Muntah Pascaoperasi Mastektomi

Jurnal Anestesi Perioperatif ◽

10.15851/jap.v7n1.1587 ◽

2019 ◽

Vol 7 (1) ◽

pp. 25-32

Author(s):

Arna Fransisca ◽

Iwan Fuadi ◽

Dewi Yulianti Bisri

Keyword(s):

Randomized Controlled Trial ◽

Postoperative Nausea ◽

Controlled Trial ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Chi Square ◽

Double Blind ◽

Consecutive Sampling ◽

Randomized Controlled ◽

Significant Difference

Mual muntah pascaoperasi merupakan salah satu komplikasi anestesi dan operasi yang menjadi perhatian khusus karena memengaruhi kualitas pelayanan kesehatan, memperpanjang lama perawatan, dan meningkatkan angka morbiditas perioperatif. Pascaoperasi payudara berkaitan dengan angka kejadian mual muntah pascaoperasi yang tinggi. Beberapa konsensus penatalaksanaan mual muntah pascaoperasi merekomendasikan pemberian terapi nonfarmakologi dengan aromaterapi sebagai terapi rescue untuk mengatasi mual muntah pascaoperasi. Tujuan penelitian ini adalah membandingkan aromaterapi pepermin dengan ondansetron sebagai terapi rescue dalam menurunkan kejadian mual muntah pascaoperasi mastektomi. Penelitian ini merupakan penelitian eksperimental yang dilakukan secara prospektif dengan desain penelitian double blind randomized controlled trial dan consecutive sampling terhadap 32 subjek penelitian yang menjalani operasi mastektomi elektif dan memenuhi kriteria inklusi di RSUP Dr. Hasan Sadikin Bandung pada bulan Juli–September 2018. Pada penelitian ini, data ordinal diuji dengan Uji Mann Whitney dan untuk data kategorik diuji dengan uji chi-square. Hasil penelitian ini didapatkan penurunan kejadian mual muntah pascaoperasi yang signifikan pada kelompok pepermin dibanding dengan kelompok ondansetron dengan perbedaan yang bermakna (p<0,05) pada penilaian menit kedua dan menit kelima setelah perlakuan. Simpulan, aromaterapi pepermin efektif menurunkan kejadian mual muntah pascaoperasi mastektomi dan dapat digunakan sebagai alternatif terapi atau terapi tambahan untuk penatalaksanaan mual muntah pascaoperasi.Comparison of Peppermint Aromatherapy with Ondansetron Intravenous as a Rescue for Postoperative Nausea Vomiting after Mastectomy SurgeryPostoperative nausea and vomiting are among anesthesia and surgery complications that receive special considerations as it affects the quality of healthcare services, prolongs care, and increases perioperative morbidities. The incidence of postoperative nausea and vomiting is high in patients that have undergone breast surgery. The consensus for postoperative nausea and vomiting management recommends non-pharmacological treatments, one of which is through the use of aromatherapy as a rescue to resolve postoperative nausea and vomiting. This study aimed to compare the effects of peppermint aromatherapy and ondansetron as a rescue in reducing the incidence of postoperative nausea and vomiting after elective mastectomies. This was a prospective experimental double blind randomized controlled trial study with consecutive sampling on 32 research subjects underwent elective mastectomies and met the inclusion criteria in Dr. Hasan Sadikin General Hospital in July–September 2018. The ordinal data were tested using the Mann Whitney statistics test and the categorical data using the chi square test. The results show a significant decrease in nausea and vomiting incidence in the peppermint group compared to the ondansetron group with significant difference (p<0.05) in two minutes and five minutes after treatment. In conclusion, peppermint aromatherapy is effective in reducing the incidence of postoperative nausea and vomiting after mastectomies and can be used as an alternative or additional treatment in managing postoperative nausea and vomiting.

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Randomized, double-blind, three-arm, parallel-group study to compare the efficacy and safety of a single dose of 100 and 200 mg of mifepristone for cervical ripening in term pregnancies

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210288 ◽

2021 ◽

Vol 10 (2) ◽

pp. 428

Author(s):

Leonardo J. Orozco ◽

Silvia Guerrero ◽

Mixel J. Rosales ◽

Jose S. Ramos

Keyword(s):

Controlled Trial ◽

Uterine Fibroids ◽

Cervical Length ◽

Mean Value ◽

Cervical Ripening ◽

Efficacy And Safety ◽

Chi Square ◽

Double Blind ◽

Significant Difference ◽

Chi Square Test

Background: Mifepristone is an antiprogestin developed to antagonize the action of progesterone by inhibiting its receptors. It has had a recognized role in the medical termination of early pregnancy, reduction in the volume of uterine fibroids and endometriosis symptoms. A new indication for labor induction and cervical ripening in has been proposed. The objective was to compare the efficacy and safety of mifepristone 100 and 200 mg with placebo for cervical ripening in term pregnancies.Methods: Double-blind, placebo-controlled trial of 90 term pregnancy women randomly assigned to receive orally tablet of 100 mg and 200 mg mifepristone or placebo. Efficacy was assessed by measuring changes in cervical ripening according to Bishop 72 hours after treatment. Statistical analysis was using the t-student test and the chi-square test. The relative risk (RR) was determined with a 95% confidence interval.Results: The bishop score and the number of contractions at 48 hours in the group of 200mg of mifepristone presented a significantly higher mean value in relation to the placebo (p=0.04). At 72 hours, cervical length showed a significant difference (p<0.01) in both mifepristone groups compared to the placebo group. Also, at 72 hours a significant increase in the mean duration of contractions was demonstrated in the 100 mg mifepristone group.Conclusions: There was a significant increase in Bishop's score for the 200 mg mifepristone group probably due to a significant increase in contractions at 24 hours. No differences were observed between groups in adverse events.

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