Pentazocine versus tramadol-paracetamol combination as analgesia in labor: A randomized controlled trial

Objectives: Labor should be a satisfactory experience and effective pain management should be employed as recommended by the American Congress of Obstetricians and Gynaecologists. In developing countries, pain management in labor is still a big challenge and the search for the ultimate labor analgesia is still ongoing. The objectives of the study were to determine whether the synergistic analgesic effect of the combination of tramadol and paracetamol will produce analgesia comparable to pentazocine with a better side effect profile. Material and Methods: This was a randomized controlled, double-blinded trial of tramadol-paracetamol combination versus pentazocine as labor analgesia and was carried out at the University of Abuja Teaching Hospital, Abuja, between June 2018 and March 2019. A total of 218 eligible parturients recruited at term, were counseled on labor analgesia, its benefits, and the options made available to them and educated on the pain scoring system. Parturients were allocated into two groups using computer-generated numbers with the WINPEPI software. Group A was given tramadol-paracetamol combination, while Group B received pentazocine, both at standard doses. Hourly pain scores, APGAR scores, labor duration, patients' satisfaction, and side effects were collated. The level of significance was set at <0.05. Results: Tramadol-paracetamol was administered to 109 (50.9%) while pentazocine was administered to105 (49.1%) of the study participants. The mean age in the tramadol-paracetamol group was 29.6 ± 4.8 years, and in the pentazocine group, it was 28.8 ± 4.5 years. The difference in pain scores on the visual analog scale was statistically significant at the 3rd and 4th h (P = 0.02 and 0.004), but not significant in the 1st and 2nd h (P = 0.05 and 0.22) in the two groups. Overall, the average pain score in the tramadol-paracetamol group was significantly higher compared to the pentazocine group (5.27 ± 1.86 vs. 4.72 ± 1.54; P = 0.02). The 1st and 5th min APGAR scores (P = 0.44 and 0.67, respectively) of neonates in the tramadol-paracetamol and pentazocine groups were comparable. Nausea and drowsiness occurred more frequently in the pentazocine group at P-values of 0.047 and 0.0015, respectively. There was no statistically significant difference in the duration of labor between the tramadol-paracetamol and pentazocine groups. not statistically significant, a higher proportion of parturients in the pentazocine group was satisfied compared with the tramadol-paracetamol group (71.4% vs. 63.3%; P = 0.13).Conclusion: This study showed that intravenous pentazocine provides better pain relief in labor, but the tramadol-paracetamol combination has fewer side effects

An overview of analgesics: NSAIDs, paracetamol, and topical analgesics

Pain is a complex and unique experience. It encompasses several pathways, involving nociceptive signal generation (transduction) and propagation (transmission), as well as perception and modulation of the nociceptive stimuli. Nonsteroidal anti-inflammatory drugs (NSAIDs) primarily exert their analgesic effects through inhibition of cyclooxygenase (COX) enzymes, thereby attenuating prostaglandin synthesis. The COX-2 selective NSAIDs (coxibs) and aspirin have also been shown to reduce colorectal cancers,presumably by prostaglandin-inhibition mechanisms. Paracetamol appears to have both peripheral and central effects. The postulated mechanism for its peripheral effects is indirect COX inhibition, while the central effects are thought to be mediated by modulation of descending pain inhibition pathways. Topical analgesics are available in various formulations. The topical NSAIDs have the same mechanism of action as the systemic formulations, but with less systemic absorption and effects. The local anaesthetics provide a dense sensory block via inhibition of nerve impulse transmission, and are available in percutaneous and transdermal preparations. Capsicum is effective forneuropathic pain, and acts by stimulating and then desensitising peripheral sensory nerves

Comparative clinical study between preoperative oral administration of paracetamol, celecoxib and pregabalin on postoperative pain in gynecological laparoscope

Background: Since the introduction of laparoscopic surgeries, postoperative pain has been generally reduced. However, it can still peak, especially during the early postoperative period and becomes the main cause of overnight hospital stay and prolonged convalescence after this day-case surgical procedure. Thus, optimizing postoperative pain relief, not only to sub-serve reduction of its intensity but to also enhance the recovery and shorten length of stay became the broader target of multimodal pain control regimens nowadays. That is why; searching for a drug that would be effective in reducing pain, safe from major adverse effects and can meanwhile possess an opioid-sparing potentiality would be a merit so as to improve the success rate of ambulatory day-care surgeries. Objective: To study the analgesic effects of preemptive single oral dose of paracetamol, celecoxib and pregabalin in patients undergoing gynecological laparoscope. Method: Preoperative evaluation, preparation and premedication was assessment, and routine laboratory investigations was done. Postoperative pain, Level of Sedation was measured. Results: There was statistical significant difference between the three groups regarding VAS. There was statistical significant difference between the three groups regarding the total pethidine consumption. Regarding postoperative level of sedation, blood glucose there was no statistical significant difference between the three groups. Conclusion: Oral pregabalin in a dose of 150 mg 2 hour before surgery, is significantly attenuating pain intensity and total meperidine consumption during the first 6 hours postoperatively

Intravenous paracetamol ­ waste not, want not: a retrospective audit on the appropriate use of intravenous paracetamol at Universitas Academic Hospital Complex­Bloemfontein

Background: Paracetamol can be given both orally and intravenously (IV) with similar clinical efficacy, but the IV formulation is 360 times more expensive. IV paracetamol is therefore only recommended when the oral route is not available. This study investigated whether IV paracetamol was being used appropriately and whether there had been a change in prescribing patterns between 2008 and 2015 after the introduction and update of a prescribing protocol at an academic hospital complex in Bloemfontein, South Africa. Methods: A retrospective comparative audit of patient files was undertaken. The prescribing and administration habits of IV paracetamol were compared for two consecutive months, seven years apart, including 88 and 83 patients, respectively, who had received IV paracetamol. Results: IV paracetamol was administered appropriately in 37.5% of patients in 2008 and in 43.4% of patients in 2015 (p = 0.43). There was an improvement in the duration that IV paracetamol was prescribed for, which decreased from a median two days in 2008 to one day (p < 0.01) in 2015. In total, 55 (32.4%) patients had a concomitant oral and IV paracetamol prescription, of which 37 (21.6%) patients also received concomitant paracetamol administration. Twenty patients exceeded the 24-hour maximum dose. Seventeen patients weighed less than 40 kg; six of these patients (three paediatric and three adult) did not receive the correct weight adjusted dose of paracetamol, 15 mg/kg, resulting in excessive doses of paracetamol being administered (21­ 32.3 mg/kg). Conclusions: Patients are receiving IV paracetamol when the oral route is available; this is an unnecessary waste of money. Excessive doses of paracetamol were administered due to concomitant oral and IV paracetamol prescription and administration, and a failure to calculate dose of paracetamol according to body weight in low body weight patients. Further remedial interventions are therefore required

The suspending properties of Cissus rubiginosa fruit mucilage in paracetamol suspension formulation

Background: Materials with suspending properties like mucilage have been obtained from natural sources and used to stabilize liquid formulations containing poorly dispersible solids.Objective: The aim of this study was to evaluate the suspending properties of Cissus rubiginosa fruit mucilage (CRM) in paracetamol oral suspension.Materials and Methods: Paracetamol suspensions containing 0.5, 1.0, 1.5 and 2.0 %w/v CRM were prepared and compared with suspensions formulated with same concentrations of compound tragacanth (CT). The sedimentation volume, ease of re-dispersibility, effect of shear rate on viscosity, flow rate and drug release pattern were studied as assessment parameters.Results: Characterization studies of the suspensions revealed that there was a corresponding increase in the viscosity of the suspension with increase in the concentration of the gum. Paracetamol suspension having CRM had significantly higher viscosity (p<0.05) compared to those containing CT. The viscosities of all suspensions decreased with increase in shear rate. There was decrease in flow rate as the viscosity of the suspension increased.Paracetamol suspensions containing CRM were easily re-dispersible with minimum agitation at concentration less than 1.0 %. Drug release from the suspension containing 0.5 % CRM was rapid while release from suspension containing higher concentrations of CRM occurred at a later time, eliciting a delay in drug release.Conclusion: This study has been able to elucidate the ability of Cissus rubiginosa fruit mucilage to act as a suspending agent in pharmaceutical suspensions

Knowledge of Caregivers of Febrile Children about Fever; Paracetamol Use and Paracetamol Induced Hepatic Toxicity in Lagos Nigeria

Background: Fever is as a result of immune response to many pathogens. Paracetamol is widely and irrationally used at home for treatment of fever in children before presentation at the health facility but it is not clear whether caregivers are aware of the toxicity that can result from non-rational use of paracetamol.Objectives: The aim of this study was to evaluate the knowledge of fever; the use of paracetamol; and paracetamol induced hepatic toxicity amongst caregivers of febrile children. Methods: This was a prospective descriptive study in which we interviewed two hundred and ten caregivers who brought febrile children to Onwusikawa Children's Medical Center Okota Lagos over a period of one year (Jan 2013- Dec 2013). A pretested closed ended questionnaire was used to collect data on the use of paracetamol; knowledge about fever; and toxicity of paracetamol during routine clerking.Result: Paracetamol in both syrup and tablet formulations was administered by the study population to febrile children before presentation in hospital . Majority of the respondents (61%) knew fever as an increase in body temperature. About 8% of those interviewed gave paracetamol to their children including neonates almost on a daily basis to prevent fever or because they felt the baby especially the head was hot. Ninety five percent of all respondents were not aware that paracetamol could cause adverse effects while 98% did not know that paracetamol could cause hepatic toxicity. Conclusion: The knowledge regarding toxicity of paracetamol was poor. It is proposed that education of caregivers by health workers on dangers of paracetamol misuse should be routine. Pharmaceutical companies that manufacture paracetamol for children must provide a risk management plan

L'association paracetamol+ibuprofene est-elle preferable au paracetamol seul ou a l'ibuprofene seul pour le traitement de la fievre chez les enfants?

Il apparait de plus en plus sur le marche burkinabe des medicaments; des associations de substances d'indication similaire; et dont l'interet therapeutique reste a demontrer. Ces associations contribuent-elles a un usage rationnel des medicaments? Faut-il continuer a homologuer ces associations ? Nous presentons ici les resultats d'une etude sur l'association paracetamol+ibuprofene dans la fievre chez les enfants

Traitement de l`erysipele de jambe

La prise en charge d`un erysipele de jambe est a adapter en fonction de la severite de l`atteinte cutanee; du retentissement de l`infection sur l`etat general; et des antecedents du patient. L`antibiotherapie reduit la mortalite; les complications; la duree de l`infection et les douleurs de l`erysipele

Douleur ou fievre chez les enfants : preferer le paracetamol

Dans la plupart des cas ; le paracetamol est efficace pour lutter contre la douleur et la fievre chez les enfants .Il est plus sure que les anti-inflammatoires ( y compris l'Ibuprofene et l'aspirine)

Comparative Quality Assessment and In Vitro Dissolution Profile of some Paracetamol Tablet Generics Marketed in Nigeria

Background: Studies have shown an increase in the usage of generic drug products from multiple sources. These generic drugs are expected to satisfy similar established standards as the original or innovator brands. Aim: To assess the standards and interchangeability of six common brands of paracetamol (acetaminophen) tablet generics marketed in Nigeria. Methods: The biopharmaceutical parameters; weight uniformity and assay of active ingredients were carried out according to established methods. The dissolution rates and disintegration times were determined in simulated gastric fluid (SGF) and simulated intestinal fluid (SIF) without enzymes. A variation of the concept of dissolution efficiency (DE); known as predicted availability equivalent (PAE); was used to predict the likely in vivo bioavailability. Results: All the brands complied with specifications for the weight uniformity; friability; disintegration time and assay of active ingredient tests. In the dissolution efficiency determination; all the brands released more in SGF than SIF. Conclusion: The study showed that all the six brands of paracetamol tablet tested are interchangeable with one another and thus could be prescribed one in place of the other. This would lead to the reduction in the cost of treatment; increased drug availability and an enhanced patients compliance in the use of acetaminophen tablets

"A Study of the Pharmaceutical Quality of Chloroquine and Paracetamol Products Sold in a Major Nigerian ""Market"""

"Malaria is a major public health problem in endemic countries; and the quality of anti-malarial products is a concern in the therapeutic management of individual patient. In this study; we have evaluated the pharmaceutical quality of chloroquine and paracetamol oral products obtained from a major Nigerian drug ""market"" using a less elaborate sampling procedure. Results have shown that there are still some defects in the pharmaceutical quality of these drugs; despite the activities of the Nigeria's drug regulatory agency (National agency for Food and Drug Administration and Control; NAFDAC). 21(7/34) of the drug products were not registered by NAFDAC. The pharmaceutical properties of the products indicated that 6; 15; 9; and 9of them failed tests for disintegration; dissolution; crushing strength; and percentage of active content; respectively. 4 out of the 6 chloroquine liquid preparations evaluated had inadequate active content. These defects could have resulted from deliberate counterfeiting; poor quality control during manufacture or decomposition of the products. However; this could not be ascertained from the data available to us in this study. The implication of these findings; however; is that the newer anti-malarial drugs that have recently been introduced into the Nigerian market should be safeguarded; if their therapeutic usefulness must be sustained."

Induced gastrointestinal tract (GIT) derangement following a long-term administration of a non-selective cyclooxygenase inhibitor-paracetamol in pregnant Sprague-Dawley Rats

There are two recognized isoforms of cyclooxygenase enzymes; the cyclooxygenase - 1 and cyclooxyg-enase - 2; the former is involved in the biosynthesis of prostaglandins; in organs where these eicosanoids play certain protective roles in the gastrointesional tract (GIT) and the kidney; it also enhances mucus secretions and acts as a house keeping enzyme expressed constitutively in most tissues of the body; while cyclooxygenase - 2 is the inducible form expressed in response to proinflammatory cytokines and growth factors; indicating a role in inflammation and growth and also maintains haemodynamics. In pregnant state; several drugs are used out of necessity; despite their reported toxicity. The clinical conditions often necessitating the use of non-selective cyclooxygenase inhibitors during pregnancy include hypertension; thromboembolism; hyperthyroid-ism; epilepsy; diabetes mellitus; preterm labour; arthritis; pain and fever; among others. The aim of this study was to investigate the induced gastrointestinal derangement following a long-term administration of paracetamol in pregnant Sprague-dawley rats. Twenty female adult Sprague-dawley rats weighing between 160g - 180g (as the beginning of the experiment) were used for the study. The animals were randomly divided into two groups (A and B) of ten rats each. Group A animals received distilled water orally and served as control. While paracetamol treated animals (group B) received doses of 7.3mg/kg/day respectively by gavage. The animal weights were monitored at an interval of three days before gestation to 13th day after parturition. The animals were allowed feed and water liberally. Drug administration commenced from 10th day of gestation to the end of parturition. On the 13th day after parturition the maternal rats were then sacrified for tissue processing. The results showed that the control animals had a normal architecture of the gastrointestinal tract. While the paracetamol treated animals showed a general derangement coupled with high degree inflammation of the stomach and intestinal lining; and a statistical significant weight loss (P0.005) compared to the control animals. These findings reflect gastrointestinal tract impairment. We conclude that a long-term use of non-selective cyclooxygenase inhibitor - paracetamol in pregnant state has an erosive effect on the gastrointestinal tract and may possibly be the aftermath of gastrointestinal tract inflammation in women

Induced Gastrointestinal Tract (GIT) Derangement Following a Long-Term Administration of a Non-Selective Cyclooxygenase Inhibitor - Paracetamol in Pregnant Sprague-Dawley Rats

There are two recognized isoforms of cyclooxygenase enzymes; the cyclooxygenase - 1 and cyclooxyg-enase - 2; the former is involved in the biosynthesis of prostaglandins; in organs where these eicosanoids play certain protective roles in the gastrointesional tract (GIT) and the kidney; it also enhances mucus secretions and acts as a house keeping enzyme expressed constitutively in most tissues of the body; while cyclooxygenase - 2 is the inducible form expressed in response to proinflammatory cytokines and growth factors; indicating a role in inflammation and growth and also maintains haemodynamics. In pregnant state; several drugs are used out of necessity; despite their reported toxicity. The clinical conditions often necessitating the use of non-selective cyclooxygenase inhibitors during pregnancy include hypertension; thromboembolism; hyperthyroid-ism; epilepsy; diabetes mellitus; preterm labour; arthritis; pain and fever; among others. The aim of this study was to investigate the induced gastrointestinal derangement following a long-term administration of paracetamol in pregnant Sprague-dawley rats. Twenty female adult Sprague-dawley rats weighing between 160g - 180g (as the beginning of the experiment) were used for the study. The animals were randomly divided into two groups (A and B) of ten rats each. Group A animals received distilled water orally and served as control. While paracetamol treated animals (group B) received doses of 7.3mg/kg/day respectively by gavage. The animal weights were monitored at an interval of three days before gestation to 13th day after parturition. The animals were allowed feed and water liberally. Drug administration commenced from 10th day of gestation to the end of parturition. On the 13th day after parturition the maternal rats were then sacrified for tissue processing. The results showed that the control animals had a normal architecture of the gastrointestinal tract. While the paracetamol treated animals showed a general derangement coupled with high degree inflammation of the stomach and intestinal lining; and a statistical significant weight loss (P0.005) compared to the control animals. These findings reflect gastrointestinal tract impairment. We conclude that a long-term use of non-selective cyclooxygenase inhibitor - paracetamol in pregnant state has an erosive effect on the gastrointestinal tract and may possibly be the aftermath of gastrointestinal tract inflammation in women

Preliminary Investigation into the Use of Pleurotus Tuber-Regium Powder as a Tablet Disintegrant

PURPOSE: This investigation aims at developing a pharmaceutical excipient from local sources. Pleurotus tuber-regium powder is used locally as a soup thickener because of its ability to swell in water and add bulk to the soup. Since swelling is one of the mechanisms of action of some tablet disintegrants it was thought that the powder of P. tuber regium would be able to act as a tablet disintegrant. METHOD: The powder obtained from the mycelia of the edible giant mushroom; Pleurotus tuberregium was characterised. Its disintegrant ability in comparison with maize starch BP was investigated in paracetamol tablets prepared via the wet granulation method. RESULTS: P. tuber-regium and maize starch BP have similar true; bulk and tapped density values. The Pleurotus powder; however; showed superior flow; swelling capacity as well as waterretention capacity to maize starch BP. The swelling capacity was three times that of maize starch BP. Tablets prepared with P. tuber-regium powder disintegrated faster than those prepared with maize starch BP at concentrations below 10w/w. At the disintegrant concentration of 10 percentw/w paracetamol tablets made from both Pleurotus powder and maize starch BP had similar disintegration times and dissolution profiles. It is believed that the ability ofPleurotus powder to swell by over three times its volume in the presence of water may explain its ability to function as a tablet disintegrant. CONCLUSION: Pleurotus tuber-regium powder may therefore be used as an alternative to maize starch BP as a tablet disintegrant