Evaluation of prescription pattern of analgesic use among ambulatory elderly in South-Western Nigeria

Inappropriate prescribing of analgesics has a global impact on the health of elderly patients and the society. Empirical evidence on the prescription of analgesics among elderly Nigerians is scarce. Objectives: The objective of the study was to evaluate the prescription pattern of analgesics and describe the co-prescribing of gastroprotective agents with non-steroidal anti-inflammatory drugs (NSAIDs) among elderly patients at the geriatric center, University College Hospital, Ibadan. Methods: A retrospective cross-sectional, hospital-based study was carried out among elderly patients (≥60 years) who were prescribed analgesics. Using a data extraction sheet, information on demographic characteristics, drug utilization pattern, and morbidities was obtained from patients' case files via electronic health records. Results: A total of 337 patients case files were reviewed, the mean age was 72 ± 8.8 years, and 210 (62.3%) were females. There were a total of 2074 medications prescribed, with 733 (35.3%) being analgesics. Majority of the elderly patients (259, 76.9%) were on nonopioids, with 252 (74.8%) on NSAIDs. Paracetamol was the most commonly prescribed analgesics (181, 24.6%), followed by diclofenac/misoprostol (177, 24.1%), opioid analgesic prescribed was 88 (12.0%), with paracetamol/codeine 58 (65.9%), and tramadol 16 (18.2%) being the most prescribed opioid. A significant proportion of the hypertensive elderly patients (160, 78.8%; P < 0.036) were on NSAIDs. The oral route of administration (302, 89.6%) was the most common route of administration. Majority (310, 92%) of elderly patients taking NSAIDs had a co-prescription for gastroprotective agents. Conclusions: Majority of hypertensive patients were on NSAIDs. This calls for prompt awareness of rational analgesic use among the elderly to improve management and their survival

An overview of analgesics: opioids, tramadol, and tapentadol (Part 2)

Pain can be caused by several mechanisms, and the development of chronic pain (also known as pain chronification) is a complex and often unpredictable process. Opioids, tramadol, and tapentadol provide pharmacological solutions to chronic pain of cancer or non-cancer origins, particularly if central sensitization is present. It may also be indicated for short-term use in acute pain.Despite large studies and meta-analyses of opioids for a variety of pain conditions, the evidence for its clinical effectiveness is still unclear. This is, however, mostly due to significant heterogeneity and bias between studies assessed. The dual analgesic mechanisms of tramadol and tapentadol appear to be effective options for pain relief, with an overall lower incidence of opioidrelated adverse effects. Tapentadol has an analgesic effect comparable to the strong opioids,which appearto be mediated by itsgreater mu opioid receptor activity and more selective noradrenaline reuptake inhibition. Tramadol produces less analgesia than tapentadol, but it is also associated with reduced opioid-related adverse effects and dependence. The opioids and tramadol may be significantly affected by polymorphisms of CYP2D6, while this effect is lessened with tapentadol

Analgesic efficacy of dexmedetomidine versus fentanyl as an adjunct to thoracic epidural in patients undergoing upper abdominal surgery: a randomized controlled trial

Background: This randomised, double-blind study was designed to assess the analgesic efficacy of dexmedetomidine as compared with fentanyl as an adjunct to local anaesthetic in thoracic epidural for upper abdominal surgeries. Methods: Forty adult patients of American Society of Anesthesiologists grade I­II undergoing upper abdominal surgery were randomly allocated into two groups to receive 50 µg fentanyl or 50 µg dexmedetomidine as an adjunct to 10 ml 0.125% bupivacaine via thoracic epidural. Anaesthesia was induced with morphine, propofol and vecuronium and maintained by isoflurane with 60% nitrous oxide in oxygen. In the postoperative period patient-controlled analgesic pumps were used to deliver similar types of mixtures via the epidural catheter. Patients were evaluated for rescue analgesic requirements, haemodynamic stability, postoperative pain, sedation and any adverse events. Results: The groups were comparable regarding intraoperative analgesic requirements, recovery times and postoperative pain scores. The total consumption of rescue analgesia was significantly less in the dexmedetomidine group as compared with the fentanyl group (p = 0.049). Two patients in the fentanyl group had vomiting and one had pruritus. None of the patients had bradycardia, hypotension, excessive sedation or respiratory depression. Patients receiving epidural dexmedetomidine were more satisfied with the technique than those receiving fentanyl (p < 0.001). Conclusion: It was concluded that the addition of dexmedetomidine with 0.125% bupivacaine in thoracic epidural provides effective perioperative analgesia with greater patient satisfaction compared with fentanyl

Evaluation of the analgesic activity of the methanolic stem bark extract of dialium guineense (wild)

Background: Dialium guineense is a medicinal plant used by some communities of Enugu-Ezike in Enugu State; Nigeria for treatment of fever; headache and other diverse ailments. Objectives: The present study evaluated the analgesic activity of the methanolic stem bark extract of the plant. Method: Acetic acid-induced abdominal constriction or writhing; tail immersion and hot plate analgesic models in albino Wistar mice were used for the study. Three test doses (250; 500; 1000 mg/kg body weight) of the extract were administered orally by gastric gavage. The activity was compared with a standard reference drug; acetylsalicylic acid (aspirin) (400 mg/kg) and negative control. The results were analysed by SPSS version 17 using ANOVA and Post Hoc Duncan. Result: In the acetic acid-induced writhing reflex model; D. guineense extract and the reference drug significantly (P =0.014 - 0.002) decreased the mean total number of abdominal constriction in the mice in a dose dependent fashion. The percentage inhibition of the abdominal constriction reflex was increased dose dependently from 0in the negative control group to 71at the highest dose of the extract (1000mg/kg). In the tail immersion model the extract at the dose of 1000 mg/kg significantly (P = 0. 048) increased the pain reaction time (PRT) while in hot plate model the extract and drug also significantly (P = 0.048 - 0.05) increased the mean PRT at the doses of 500 and 1000 mg/kg. The dose of 250 mg/kg showed no analgesic activity in tail immersion and hot plate models. Conclusion: Dialium guineense demonstrated significant analgesic activity that may be mediated through peripheral pain mechanism

Evaluation of analgesic and anti-inflammatory activity of Diospyros Cordifolia Extract

Abstract: In this study we evaluated the analgesic and anti- inflammatory activities of the methanol extract of stem bark of Diospyros cordifolia (MEDC) Roxb. The analgesic effects of the stem bark of the plant was assessed in mice using the tail-flick method while carrageenan, histamine and dextran induced paw oedema was used to study the antiinflammatory effects in rats. The MEDC exhibited significant (p<0.01) analgesic effects comparable to the reference drug diclofenac sodium. MEDC also was evaluated for its anti-inflammatory potential against carrageenan, histamine and dextran induced rat paw edema. The methanol extract (25 and 50 mg / kg body weight) exhibited significant (p<0.01) activity against all phlogistic agents used in a dose dependent manner. All these effects were compared with reference drug phenylbutazone (100 mg/kg body weight)

Antipyretic and Analgesic Effects of the Aqueous Extract of the Fruit Pulp of Hunteria umbellata K Schum (Apocynaceae)

Purpose: The aqueous fruit pulp extract of Hunteria umbellata K. Schum is used traditionally for the treatment of various fevers. The purpose of this study was to evaluate the extract for antipyretic and analgesic activity; and determine its probable mechanism of action. Methods: Pyrexia was induced in rabbits by intravenous injection of 105 CFU of E. coli/kg. Rectal temperature was monitored at 30; 60; and 90 min post-administration of 250 and 500 mg/kg of the extract. The analgesic effect of the extract was evaluated using acetic acid-induced mouse writhing test. The extract was tested for antimicrobial activity against Staphylococcus aureus; Klebsiella pnuemoniae; Escherichia coli; and Psuedomonas aeruginosa using agar diffusion method. Phytochemical screening of the plant extract was also carried out. Results: Phytochemical screening revealed the presence of simple sugars; saponins; flavonoids; alkaloids and steroidal compounds. The extract (250; 500 mg/kg) and aspirin produced comparable antipyretic effects up to 60 min. The extract did not inhibit the growth of the microorganisms but significantly reduced the number of writhes in mice at 250 and 500 mg/kg with results comparable to ASA. Conclusion: The extract possesses antipyretic and analgesic activities which validate its use in the treatment of pains and fevers

Prise en charge de la douleur au cours de la drepanocytose selon les criteres OMS treatment of sickle cell pain

Notre etude descriptive et analytique a concerne les enfants drepanocytaires formes majeures admis pour crise douloureuse dans le service de pediatrie de l'hopital Gabriel Toure de Bamako de Janvier 2005 a Janvier 2006. L''objectif principal etait d'evaluer l'efficacite du traitement de la douleur par paliers d'analgesiques selon le protocole de l'Organisation Mondiale de la Sante (OMS). Cette etude a porte sur 70 enfants drepanocytaires formes majeures des deux sexes; ages de 6 mois a 15 ans en crise douloureuse. L'efficacite du traitement sous antalgique a ete systematiquement evaluee aux heures H2 et H24. Dans 87;1des cas les douleurs ont ete calmees par un antalgique du palier I (Paracetamol) et 12 ;9ont necessite le passage au palier II (Buprenorphine). Chez 64;3de nos patients les douleurs ont ete calmees dans un delai inferieur a 12 heures avec une moyenne de 3 heures contre seulement 35;7cedees dans un delai superieur a 12 heures avec une moyenne de 64 heures 3 minutes. Les douleurs lombaires et les cephalees ont etes les plus sensibles au traitement. L'automedication antalgique a domicile n'a pas eu d'impact reel sur la sedation des crises

Anti-Inflammatory and Antipyretic Activities of Hygrophila spinosa T. Anders Leaves (Acanthaceae)

Purpose: Hygrophila spinosa T. Anders (Acanthaceae) is commonly used in the traditional system of medicine for the treatment of inflammation; pain; jaundice; rheumatism; arthritis; anaemia; etc. In the present study; we investigated the anti-inflammatory and antipyretic activities of the petroleum ether; chloroform; alcoholic and aqueous extracts of the leaf of this plant. Methods: The anti-inflammatory activity of the various extracts was studied based on their effects on carrageenan-induced paw oedema in rats while antipyretic activity was evaluated on the basis of their effect on Brewer's yeast-induced pyrexia in rats. The extracts were screened for alkaloids; steroids; proteins; flavonoids; saponins; mucilage; carbohydrates; organic acids; fats and oils. Results: Preliminary phytochemical screening revealed the presence of alkaloids; steroids; proteins; flavonoids; fats and oils; tannins; mucilage and organic acids in the leaves of H. spinosa. Chloroform and alcoholic extracts of leaves of H. spinosa produced significant (p 0.05 and p 0.01) anti-inflammatory and antipyretic activities in a dose-dependent manner. On the other hand; petroleum ether and aqueous extracts did not show significant anti- inflammatory and antipyretic activities. The maximum anti-inflammatory activities produced by chloroform and alcoholic extracts (400 mg/kg) were 33.7and 47.5; respectively. These two extracts also reduced elevated body temperature in rats at 200 and 400 mg/kg body weight doses throughout the observation period of 6h .Conclusion: Chloroform and alcoholic extracts of H. spinosa leaves have anti-inflammatory and antipyretic activities

Effect of Centella Asiatica Extract on Nociception; Experimental Diabetes and Hyperlipidemia in Mice and Rats

This study was undertaken to determine the effect of Centella asiatica aqueous extract (CAEt) on nociception; experimental diabetes and hyperlipidemia in mice and rats. The extract was administered orally and the effects of different doses of the extract on nociception in mice; on blood glucose; glucose-6-phosphatase; and serum and tissue lipids in rats with alloxan-induced diabetes were studied. Diclofenac and chlopropamide were used as standard drugs for nociception and diabetes; respectively. The doses of extract administered were 150; 300; 500 mg/kg body weight. The data obtained indicated that the aqueous extract of Centella asiatica exhibited anti-nociceptive activity in mice. Results of the anti-diabetic study indicated that the extract suppressed the elevated blood glucose. In anti-hyperlipidemic study; lipid levels didn't change in diabetic rats treated with CAEt. These findings show that the extract possesses anti-nociceptive and anti-diabetic activities

Antinociceptive and antiinflammatory effects of essential oil of Dennettia Tripetala G. Baker (annonaceae) in Rodents

In this study we evaluated the analgesic and anti- inflammatory activities of the essential oil (EO) of the fruits of Dennettia tripetala in rodents. The plant is a tropical African plant and the fruits are commonly eaten as spices and consumed as a stimulant, and its various parts are used in the treatment of fever, cough and as anti-emetics. The analgesic effects of the oil was assessed in mice using the hot plate, acetic acid-induced writhings and formalin test, while carrageenan-induced paw oedema was used to study the antiinflammatory effects in rats. The EO at 25-50 mg/kg exhibited significant (p0.05) antinociceptive effects comparable to a potent opioid agonist, morphine (10 mg/kg) and non-steroidal anti-inflammatory drugs such as, aspirin (100 mg/kg) and indomethacin (80 mg/kg). The antinociceptive effect of the EO was also blocked by naloxone (2 mg/kg) in all the models used. The EO demonstrated significant (p0.05) anti-inflammatory effect in the carrageenan-induced paw oedema model of inflammation that is also comparable to dexamethasone (1 mg/kg) The results showed that the essential oil of D.tripetala possesses significant antinociceptive and antiinflammatory effects in the animal models used. The results also suggest that the analgesic effects may be mediated both centrally as well as peripherally, while the antiinflammatory activity may be effective in both early and late phases of inflammation. The results obtained may therefore be used to rationalize the use of the plant in the treatment of pain and fever in traditional medicine

The Medical Management of Opioid Dependence in South Africa

Objective : With the increase in opioid dependence in South Africa; medical practitioners are increasingly confronted with requests to treat patients with opioid use disorders. Many medical practitioners; however; do not possess the required knowledge and skills to effectively deal with these patients. An overview of the medical treatment of opioid dependence is provided. Method : A working group of key doctors working in the field of substance dependence; was elected at an Opioid Experts Meeting and compiled guidelines for the management of opioid dependence. This article provides a summery of these guidelines. Recommendations are based on current best practice as derived from scientific evidence and consensus of the working group. It should never replace individual clinical judgment

Postoperative Nausea and Vomiting in Korle Bu Teaching Hospital

Objective: Postoperative nausea and vomiting (PONV) is one of the most distressing morbidities associated with surgery. Even though the incidence can be as high as 30 elsewhere no work has been done to assess the incidence in any health facility in Ghana. This study was carried out to find out the incidence; risk factors and the management of PONV in a tertiary healthcare facility. Design: This was a prospective study. Setting: The study was carried out in Korle Bu Teaching Hospital (KBTH). Subjects and Methods: All patients above the age of 18 years who had surgery including general surgery were included in the study. Information obtained using a questionnaire included demographic data; the type of anaesthesia; the incidence of PONV and its management. Results: Three hundred and six (306) completed forms out of 322 questionnaires were analyzed. One hundred and six patients (34) had episodes of PONV of whom 82 (77.4) had intra-operative opioids. Of the other factors only age was found to be a risk factor with patients in the 20-49 age group constituting 71.8(p= 0.007). Eleven out of 93 patients who reported the episode to a health worker received medication for their PONV. Drugs used included promethazine and antimalaria. Conclusions: Thirty-four percent of patients in the study had PONV indicating that the problem is not uncommon among post-surgical patients in KBTH. Awareness of the problem should be highlighted and adequate management should be given to all patients. Patients at risk should be identified and appropriate management instituted

Evaluation of Anti-Inflammatory; Antinociceptive and Antipyretic Effects of Methanol Extract of Cleome Chelidonii

The methanol extract of Cleome chelidonii whole plant was investigated for its anti-inflammatory; antinociceptive and antipyretic activities at the doses of 50; 100 and 200 mg/kg of body weight. The experimental paradigms used were carrageenan-induced pedal edema for anti-inflammatory activity; acetic acid-induced writhing and hot plate methods to assess antinociceptive activity and yeast-induced hyperpyrexia to evaluate the antipyretic activity. In acute phase inflammation; at dose of 200 mg/kg of body weight after 3 hours treatment with methanol extract of C. chelidonii in carrageenan showed a maximum inhibition of 54.6(P 0.05) when compared with standard drug aspirin (10 mg/kg); which showed decreased formation of granuloma tissue by 60.6(P 0.01). The methanol extract possesses significant (P 0.05) antinociceptive activity in both paradigms. In rats a significant (P 0.01) reduction in hyperpyrexia was also produced by the extract. This study exhibits that the methanol extract of entire plant of C. chelidonii possesses anti-inflammatory; antinociceptive and antipyretic activities

Analgesic and Anti-Inflammatory Properties of Aqueous Extract From Leaves of Solanum Torvum (Solanaceae)

Solanum torvum is used in Cameroonian traditional medicine for the management of pain and inflammation. The present work assesses the pain-killing and anti-inflammatory properties of the aqueous extracts of Solanum torvum leaves. Acetic acid- and pressure- induced pains were reduced by this extract while carrageenan-induced inflammation was inhibited at various doses of the extract. The extract therefore has both analgesic and anti-inflammatory properties

Analgesic and Anti-Inflammatory Properties of Aqueous Extract from Leaves of Solanum Torvum (Solanaceae)

Solanum torvum is used in Cameroonian traditional medicine for the management of pain and inflammation. The present work assesses the pain-killing and anti-inflammatory properties of the aqueous extracts of Solanum torvum leaves. Acetic acid- and pressure- induced pains were reduced by this extract while carrageenan-induced inflammation was inhibited at various doses of the extract. The extract therefore has both analgesic and anti-inflammatory properties

Analgesic and Anti-Inflammatory Activities of Asparagus Africanus Root Extract

The methanolic extract of the roots of Asparagus africanus Lam (Liliaceae) which contains mainly saponins and carbohydrate showed significant analgesic and anti-inflammatory activities (P0.05) in the tail-flick/hot-plate test and egg albumen-induced rat paw oedema tests that were comparable to the test drugs (morphine 20mg/kg and indomethacin 50mg/kg respectively). These results indicate that the extract possesses analgesic and anti-inflammatory properties

Phytochemical; Analgesic and Anti-Inflammatory Effects of the Ethylacetate Extract of the Leaves of Pseudocedrella Kotschyii

Phytochemical screening was carried out on the ethylacetate portion of the ethanolic extract of the leaves of Pseudocedrella kotschyii and then evaluated for its analgesic (acetic acid-induced writhing) and anti-inflammatory (raw egg albumin-induced oedema) activities in mice and rats respectively. Phytochemical screening of the ethylacetate partition portion of ethanolic extract revealed the presence of flavonoids; glycosides and tannins as major chemical constituents. Alkaloids saponins; cardiac glycosides; steroids were not dictated in the extract. The ethylacetate extract (50 and 100 mg/kg i.p) exhibited significant activity (p0.05) against acetic acid-induced writhing in a dose dependent manner. In the anti-inflammatory activity the ethylacetate extract (50 and 100 mg/kg i.p.) caused a slight effect against the raw egg albumin-induced oedema. The effect was however observed not to be dose dependent. All these effects were compared with standard drug piroxicam (20 mg/kg i.p.)