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OBJECTIVE To compare the efficacy and safety of parecoxib and ketorolac tromethamine for perioperative analgesia， and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed， Embase， the Cochrane Library， CNKI， VIP， Wanfang Data， Baidu and Google， randomized controlled trials （RCT） about parecoxib （trial group） versus ketorolac tromethamine （control group） for perioperative analgesia were collected from the inception to Jun. 17th， 2022. After screening the literature and extracting the data， the quality of the included literature was evaluated using the bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0. Meta-analysis， sensitivity analysis and publication bias analysis were performed with RevMan 5.4 software. RESULTS A total of 12 RCTs were included， with 1 118 patients. Meta- analysis results showed that at the time of administration before anesthesia induction， there was no statistically significant difference between the 2 groups in visual analogue scale （VAS） [MD＝－0.16， 95%CI （－0.41， 0.09）， P＝0.20]， numerical rating scale （NRS） [MD＝0.01， 95%CI （－0.36， 0.38）， P＝0.97]， postoperative bleeding [MD＝0.15， 95%CI （－0.63， 0.93）， P＝0.71]， and consumption of opioid analgesics [MD＝0.12， 95%CI （－0.77， 1.01）， P＝0.79]. At the time of postoperative administration， VAS and bleeding volume at 48 h after operation of trial group were significantly lower than control group （P＜0.05）. The results of subgroup analysis by different com assessment time points showed that the VAS of patients in trial group at 0 h after operation were significantly lower than control group at the time of administration before anesthesia induction； at the time of postoperative administration， VAS of patients in the trial group at 12 h and 48 h after operation were significantly lower than control group （P＜0.05）. There was no statistical significance in the incidence of ADR between 2 groups [RR＝0.93，95%CI （0.78，1.11），P＝0.43]. The results of subgroup analysis according to different types of adverse reactions showed that the incidence of nausea and vomiting of trial group was significantly lower than control group， and the incidence of other adverse reactions was significantly higher than control group （P＜0.05）. Results of sensitivity analysis showed that study results were stable and reliable. Results of publication bias analysis showed that there was great possibility of publication bias in this study. CONCLUSIONS The efficacy of parecoxib is equivalent to that of ketorolac tromethamine for perioperative analgesia before operation； at the time of administration after operation， parecoxib has better analgesic effect and less postoperative bleeding； the incidence of nausea and vomiting caused by parecoxib is lower at any time of administration.
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This study describes the formulation of immediate release Ketorolac tromethamine (KT) 10-mg tablet by directcompression method; evaluation of their compliance to various Pharmacopoeial quality parameters, i.e., weightvariation, friability, hardness, thickness, moisture content, disintegration, assay, and dissolution; and their comparisonwith marketed brands for determination of pharmaceutical equivalency. Five formulations of KT were prepared(coded as FKT1, FKT2, FKT3, FKT4, and FKT5) by direct compression method using different superdisintegrants.Micrometric properties of the mixtures of the drug and the excipients prepared for formulation were evaluated. Qualityevaluation of the five different formulations and randomly selected four different brands of KT 10-mg tablets purchasedfrom the local market (coded as LKT1, MKT2, MKT3, and SKT4) were performed according to Pharmacopoeia. Theresults were obtained by UV-Vis spectrophotometer and all the dissolution profiles were characterized by the zeroorder kinetics. All the brands of KT and developed formulations met the official specification except SKT4 whichshowed excessive moisture content of 7.18%. None of the tested brands of KT were found to be pharmaceuticallyequivalent, whereas two developed formulation were pharmaceutically equivalent with the in house benchmark(MKT2) from which their interchangeability can be suggested.
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Objective To observe the effect of combination use of tramadol and ketorolac tromethamine for patientcontrolled intravenous analgesia (PCIA) after gynecological laparoscopic surgery. Methods Ninety patients with American Society of Anesthesiologists (ASA) grade I or Ⅱ undergoing gynecological laparoscopic surgery under general anesthesia were randomly divided into three groups: group T (using tramadol for PCIA) , group TK (using tramadol and ketorolac tromethamine for PCIA) and group K (using ketorolac tromethamine for PCIA) . The visual analog scale (VAS) scores at rest and moving and Ramsay sedation scale(Ramsay) scores were recorded at 1 h (t1) ,4 h (t2) ,8 h (t3) , 12 h (t4) , 24 h (t5) , 36 h (t6) , 48 h (t7) after surgery.The total dosage of rescue analgesia drug and the times of needing rescue analgesia were recorded. Adverse reactions were also recorded. Results VAS scores at rest in t 1,t2,t3,t4,t5 and t6 after surgery were significantly lower in group T and group TK than in group K(P<0.05) . VAS scores at movement time was not significantly different. After surgery,incidence rate of nausea,vomiting,dizziness or sleepiness was significantly higher in group T than in group TK and group K(P<0.05) . The total dosage of rescue analgesia drug in group K was significantly higher than in group T and in group TK (P<0.05) . In 24 h after surgery,patients pressed the button of PCIA (2.89±0.597) times in group TK,(3.05±0.574) times in group T,(6.50±0.859) times in group K.Ramsay scores at each time points after surgery were significantly increased (P<0.05) . Total dosage amount of rescue drugs and number of patients using rescue drugs were significantly higher in group K than in group T and group TK (P< 0.05) . Conclusion Combination use of tramadol and ketorolac tromethamine for PCIA after gynecological laparoscopic surgery has better analgesia effect with reduced side effects.
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Objective@#To study the median effective dose of ketorolac tromethamine combined with different doses of sufentanil.@*Methods@#From February 2016 to June 2017, 60 cases of cesarean section were selected.According to the random number table method, they were divided into two groups, with 30 cases in each group.Group I was treated with sufentanil 0.75μg/kg+ dexmedetomidine 200μg, while sufentanil 1μg/kg+ dexmedetomidine 200μg was used in group II.The first two groups were added to pump 150 mg ketorolac tromethamine, gradually increased or decreased in accordance with 30mg effect according to satisfaction or dissatisfaction.The median effective dose of ketorolac tromethamine in the two groups was analyzed.@*Results@#After operation, the systolic blood pressure[(112.5±9.6)mmHg vs.(122.5±8.4)mmHg, (114.2±9.9)mmHg vs.(124.1±8.2)mmHg]and heart rate[(80.6±13.5)times/min vs.(90.5±16.5)times/min, (77.6±15.5)times/min vs.(88.2±18.8)times/min]in the two groups were significantly lower than those before operation (t=4.587, 5.248, 4.214, 3.983, all P<0.05). The VSA scores of the two groups decreased significantly[(6.8±2.4)points, (3.4±1.4)points, (2.1±0.9)points, (6.9±3.1)points, (3.5±1.7)points, (2.2±0.7)points], the difference was statistically significant at different time points (F=4.977, P<0.05). ED50 and 95% confidence interval of ketorolac tromethamine in the group I was 91.75mg, 78.69-106.98mg, which in the group II was 72.44mg, 60.40-86.90mg.@*Conclusion@#Ketorolac tromethamine combined with sufentanil has good analgesia effect, less adverse reaction.When sufentanil was given at 0.75 and 1μg/kg, the ED50 of ketorolac tromethamine were 91.75mg and 72.44mg.
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Objective To investigate the efficacy of preemptive analgesiawith ultrasound-guided modified dorsal penile nerve block combined ketorolac tromethamine for circumcision in pediatric patients.Methods Forty-five pediatric patients with ASA grade Ⅰ undergoing elective circumcision were randomly divided into 3 groups (n=15 each).The same intravenous compound anesthesia was used in the three groups.The pediatric patients underwent ultrasound-guided modified dorsal penile nerve block with a mixture of 0.1 ml/kg of 0.2% ropivacaine and 0.8% lidocaine before operation in group A and group B.The pediatric patients were given ketorolac tromethamine 1 mg/kg intramuscular injection before operation in group A and group C.The total consumption of propfol and sufentanil, occurrence of intraoperative body movement and respiratory depression, emergence time, time from waking up to going out of PACU and adverse reactions such as postoperative agitation, nausea, vomiting and pruritus were aslo recorded.The requirement for postoperative paracetamol suppositories was recorded.Results Compared with group C, the total consumption of propfol and sufentanil were significantly decreased, incidence of body movement andrespiratory depression were significantly decreased, the emergence time and time from waking up to going out of PACU was significantly shortened, requirement for paracetamol suppositories were significantly decreased in group A and group B(P<0.05).Compared with group B, incidence of requirement for paracetamol suppositories was significantly decreased in group A (P<0.05).No pediatric patients developed postoperative nausea, vomiting, pruritus and incidence of emergence agitation had no statistical difference in the three groups.Conclusion Preemptive analgesia with ultrasound-guided modified dorsal penile nerve block combined ketorolac tromethamine is safe and effective when used for circumcision in pediatric patients, and it has good efficacy of postoperative analgesia.
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Ophthalmic formulations in terms of eye drops are more frequently used formulation for ocular disorders. But unfortunately this mode of drug instillation into the cul-de-sac of eye shows very poor ocular bioavailability (less than 5%). A large number of carrier systems have been investigated to overcome this problem. In the present study a novel nano-carrier system (Ketorolac loaded cubosomes) is developed and evaluated for the safe and enhance ocular bioavailability. Cubosomes were developed and optimized by utilizing glyceryl mono-oleate, poloxamer 407 and initial drug concentration. Finally developed formulation was evaluated for various In vitro characteristics i.e. particles size, size distribution, shape and morphology, in-vitro release profile, corneal permeation, corneal retention, and ocular tolerance study. The optimized drug loaded cubosomal formulation showed mean particle size, polydispersity index, and entrapment efficiency 127.3±12.23 nm, 0.205±0.011, and 53.27±5.23 %, respectively. Transmission electron microscopic analysis revealed a cubic shape of developed formulation. Further, developed formulation exhibited biphasic release profile. Significant high transcorneal permeation (2.07 folds) and corneal retention (2.24 folds) of ketorolac was observed with cubosomal formulation correspond to Ketorolac solution (p< 0.01). Further safety profile of optimized formulation was evaluated by histopathology of corneal membrane. The developed novel ocular carrier system (cubosomes) might be a promising platform as a vehicle for effective ocular drug delivery.
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OBJECTIVE:To observe analgesic effect and safety of ketorolac tromethamine combined with butorphanol tartrate in the treatment of acute pain after fracture surgery. METHODS:76 acute pain patients after fracture surgery were selected and ran-domly divided into control group and observation group,with 38 cases in each group. Control group was given Ketorolac trometh-amine injection 30 mg,ivgtt,and then 2 ml/h,0.5 mg/kg,ivgtt;observation group was additionally given butorphanol tartrate 10 mg,ivgtt,on the basis of control group. Pain degree was evaluated with VAS before and 10 min,1,2,4 and 6 h after treatment, and the occurrence of ADR was observed in 2 groups. RESULTS:10 min,1,2,4 and 6 h after treatment,VAS score of 2 groups were significantly lower than before,with statistical significance(P0.05). The incidence of ADR in observation group (5.26%)was significantly lower than in control group(21.05%),with statistical significance(P<0.05). CONCLUSIONS:Com-pared with ketorolac tromethamine alone,ketorolac tromethamine combined with butorphanol tartrate shows shorter analgesia dura-tion,similar therapeutic efficacy,and lower incidence of ADR.
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O objetivo deste estudo foi avaliar o uso do cetorolaco de trometamina 10mg sublingual 30 minutos antes do procedimento de biopulpectomia em pacientes com pulpite irreversível com relação à dor antes do procedimento e nas 48 horas subsequentes, a quantidade de medicação consumida no pós-operatório e tempo esperado para sua utilização. Também foi avaliada a influência da anestesia intrapulpar, o uso da automedicação analgésica antes da procura pelo atendimento e diferença entre gêneros sobre os níveis de dor pré e pós-operatória. Propôs-se avaliar também a necessidade da presença do antibiótico na medicação intracanal, comparando o Otosporin® com hidrocortisona. Participaram da pesquisa 608 pacientes que procuraram o Setor de Urgência Odontológica da Faculdade de Odontologia de Bauru ou o Setor Odontológico do Pronto Socorro Central da Prefeitura Municipal de Bauru, sendo que 34 completaram de forma adequada o protocolo previsto. Foram divididos em 4 grupos que receberam cetorolaco ou placebo como medicação pré-operatória e Otosporin® ou hidrocortisona como medicação intracanal. Foram anotados os valores de intensidade de dor, em uma escala visual analógica, antes da medicação pré-operatória, antes do atendimento, após o atendimento, 1, 2, 4, 12, 24, 48 horas após e quando houve necessidade de medicação pós-operatória para alívio da dor. Também foi anotado se o paciente havia se automedicado e qual a droga utilizada, se houve necessidade de anestesia intrapulpar, a quantidade de medicação consumida pelo paciente no pós-operatório e o tempo esperado para seu consumo. Dos resultados observou-se que os pacientes que receberam cetorolaco como medicação pré-operatória tiveram uma redução significativa da dor em 30 minutos, quando comparado ao placebo. Foi observado que o tempo necessário para a ingestão de medicamentos pós-operatórios não demonstrou diferença significativa entre os grupos, assim como na quantidade de medicação ingerida. O tempo decorrido entre a primeira e a última dose de medicação pós-operatória também não demonstrou diferença estatística. Com relação a anestesia intrapulpar, 78% dos pacientes necessitaram desta técnica, mas devido ao pequeno tamanho da amostra obtida, não foi possível correlacionar o seu uso com a utilização da medicação pós-operatória. Para os pacientes que se automedicaram previamente, não houve diferença significativa em relação à dor inicial. Quando os gêneros foram comparados, não foi possível observar uma diferença estatística significante entre eles com relação aos parâmetros estudados. Também foram descritos no trabalho os motivos de não inclusão dos 574 pacientes que foram abordados durante a realização deste estudo. Com base nos resultados, conclui-se que o cetorolaco diminuiu expressivamente o nível de dor durante a espera pelo atendimento, porém com relação ao tempo esperado pelo paciente para tomar a primeira dose de medicação pós-operatória, a última dose, a quantidade de comprimidos e a frequência de ingestão não demonstrou a mesma diferença. Também não houve diferença no nível de dor inicial entre os pacientes que se automedicaram e os que não fizeram uso dessa prática. Devido ao pequeno número da amostra, não foi possível encontrar uma correlação entre o uso da técnica anestésica intrapulpar e medicação pós-operatória, sugerindo mais estudos futuros.(AU)
The aim of this study was to evaluate the use of ketorolac tromethamine (10mg sublingual taken 30 minutes before pulpectomy in patients with irreversible pulpitis) in pain reduction immediately before the procedure and the 48 subsequent hours, postoperative consumption of analgesic drugs and time for its use. The influence of intrapulpal anesthesia, the use of analgesic self-medication prior to the demand for care and gender difference on the levels of pre- and postoperative pain was also evaluated. It was also proposed assess the need for antibiotic presence in the intracanal medicament, comparing Otosporin® with hydrocortisone. A total of 608 patients who presented to Dental Urgency Sector from Dental School of Bauru (USP) or Emergency Dental Sector from Bauru City Hall were invited to participate, and 34 completed properly planned protocol. They were distributed in 4 groups that received either ketorolac or placebo as preoperative medication and Otosporin® or hydrocortisone as intracanal medication. The rates of pain intensity were recorded by means of a visual analogue scale before pretreatment medication, immediately before the appointment, 1, 2, 4, 12, 24, 48 hours after the appointment, and when there was taken post medication for postoperative pain relief. It was also recorded if the patient had self medicated and which the drug used and, if there was need intrapulpal anesthesia, amount of ketorolac and rescue medication (paracetamol 750mg) consumed by the patient postoperative time and the waitng time for consumption. The results showed that patients receiving Ketorolac as preoperative medication had a significant reduction of pain in 30 minutes compared to placebo. It was observed that the time required for the intake of postoperative drug showed no significant difference between groups, as well as the amount of medication intake. The time elapsed between the first and last dose of postoperative medication also showed no statistical difference. Concerning intrapulpal anesthesia, 78% of patients required for this technique, but because of the small sample size obtained it was impossible to correlate their use with the use of postoperative medication. For patients who practiced self medication previously, there was no significant difference with respect to initial pain. When genders were compared, it was not possible to observe a statistically significant difference between them regarding the parameters studied. Were also described in the study the reasons of non-inclusion of 574 patients that were addressed during this study. Based on the results, it is concluded that ketorolac significantly decreased the level of pain during the waiting time, but with respect to the time length for the patient to take the first dose of postoperative medication, the last dose, the number of tablets and taken frequency did not show the same difference. There was no difference in the initial level of pain among patients who practiced self medication and those who did not use this practice. Due to the small sample size, it was not possible to find a correlation between the use of the anesthetic technique intrapulpal and postoperative medication, suggesting more future studies.(AU)
Subject(s)
Humans , Male , Female , Anesthesia, Dental/methods , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Hydrocortisone/therapeutic use , Ketorolac Tromethamine/therapeutic use , Pulpectomy/methods , Pulpitis/drug therapy , Root Canal Irrigants/therapeutic use , Toothache/drug therapy , Acute Pain/drug therapy , Drug Combinations , Neomycin/therapeutic use , Pain Measurement , Polymyxin B/therapeutic use , Preoperative Care , Time Factors , Treatment OutcomeABSTRACT
64 patients with severe chronic periodontitis were divided into 2 groups(n =32)randomly.Intramuscular injection of ketorolac tromethamine(KT group)and local block injection of lidocaine(L group)were respectively applied for periodontal subgingival scaling and root planning.The analgesic effect was assessed using VAS,the adverse drug reactions were recorded during and after operation.During op-eration the VAS between the 2 groups was not statistically different(P >0.05).6 and 1 2 h after operation the VAS of KT group was lower than that of L group(P 0. 05).
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OBJECTIVE:To study protective effects of Ketorolac tromethamine ophthalmic gel against Staphylococcus aureus corneal ulcer in rabbits. METHODS:S. aureus corneal ulcer in rabbits model was induced by corneal substance layer inoculation, and then divided into model group,positive control group (Clarithromycin ophthalmic gel),gel high-dose,medium-dose and low-dose groups(Ketorolac tromethamine ophthalmic gel 120,80,40 mg/ml),with 20 rabbits in each group. They were given re-levant medicine,once a day for 2 weeks. The keratopathy of rabbits was observed;the clinical efficacy and keratopathy score were compared. The change of ratina was observed under micrescope. RESULTS:Compared with model group,the keratopathy score de-creased while total effective rate increased in positive control group and gel groups after medication, and the effects of gel high-dose and low-dose groups were significantly lower than that of positive control group,with statistical significance(P<0.05). The retina of rabbits had not affected by the experiment. CONCLUSIONS:Ketorolac tromethamine ophthalmic gel has protective effect against S. aureus corneal ulcer in rabbits.
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Ketorolac tromethamine (KT) is a non-steroidal anti-inflammatory drug that belongs to class of heteroacetyl derivatives. An attempt has been made to make use of ointments, creams and gels as suitable vehicles for KT, which will released the drug effectively on surface when applied topically. Formulations belongs to ointment, cream and gel bases containing 1% KT were prepared and were evaluated for physiochemical parameters like physical appearance, pH, viscosity, spreadability, drug content. Drug release was also studied by in-vitro techniques. Viscosity was found highest in ointment formulation F3 Gel formulation showed better extrudability and spreadability as compared to ointment and creams. Gel formulation showed better release as compared to ointment and creams.
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BACKGROUND AND OBJECTIVES: Understanding that pain is the most important postoperative problem, in face to the need of establishing a therapeutic protocol to control post-tooth extraction pain and due to few studies comparing these drugs is that our study is justified. This study aimed at evaluating and at comparing the preemptive analgesic effect of two drugs, both administered in bolus. METHODS: This is an experimental research as from a clinical trial with human beings. It is a double-blind, crossover and randomized trial with 51 patients seen by the Oral Surgery Ambulatory of the Dentistry Department, Federal University of Sergipe (DOD/UFS), between September 2011 and September 2012, who needed simple alveolar extractions in different hemiarcades, using dexamethasone (4mg) or ketorolac tromethamine (10mg), one hour before surgery distinctively. Pain was evaluated in the first 24 and 48 hours with the visual analog scale. The interval of eight days was established between extractions. RESULTS: There have been no statistically significant differences by Fisher (p>0.05) and Friedman (p>0.05) Exact tests, or between drugs (considering a same period) or between periods (considering the same drug). CONCLUSION: There are no significant differences between drugs and observed periods. .
JUSTIFICATIVA E OBJETIVOS: Entendendo que a dor é o maior transtorno pós-operatório, diante da necessidade de estabelecer um protocolo terapêutico do seu controle pós-exodontias e dos poucos estudos comparando esses fármacos é que se justifica o trabalho. O objetivo deste estudo foi avaliar e comparar o efeito analgésico preemptivo de dois fármacos, ambos administrados em dose única. MÉTODOS: A pesquisa tem caráter experimental a partir de um ensaio clínico com seres humanos. Trata-se de um estudo duplamente encoberto, cruzado e randomizado, com 51 pacientes atendidos no Ambulatório de Cirurgia Oral do Departamento de Odontologia da Universidade Federal de Sergipe (DOD/UFS), entre setembro de 2011 e setembro de 2012, que necessitaram de extrações simples por via alveolar em hemiarcadas diferentes utilizando dexametasona (4mg) e cetorolaco de trometamol (10mg), uma hora antes da cirurgia distintamente. A dor foi avaliada nas primeiras 24 e 48h, com o uso da escala analógica visual. O intervalo de 8 dias foi estabelecido entre as exodontias. RESULTADOS: Não houve diferenças estatisticamente significantes no teste Exato de Fisher (p>0,05) e Friedman (p>0,05), nem entre os fármacos (considerando um mesmo período) nem entre os períodos (considerando o mesmo fármaco). CONCLUSÃO: Não existem diferenças significativas entre os fármacos e os períodos observados. .
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Purpose: To evaluate the effects of preservativefree 0.45% ketorolac tromethamine and artificial tears (carboxymethylcellulose) compared with those of preservativefree artificial tears alone on the symptoms and signs of acute viral conjunctivitis. Methods: This was a randomized, doublemasked clinical trial that included 50 patients who were diagnosed with acute viral conjunctivitis and distributed into two groups (Group 0: artificial tears and Group 1: 0.45% ketorolac tromethamine + carboxymethylcellulose). The patients were instructed to use the medication 4 times daily. Signs (conjunctival hyperemia, chemosis, follicles, and secretion) and symptoms (general ocular discomfort, itching, foreign body sensation, tearing, redness, and swelling of the eyelids) were scored at baseline and on the third and seventh days of treatment using a standardized questionnaire and slitlamp anterior segment examination. Results: Both groups showed an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group 0 and Group 1 in the study visits (p>0.05). The frequency of side effects during treatment was similar between groups (p>0.05). Conclusions: Our findings indicate that 0.45% ketorolac tromethamine was not superior to the use of artificial tears in relieving the signs and symptoms of viral conjunctivitis. .
Objetivo: Avaliar o efeito do colírio de cetorolaco de trometamina 0,45% associado à carboximetilcelulose sem conservante em comparação ao uso isolado de lágrimas artificiais sem conservantes nos sinais e sintomas da conjuntivite viral aguda. Métodos: Ensaio clínico duplo-mascarado randomizado incluindo 50 pacientes com diagnóstico de conjuntivite viral aguda, distribuídos em dois grupos (Grupo 0: lágrimas artificiais e Grupo 1: cetorolaco 0,45% + carboximetilcelulose). Os pacientes foram orientados a utilizar a medicação quatro vezes ao dia. Sinais (hiperemia conjuntival, quemose, folículos e secreção) e sintomas (desconforto ocular geral, prurido, sensação de corpo estranho, lacrimejamento, vermelhidão e inchaço de pálpebras) foram avaliados na consulta inicial, no terceiro e no sétimo dia de tratamento utilizando um questionário padronizado e biomicroscopia de segmento anterior. Resultados: Ambos os grupos apresentaram melhora dos sinais e sintomas de conjuntivite nas visitas de reavaliação. Não foi observado diferença estatística na mudança dos escores dos sinais e sintomas entre o Grupo 0 e o Grupo 1 durante as visitas do estudo (p>0.05). A frequência de efeitos colaterais durante o tratamento foi similar entre os dois grupos (p>0.05). Conclusão: O uso do cetorolaco de trometamina 0,45% não se mostrou superior ao uso isolado de lágrimas artificiais no alívio dos sinais e sintomas da conjuntivite viral. .
Subject(s)
Adult , Female , Humans , Male , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Conjunctivitis, Viral/drug therapy , Ketorolac Tromethamine/administration & dosage , Lubricant Eye Drops/administration & dosage , Ophthalmic Solutions/administration & dosage , Acute Disease , Double-Blind Method , Drug Therapy, Combination , Prospective StudiesABSTRACT
Background Intravitreal injection with triamcinolone acetonide (TA) may cause complications,including increase of intraoculapressure (IOP),cataracand endophthalmitis.Ketorolatromethamine (Ketorolac) inew,lesadverse reactionof non-steroidal anti-inflammatory drug.The action mechanism of Ketorolaisimilato TA.Therefore,Ketorolamay be completely opartly replace Tin the treatmenof retinal edema.Objective The purpose of thistudy wato investigate the effectof Tand Ketorolaon the expressionof aquaporin-4 (AQP4) and vasculaendothelial growth facto(VEGF) in hypoxiretinal Müllecellin vitro and to explore the mechanism of treating retinal edemwith Tand Ketorolac.MethodThe propose of research and use of the animalwere approved by Animal ExperimenResearch Review Committee of Hubei University of Medicine.Twenty eyeof New Zealand albino rabbitwere extracted and the retinal tissue waisolated.The Müllecellwere cultured and passaged using the enzymatidigestion method and Müllecellwere identified using glial fibrillary acidiprotein (GFAP),vimentin and α-smooth muscle actin (α-SMA) by immunofluorescence staining.The hypoxicell modelwere established by culturing the cellin DMEM with 500 μmol/L CoCl2 fo0,6,12,24 hours.The cellof hypoxifo24 hourwere divided into normal control group,hypoxicontrol group,hypoxia+50,100,200 mg/L To50,100,200 mg/L Ketorolagroups.Corresponding drugwere added into the medium in the differengroups.The expressionof AQP4 mRNand VEGF mRNin Müllecellwere detected by semi-quantitative reverse transcription PC(RT-PCR).ResultThe cellgrew well and reached 80％ confluence with the irregulashape and ovoid nuclei 14-15 dayaftecultured.More than 95％ primary cellshowed positive reaction to GFAP,vimentin and α-SMA.The expressing levelof AQP4 mRNand VEGF mRNin Müllecell(values) were significantly differenin varioutime point(AQP4 mRNA:F=18.70,P＜0.01 ; VEGF mRNA:F =53.20,P＜0.01),and those of 6,12 and 24 houraftecultured with CoCl2were increased than those withouCoCl2 (P＜0.05).The expressing levelof AQP4 mRNand VEGF mRNin Müllecell(values) were significandifferenamong the normal control group,hypoxicontrol group,hypoxia+50,100,200 mg/L ToKetorolagroup(AQP4 mRNA:F =27.98,P ＜ 0.01 ; VEGF mRNA:F =10.03,P ＜0.01).Compared with the hypoxicontrol group,the expressing levelof AQP4 mRNand VEGF mRNin the Müllecellwere declined in the hypoxia+ 100,200 mg/L Tgroup and the hypoxia+100,200 mg/L Ketorolagroup (P＜0.05).The expressing levelof AQP4 mRNand VEGF mRNwere found statistically insignificandifference between hypoxia+ 100 mg/L Tgroup and hypoxia+ 100 mg/L Ketorolagroup,obetween hypoxia+ 200 mg/L Tgroup and hypoxi+200 mg/L Ketorolagroup (P＞ 0.05).ConclusionTand Ketorolacan downregulate the expressionof AQP4 and VEGF in Müllecellundehypoxiconditions,inferring thathey have similamechanism in the impacon AQP4 function in retinal edematoueye.
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A high performance liquid chromatographic (HPLC) method for the analysis of ketorolac tromethamine and its associated impurities was examined with the aim of reducing analysis times while maintaining good efficiency. The separation was carried out using a waters X-bridge – C8 (3mm x75mm, 2.5μm particle size) column with a mobile phase of tetrahydrofuran – ammonium dihydrogen phosphate (0.05M, pH3, 28:72 v/v) at a flow rate of 1.7mL/min and UV detection at 313nm. The method was validated according to ICH (international conference on harmonisation) guidelines with respect to precision, accuracy, linearity, specificity, robustness and limits of detection and quantification. All parameters examined were found to be well within the stated guidelines. Naturally aged samples were also tested to determine sample stability. A profile of sample and impurity breakdown was presented. A three-fold reduction in analysis time was achieved in comparison with the current approved EP (european pharmacopeia) method and the method can be immediately used for routine assay and related substance determination.
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Objective To evaluate the sufentanil-sparing effect of ketorolac tromethamine for postoperative analgesia in the elderly patients.Methods Sixty ASA Ⅱ or Ⅲ patients,aged ≥ 65 yr,with a body mass index of 18-24 kg/m2,undergoing elective gynecological operations,were randomly divided into 2 groups(n =30 each):sufentanil group(group S)and ketorolac tromethamine plus sufentanil group(group T).Both groups received combined intravenous-inhalational anesthesia and patient-controlled intravenous analgesia(PCIA)after operation.PCIA solution contained ketorolac tromethamine 180 mg and sufentanil 100 μg in 100 ml of normal saline in group T.After a loading dose of ketorolac tromethamine 30 mg was injected intravenously at 15 min before the end of operation,the PCA pump was set up with a 1.6 ml bolus dose,a 20 rain lockout interval and background infusion at a rate of 1.5 ml/h in group T.PCIA solution contained sufentanil 100 μg in 100 ml of normal saline in group S.After a loading dose of sufentanil 5 μg was injected intravenously at 15 min before the end of operation,the PCA pump was set up with a 1.6 ml bolus dose,a 20 min lockout interval and background infusion at a rate of 1.5 ml/h in group S.The effective analgesia(postoperative VAS scores at rest and during activity ＜ 3)was maintained within 48 h after operation.The amount of sufentanil consumed within 48 h after operation and adverse effects were recorded.Results Compared with group S,the amount of sufentanil consumed within 48 h after operation was significantly reduced,and the incidence of nausea and vomiting,urinary retention and pruritus was significantly decreased in group T(P ＜ 0.05).Conclusion Ketorolac tromethamine used with PCIA with sufenlanil has a significant sufentanil-sparing effecl for posloperative analgesia and improves the safety of analgesia in the elderly patients.
ABSTRACT
The present study concerns the development of polymeric films of Ketorolac tromethamine by solvent casting method to explore the possibilities of using kollidon SR as a transdermal drug delivery system. Ketorolac tromethamine was used as a model drug & incorporated in low doses. The films were prepared by using various amounts of Kollidon SR to prolong the drug release with localized action. Some films were also prepared containing certain percent of PEG-6000 along with the drug & polymer. The prepared polymeric films were evaluated for various parameters like weight uniformity, flatness, % elongation, surface pH, uniformity of drug content, in-vitro dissolution studies. The drug-polymer ratio was found to influence the drug release. The rate of drug release decreased with increased polymer concentration. About 10% increased in polymer concentration causes 50% decreased drug release. All the formulation followed Higuchian kinetics & the mechanism of release was diffusion mediated. When PEG-6000 was used as a channeling agent in this formulation drug release was increased accordingly but higher concentration of PEG-6000 results in decreasing release rate of drug because of increasing viscosity of the matrix channels.
ABSTRACT
Quality of pharmaceutical product is very important because drugs must be marketed as safe and therapeutically active formulations whose performance is consistent and predictable. The evaluation of the physical characteristics of the pharmaceutical products can ensure their quality as well as bioavailability and impart optimum therapeutic activity. Ketorolac tromethamine was chosen for this comparative study because this drug is widely used worldwide for treating moderate to severe pain. The present study compared the weight variation, hardness and the abrasion withstanding ability of eight brands of Ketorolac tromethamine tablets marketed in Bangladesh following USP guidelines. All eight brands of Ketorolac tromethamine tested conformed to the USP weight variation test. All the brands had average hardness of ≥3 kg which was satisfactory for immediate release tablet like ketorolac tromethamine. All the brands had shown their friability variation within ±1% range specified by USP. Standard deviation was calculated among all the brands which was very close to individual percentage friability of all the brands. All the brands of ketorolac tromethamine complied with USP requirements of physical quality parameters. It follows that these brands will show good disintegration and dissolution profile which would further help in achieving optimum bioavailability and in fulfilling the patient demands.
ABSTRACT
O controle da dor e da inflamação pós-operatória são constantes preocupações dos cirurgiões, bem como o bem-estar do paciente após o ato cirúrgico, esses fatores estão intimamente ligados ao sucesso dos procedimentos e técnicas aplicadas. O cetorolaco é um anti-inflamatório não esteroidal (AINE) não seletivo, que age indistintamente sobre as cicloxigenases 1 e 2 e está indicado no tratamento da dor pós-operatória ou processos dolorosos de intensidade moderada a grave. Esta revisão de literatura se propôs a elucidar os efeitos analgésicos e anti-inflamatórios do cetorolaco de trometamol aplicado tanto de forma preventiva quanto pre-emptiva no tratamento da dor, bem como suas reações adversas, apresentando vantagens e desvantagens deste fármaco. Diante da revisão de literatura abordada, os autores concluíram que: a analgesia pre-emptiva deve ser feita sempre que possível; o cetorolaco de trometamol apresenta maior eficácia analgésica que os opióides, porém, deve ser usado em curto prazo, pelo risco de desenvolver doenças gastrointestinais, além do cuidado da sua indicação que segue as recomendações comuns a todos os AINES empregados em odontologia.
The pain control and postoperatory inflammation are constant concerns of surgeons, as well as the welfare of the patient after surgery, these factors are closely linked to the success of the procedures and techniques. Ketorolac is a non steroid anti-inflammatory drug (NSAID) non-selective, which acts indiscriminately on cyclooxygenase 1 and 2 and is indicated for the treatment of postoperative pain or painful processes of moderate to severe intensity. This literature review aimed to elucidate the analgesic and anti- inflammatory ketorolac trometamol applied as a preventive and preemptive treatment of pain and its adverse reactions, presenting advantages and disadvantages of this drug. Given the literature review addressed, the authors concluded that: preemptive analgesia should be performed whenever possible; ketorolac trometamol shows greater efficacy than opioids, however, should be used in short term, at risk of developing gastrointestinal diseases, beyond the care of his statement following the recommendations common to all NSAIDs used in dentistry.
Subject(s)
Anti-Inflammatory Agents , Ketorolac Tromethamine/administration & dosage , Ketorolac Tromethamine/adverse effects , Ketorolac Tromethamine/therapeutic use , Ketorolac/administration & dosage , Ketorolac/adverse effects , Ketorolac/therapeutic useABSTRACT
BACKGROUND: In patient-controlled analgesia (PCA), ketorolac tromethamine has been mixed with nalbuphine HCL in the same PCA balloon or syringe. The compatibility of mixed drugs is an important factor in determining the effects of the administered drugs, so we examined the compatibility of the mixed solution of the both drugs in various dilutions. METHODS: Ketorolac tromethamine (K1, 3, 7, 19 group; n = 10/group) or nalbuphine HCl (N1, 3, 7, 19 group; n = 10/group) was diluted 1: 1, 3, 7, or 19 with normal saline and then the other drug was added. The presence of precipitates, turbidity by visual and spectrophotometric methods, and the pH of the mixed solutions were evaluated 0, 1, 6, 12 and 24 hours later. RESULTS: Precipitates were observed in all studied solutions except in solutions of nalbuphine HCl diluted 1 : 19 with normal saline plus ketorolac tromethamine at the observed intervals. Turbid changes were observed in N1, 3, K1, 3, and 7, but significantly decreased from 6 hours after mixing. The pH of the K groups were significantly lower than those of the N groups. CONCLUSIONS: The mixed solutions of ketorolac tromethamine with nalbuphine HCl were visually incompatible in almost all studied cases, so careful considerations are needed in mixing ketorolac tromethamine with nalbuphine HCl.