Comparison of ketorolac and indomethacin for the closure of patent ductus arteriosus among preterm infants born at the Philippine General Hospital: A randomized controlled crossover design

@#<p style="text-align: justify;"><strong>Background.</strong> Indomethacin has been the gold standard for the closure of patent ductus arteriosus (PDA). Still, the availability of the intravenous (IV) form has been a big issue precluding its use in the Philippines. IV ketorolac is another non-steroidal anti-inflammatory drug (NSAID) that is cheaper and more available in our country and used for post-cardiac surgery pain management among neonates.</p><p style="text-align: justify;"><strong>Objectives.</strong> To compare the efficacy of ketorolac versus indomethacin in the closure of patent ductus arteriosus among preterm infants.</p><p style="text-align: justify;"><strong>Methods.</strong> We conducted a randomized controlled, double-blind, crossover design, non-inferiority trial on the use of iindomethacin versus ketorolac among preterm infants with PDA. We enrolled preterm infants at 5-12 days postnatal life, diagnosed with PDA by echocardiography at the Philippine General Hospital (PGH). We excluded infants with upper gastrointestinal bleeding, renal failure, birthweight < 500 grams, septic shock, and lethal anomalies. Patients were randomly allocated between two treatment groups (indomethacin versus ketorolac). The primary outcome measure was PDA closure measured after the treatment course. Adverse events like oliguria and bleeding were recorded.</p><p style="text-align: justify;"><strong>Results.</strong> A total of 27 preterm infants were randomly assigned to the indomethacin (0.2 mg/kg/dose) and ketorolac (0.6 mg/kg/dose) group. Ketorolac has a 60% success rate for PDA closure (9/15) compared to indomethacin 41.67% (5/12) (p=0.154). No renal insufficiency and bleeding diathesis were noted. Five patients died in the study, four in the group initially allocated in ketorolac and one in indomethacin. Causes of death were late-onset sepsis, bronchopulmonary dysplasia, and congenital adrenal hyperplasia.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The success rate of PDA closure between IV ketorolac and IV indomethacin was not significantly different. There was neither oliguria nor bleeding observed in both groups.</p>

RODEXKE. Infiltración con ropivacaína, dexmedetomidina y ketorolac en cirugía espinal: Una estrategia para disminuir el consumo de opioides / RODEXKE. Infiltration with ropivacaine, dexmedetomidine, and ketorolac in spinal surgery: A strategy to decrease opioid consumption

Objetivos: Evaluar la efectividad de la infiltración del sitio quirúrgico, con ropivacaína, dexmedetomidina y ketorolac, en pacientes sometidos a instrumentación transpedicular dorsolumbar con técnica mini invasiva, en cuanto al consumo de opioides durante la internación. Materiales y métodos: Se recolectaron en forma retrospectiva los datos prospectivos de las historias clínicas de pacientes con una instrumentación con tornillos transpediculares percutáneos operados entre Junio del 2016 y Diciembre del 2018. 32 pacientes cumplieron con los criterios de selección. Se infiltró en el momento del cierre quirúrgico con una solución preparada con 150 mg de ropivacaína, 0,7 mcg/kg de dexmedetomidina y 60 mg de ketorolac, disuelto en solución fisiológica estéril para completar 40ml (Grupo M) y se la comparó con pacientes en los cuales solo se infiltró con 150mg de ropivacaína (Grupo E). Resultados: El consumo de equivalentes de morfina durante las primeras 72hs postoperatorias presentó en el grupo M una mediana de 0mg, y el grupo E, una mediana de 9,5mg (RIQ de 13,35), con una p<0,000. Por el contrario el consumo de morfina en la sala de recuperación presentó una mediana de 0mg (RIQ de 2) para el grupo M, y de 2mg (RIQ de 5) para el grupo E, sin encontrarse una diferencia significativa, p=0,132. Conclusión: Los resultados obtenidos en la comparación del consumo de opioides durante las primeras 72hs de la internación permite inferir que esta combinación de fármacos es superior respecto a la infiltración estándar con ropivacaína, independientemente de la estrategia analgésica utilizada durante el tiempo quirúrgico.

Objectives: To assess the effectiveness of a surgical site infiltration with ropivacaine, dexmedetomidine and ketorolac, in reducing opioid consumption in patients with a transpedicular dorsolumbar instrumentation using a minimally invasive technique. Materials y methods: We retrospectively collected data from patient's charts from June of 2016 to December of 2018. 32 patients with minimally invasive transpedicular dorsolumbar instrumentation, who met all criteria, were included in the analysis. During wound closure a mixture of 150mg of ropivacaine, 0,7mcg/kg of dexmedetomidine and 60mg of ketorolac, diluted in normal saline to achieve 40ml was injected (Group M). We compared them with patients in whom only 150mg of ropivacaine and saline where injected in the surgical site (Group E). Results: Morphine equivalents use during the first 72 hours postoperative had a median of 0mg for group M, and of 9,5mg (IQR of 13.35), with a p<0,000. On the contrary, morphine use during post anesthesia care unit stance had a median of 0mg (IQR of 2) for group M and of 2mg (IQR of 5) for group E, without a statistically significant difference, p=0,132. Conclusion: The result of the analysis of opioid consumption during the first 72 hours postoperative allows concluding that the infiltration of these 3 drugs together its superior to the standard infiltration with ropivacaine, independently of the analgesic strategy used during the surgery.

Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial

BACKGROUND: This study was conducted to compare the effectiveness of low-dose ketamine versus ketorolac in pain control in patients with acute renal colic presenting to the emergency department (ED). METHODS: This is a double-blind randomized clinical trial. The initial pain severity was assessed using the numerical rating scale (NRS). Then, ketamine or ketorolac was administered intravenously at a dose of 0.6 mg/kg and 30 mg respectively. The pain severity and adverse drug reactions were recorded 5, 15, 30, 60, and 120 min thereafter. RESULTS: The data of 62 subjects in the ketamine group and 64 patients in the ketorolac group were analyzed. The mean age of the patients was 34.2 ± 9.9 and 37.9 ± 10.6 years in the ketamine and ketorolac group, respectively. There was no significant difference in the mean NRS scores at each time point, except for the 5 min, between the two groups. Despite a marked decrease in pain severity in the ketamine group from drug administration at the 5 min, a slight increase in pain was observed from the 5 min to the 15 min. The rate of adverse drug reactions, including dizziness (P = 0.001), agitation (P = 0.002), increased systolic blood pressure (> 140 mmHg), and diastolic blood pressure (> 90 mmHg) was higher in the ketamine group. CONCLUSIONS: Low dose ketamine is as effective as ketorolac in pain management in patients with renal colic presenting to the ED. However, it is associated with a higher rate of adverse drug reactions.

Oxycodone versus Fentanyl for Intravenous Patient-Controlled Analgesia after Laparoscopic Gynecologic Surgery

OBJECTIVE: Oxycodone, a semi-synthetic thebaine derivative opioid, is commonly used for treating moderate to severe pain. The aim of this study was to compare the efficacy and side effects of oxycodone and fentanyl used for treating postoperative pain with intravenous patient-controlled analgesia (IV-PCA) after laparoscopic gynecologic surgery. METHODS: A total of 122 patients were randomized to receive postoperative pain treatment with either oxycodone (n=62, group O) or fentanyl (n=60, group F). Patients received 7.5 mg oxycodone and 150 mcg fentanyl with ketorolac 30 mg at the end of anesthesia, and then continued with IV-PCA (conversion dose ratio, 50:1) for 48 hours postoperatively. A blinded observer assessed postoperative pain based on a numerical rating scale, postoperative nausea and vomiting and other side effects, infused PCA dose, patient satisfaction, and sedation level. RESULTS: No significant differences were observed in patient satisfaction according to the analgesic used during the 48 hours postoperative period. CONCLUSION: Oxycodone showed similar efficacy for pain relief compared to fentanyl when used at a conversion dose ratio of 50:1. Therefore, oxycodone may be useful as an alternative to fentanyl for IV-PCA after laparoscopic gynecologic surgery.

Ketorolac versus magnesium sulphate as an adjuvant to lidocaine in intravenous regional anesthesia for upper limb surgeries

Background: intravenous regional anesthesia [IVRA] was first described almost a century ago by August Bier and has been used for the past 50 years. It is a safe anesthetic technique for upper or lower distal limb surgery

Purpose: to compare the onset time of sensory blockade when adding ketorolac versus adding magnesium to the IVRA solution, and to compare the duration of postoperative analgesia

Material and Methods: this is a randomized controlled trial in two groups. The study was performed in Ain Shams University Hospitals. Study period range was 1-2 years

Results: there are 146 patients participated in our study, patients were allocated to two groups 73 patients in each group, a group of which received magnesium sulphate solution and the other received ketorolac solution

Conclusion: we evaluated the effects of adding ketorolac and compared it to the effects of adding magnesium sulphate to the anesthetic solution used in IVRA and we found that magnesium sulphate addition can be of benefit in faster onset of sensory block in the operative limb. However, magnesium sulphate in the used concentration [10 ml MgSo4 10% in 40 ml solution] appeared to cause burning pain varying in intensity while injecting the anesthetic solution

Concurrent Use of Nefopam vs. Ketorolac with Opioid Analgesic for Post-operative Pain Management

OBJECTIVE: To compare the analgesic effects and adverse drug reactions (ADRs) of fentanyl intravenous patient-controlled analgesia (ivPCA) with nefopam, a centrally acting analgesic agent with demonstrated opioid sparing activity, as compared to ketorolac in a tertiary teaching hospital. METHODS: A retrospective evaluation of electronic medical records was conducted on patient records including either nefopam or ketorolac with opioid ivPCA for post-operative pain management in general surgery department from January to December 2014. The status of pain control and ADRs were collected. RESULTS: Out of 6,330 general surgery cases, nefopam was given in 153 prescriptions (6.9%) and ketorolac in 81 prescriptions (3.6%). The level of pain control was not different between two groups (70.9% vs. 75.3%; p = 0.51), but ADRs were more frequently reported in nefopam group (9.8% vs. 2.5%; p < 0.05). New ADRs of hot flushes (n = 1) and paresthesia in hands (n = 1) were reported in nefopam group and they were unlisted in the approved package insert. No serious ADRs were reported in both groups. CONCLUSION: Our findings presented that nefopam showed a similar analgesic effect and higher ADR rates compared to ketorolac as an adjuvant to fentanyl iv PCA for postoperative pain management in general surgery patients in South Korea.

Pain alleviation in patients undergoing cardiac surgery; presternal local anesthetic and magnesium infiltration versus conventional intravenous analgesia: a randomized double-blind study

BACKGROUND: Magnesium is one of the effective, safe local anesthetic adjuvants that can exert an analgesic effect in conditions presenting acute and chronic post-sternotomy pain. We studied the efficacy of continuous infusion of presternal magnesium sulfate with bupivacaine for pain relief following cardiac surgery. METHODS: Ninety adult patients undergoing valve replacement cardiac surgery randomly allocated into three groups. In all patients; a presternal catheter was placed for continuous infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for 48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group 2, versus conventional intravenous paracetamol and ketorolac in group 3. Rescue analgesia was iv 25 µg fentanyl. Postoperative Visual Analog Scale (VAS) and fentanyl consumption during the early two postoperative days were assessed. All patients were followed up over two months for occurrence of chronic post-sternotomy pain. RESULTS: VAS values showed high significant differences during the first 48 hours with the least pain scale in group 1 and significantly least fentanyl consumption (30.8 ± 7 µg in group 1 vs. 69 ± 18 µg in group 2, and 162 ± 3 in group 3 respectively). The incidence of chronic pain has not differed between the three groups although it was more pronounced in group 3. CONCLUSIONS: Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.

Comparison of lidocaine and a combination of lidocaine and ketorolac pretreatment on withdrawal movement induced by rocuronium injection

Introduction: Rocuronium is a widely used monoquaternary aminosteroid nondepolarizing muscle relaxant of intermediate duration with a rapid onset to achieve optimal conditions for endotracheal intubations. The injection of rocuronium bromide during induction of anesthesia has often been associated with pain-induced withdrawal movement near the site of injection. It has been hypothesized that addition of ketorolac and Lidocaine in combination as pretreatment drugs among patients undergoing general anesthesia with rocuronium injection provides a better control of withdrawal movements in comparison to patients who receive only lidocaine. The objective of this study was to compare the efficacy of pretreatment of combination of ketorolac and Lidocaine and Lidocaine alone in the frequency of withdrawal movement associated with rocuronium injection in peripheral veins during intubation

Methodology: This study was conducted on 90 patients undergoing elective surgeries under general anesthesia in operation theater complex of our hospital. Patients were randomly divided in group A and B by lottery method. Group A received 20 mg lidocaine IV prior to rocuronium. Group B received lidocaine 20 mg and ketorolac 10 mg IV. General anesthesia was administered by induction via 5 mg/kg thiopental sodium in a separate peripheral intravenous line. Withdrawal movements were observed as mild, moderate and severe, and recorded on a well-structured performa. Efficacy was defined as no withdrawal movement on injecting rocuronium

Results: The differences in age and gender of patients were not significant in both groups and these were not associated with efficacy of treatment in the groups. However ASA status of the patients was significantly associated with efficacy of treatment groups. In Group-A 27[60%] and in Group-B 36[80%] patients had no withdrawal movement while mild movement was observed in 12[26.7%] patients in Group-A, and in 7[15.6%] patients in Group-B. Moderate movement was seen in 6[13.3%] patients in Group-A, and in 2[4.4%] patients in Group-B. The number of patients who had withdrawal movement was 18[40%] vs. 9[20%] in Group-A and Group-B respectively [p = 0.0384]. The criterion of efficacy was fulfilled by 27[60%] Group-A patients, compared to 36[80%] patients in Group-B

Conclusion: Results of this study showed that combination of intravenous lidocaine and ketorolac prior to rocuronium injection is more effective that lidocaine alone for preventing withdrawal movements for general anesthesia

Comparison of analgesic effect of preoperative topical diclofenac versus ketorolac on postoperative pain after corneal collagen cross linkage

Objective: To compare post-operative pain relieving effect of topical diclofenac 0.1 0,5% in Corneal Collagen Cross Linking [CXL] for patients diagnosed with keratoconus

Methods: This randomized controlled trial was carried out for six months from October 2016 to March 2017. We included young patients having keratoconus with k-readings greater than 47D and central corneal thickness more than 400 microns. All the patients received single dose one drop of topical diclofenac 0.1% to [Group-A] and ketorolac 0.5% to [Group-B] 30 minutes in advance of the corneal collagen cross linking [CXL] procedure. The CXL was performed with topical 0.1% riboflavin eye drops in 20% dextran as a photo sensitizer. After 36 hours of the CXL procedure, the postoperative intensity of pain was assessed verbally by patients with the help of visual analog scale [VAS] numbers from zero to five where 0 designated no pain 6 5 symbolized worst pain

Results: The study comprised sixty eyes of forty one patients. Out of total 16 were male while 25 female patients. The mean age of the patients was 24.27 +/- 2.93 years [range 20 to 29 years]. In the conclusive analysis, diclofenac 0.1% was used on 30 patients in Group-A and ketorolac 0.5% on 30 subjects in Group-B. Pain relieving scores in Group-A [diclofenac 0.1%] was 2.57 +/- 0.67 while in Group-B [ketorolac 0.4% treated arm] was 3.20 +/-0.61

Conclusion: Topical diclofenac 0.1% is statistically comparable to topical ketorolac 0.5% in precluding severity of pain after corneal collagen cross linkage operation

The effect of ketorolac and dexamethasone on the incidence of sore throat in women after thyroidectomy: a prospective double-blinded randomized trial / 대한마취과학회지

BACKGROUND: We evaluated the effect of two drugs with anti-inflammatory action, dexamethasone and ketorolac, on reduction of postoperative sore throat (POST) after general anesthesia with endotracheal intubation in patients undergoing thyroidectomy. METHODS: One hundred and ninety-two female patients scheduled to undergo general anesthesia with endotracheal intubation for thyroidectomy were enrolled in this prospective study. Participants were randomly allocated to receive intravenous medication; placebo (Group C, n = 45), ketorolac 30 mg immediately before intubation (Group Kpre, n = 47), ketorolac 30 mg at the end of surgery (Group Kpost, n = 45) and dexamethasone 10 mg (Group D, n = 43). The incidence and severity of POST and hoarseness were evaluated at 1, 6 and 24 hours after surgery. RESULTS: Incidences and severities of POST at rest and during swallowing in first 6 hours after extubation were comparable among 4 groups. At 24 hours postextubation, the incidence (P = 0.002, 95% CI of proportion differences; 0.05–0.39) and severity (P = 0.008) of POST during swallowing were significantly lower in group D than in group C. Kpre and Kpost groups did not show a greater reduction in POST than group C, despite lower rescue analgesic requirement at 1 hour after extubation in group Kpre (P = 0.006; 95% CI of proportion differences; 0.07–0.38). No intergroup differences were observed in incidences of hoarseness or adverse events. CONCLUSIONS: Intravenous administration of dexamethasone 10 mg, but not ketorolac, before induction of anesthesia reduces the incidence and severity of POST during swallowing at 24 hours after thyroidectomy.

Propacetamol as an alternative of ketorolac for postoperative pain management using patient-controlled analgesia

BACKGROUND: The objective of this study was to examine effect of propacetamol in comparison with ketorolac in intravenous patient-controlled analgesia after gynecologic surgeries. METHODS: Patients aged 18 to 70 years and undergoing laparoscopic gynecologic surgeries were selected. They were randomly allocated to either group K (180 mg of ketorolac with fentanyl and ramosetron) or group P (10 g of propacetamol with fentanyl and ramosetron). Their vital signs and visual analogue scale (VAS) were examined six times (0 min, 15 min, 30 min, 60 min, 12 h, and 24 h) and laboratory workup was done 48 hours after PCA application. Development of side effects was examined 15 minutes after the PCA application. Data from 111 patients were used for the final analysis. RESULTS: There were no significant differences in changes of systolic and diastolic blood pressures, heart rate, body temperature, and VAS between the groups (P = 0.325, 0.835, 0.346, 0.524, and 0.382, respectively). There were significant differences in the levels of hemoglobin, hematocrit, blood urea nitrogen, and international normalized ratio but it was not clinically meaningful. The development of vomiting, dizziness, and headache were not significantly different between the groups and no patient developed pruritus. Although the overall number of patients with nausea was higher in group P with statistical significance (P = 0.002), there were no significant differences between the groups when examined at each detection time. CONCLUSIONS: The present study suggested propacetamol as a possible alternative of ketorolac in postoperative care after laparoscopic gynecologic surgeries.

Propacetamol as an alternative of ketorolac for postoperative pain management using patient-controlled analgesia

BACKGROUND: The objective of this study was to examine effect of propacetamol in comparison with ketorolac in intravenous patient-controlled analgesia after gynecologic surgeries. METHODS: Patients aged 18 to 70 years and undergoing laparoscopic gynecologic surgeries were selected. They were randomly allocated to either group K (180 mg of ketorolac with fentanyl and ramosetron) or group P (10 g of propacetamol with fentanyl and ramosetron). Their vital signs and visual analogue scale (VAS) were examined six times (0 min, 15 min, 30 min, 60 min, 12 h, and 24 h) and laboratory workup was done 48 hours after PCA application. Development of side effects was examined 15 minutes after the PCA application. Data from 111 patients were used for the final analysis. RESULTS: There were no significant differences in changes of systolic and diastolic blood pressures, heart rate, body temperature, and VAS between the groups (P = 0.325, 0.835, 0.346, 0.524, and 0.382, respectively). There were significant differences in the levels of hemoglobin, hematocrit, blood urea nitrogen, and international normalized ratio but it was not clinically meaningful. The development of vomiting, dizziness, and headache were not significantly different between the groups and no patient developed pruritus. Although the overall number of patients with nausea was higher in group P with statistical significance (P = 0.002), there were no significant differences between the groups when examined at each detection time. CONCLUSIONS: The present study suggested propacetamol as a possible alternative of ketorolac in postoperative care after laparoscopic gynecologic surgeries.

The prevalence of potentially inappropriate medications prescribed in elderly patients admitted in a tertiary teaching hospital: A retrospective cross-sectional study

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong>The number of elderly people (aged 60 years or over) is expected to double in the next 35 years as a result of decreasing mortality and declining fertility worldwide. The elderly population is at increased risk of being prescribed potentially inappropriate medications (PIM).<br /><strong>OBJECTIVES:</strong>To determine the prevalence of PIM prescribed among the geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014.<br /><strong>METHODS:</strong>This is a retrospective cross-sectional study on patients who are 65 years and older admitted under Internal Medicine between January 2014 to December 2014. Medical records were reviewed for PIM prescription according to the updated 2012 Beers Criteria.<br /><strong>RESULTS:</strong> PIMs were noted in 303 out of of 618 patients.The most common PIMs were insulin sliding scale, digoxin,orphenadrine, ipratropium, ketorolac, clonazepam, clonidine, hydroxyzine, amiodarone and spironolactone.<br /><strong>CONCLUSION:</strong>The prevalence of PIM prescription is 49% among geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014. It is recommended to determineprevalence of PIM use in other geriatric care settings, the predictors for PIM use, and the economic burden of PIM use.</p>

The prevalence of potentially inappropriate medications prescribed in elderly patients admitted in a tertiary teaching hospital: A retrospective cross-sectional study

BACKGROUND:The number of elderly people (aged 60 years or over) is expected to double in the next 35 years as a result of decreasing mortality and declining fertility worldwide. The elderly population is at increased risk of being prescribed potentially inappropriate medications (PIM).OBJECTIVES:To determine the prevalence of PIM prescribed among the geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014.METHODS:This is a retrospective cross-sectional study on patients who are 65 years and older admitted under Internal Medicine between January 2014 to December 2014. Medical records were reviewed for PIM prescription according to the updated 2012 Beers Criteria.RESULTS: PIMs were noted in 303 out of of 618 patients.The most common PIMs were insulin sliding scale, digoxin,orphenadrine, ipratropium, ketorolac, clonazepam, clonidine, hydroxyzine, amiodarone and spironolactone.CONCLUSION:The prevalence of PIM prescription is 49% among geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014. It is recommended to determineprevalence of PIM use in other geriatric care settings, the predictors for PIM use, and the economic burden of PIM use.

Early Clinical Outcomes after Subacromial Injection of Ketorolac in Patients with Shoulder Impingement Syndrome: A Comparison with Steroid Injection / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical results between the subacromial injection of the ketorolac and that of the corticosteroid in patients with subacromial shoulder impingement syndrome. MATERIALS AND METHODS: Twenty patients with shoulder impingement syndrome received an injection of 60 mg ketorolac and were evaluated in terms of visual analogue scale (VAS), range of motion (ROM) and Constant-Murley score. The outcomes are compared with the data of patients treated by 40 mg triamcinolone injection, retrospectively. RESULTS: There was no significant difference in the demographics, VAS, ROM, and Constan-Murley score between the two groups before the injection. At the 4 weeks follow-up, pain improvement was significantly greater in the corticosteroid group (2.7±1.53) than in the ketorolac group (4.9±2.08; p=0.001). However 12 weeks after the injection, there was no significant difference in pain improvement between the two groups (ketorolac: 2.9±2.32, corticosteroid: 2.6±1.82; p=0.707). The Constant-Murley score at the final follow-up improved from 33.5 to 52.1 in the corticosteroid group, and from 39.0 to 56.6 in the ketorolac group (p=0.677). ROM was increased in both groups, and external rotation was significantly greater in the ketorolac group than in the corticosteroid group at the final follow-up (ketorolac: 29.3°±9.90°, corticosteroid: 20.8°±7.99°; p=0.005). CONCLUSION: In this study, ketolorac provided an effect equivalent to triamcinolone in the treatment of subacromial shoulder impingement syndrome at 12 weeks after the injection. This result could offer better opportunities to manage patients with diabetes or local and systemic side effects of repetitive use of corticosteroids.

The prevalence of potentially inappropriate medications prescribed in elderly patients admitted in a tertiary teaching hospital: A retrospective cross-sectional study

BACKGROUND:The number of elderly people (aged 60 years or over) is expected to double in the next 35 years as a result of decreasing mortality and declining fertility worldwide. The elderly population is at increased risk of being prescribed potentially inappropriate medications (PIM).OBJECTIVES:To determine the prevalence of PIM prescribed among the geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014.METHODS:This is a retrospective cross-sectional study on patients who are 65 years and older admitted under Internal Medicine between January 2014 to December 2014. Medical records were reviewed for PIM prescription according to the updated 2012 Beers Criteria.RESULTS: PIMs were noted in 303 out of of 618 patients.The most common PIMs were insulin sliding scale, digoxin,orphenadrine, ipratropium, ketorolac, clonazepam, clonidine, hydroxyzine, amiodarone and spironolactone.CONCLUSION:The prevalence of PIM prescription is 49% among geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014. It is recommended to determineprevalence of PIM use in other geriatric care settings, the predictors for PIM use, and the economic burden of PIM use.

A comparison between ketorolac and nefopam as adjuvant analgesics for postoperative patient-controlled analgesia: a randomized, double-blind, prospective study / 대한마취과학회지

BACKGROUND: We compared the analgesic efficacy and side effects of ketorolac and nefopam that were co-administered with fentanyl via intravenous patient-controlled analgesia. METHODS: One hundred and sixty patients scheduled for laparoscopic cholecystectomy were randomly assigned to ketorolac (Group K) or nefopam (Group N) groups. The anesthetic regimen was standardized for all patients. The analgesic solution contained fentanyl 600 µg and ketorolac 180 mg in Group K, and fentanyl 600 µg and nefopam 120 mg in Group N. The total volume of analgesic solution was 120 ml. Postoperative analgesic consumption, recovery of pulmonary function, and pain intensities at rest and during the forced expiration were evaluated at postoperative 2, 6, 24, and 48 h. The postoperative side effects of analgesics were recorded. RESULTS: Cumulative postoperative analgesic consumptions at postoperative 48 h were comparable (Group K: 93.4 ± 24.0 ml vs. Group N: 92.9 ± 26.1 ml, P = 0.906) between the groups. Pain scores at rest and during deep breathing were similar at the time of each examination. The recovery of pulmonary function showed no significant differences between the groups. Overall, postoperative nausea and vomiting incidence was higher in Group N compared with Group K (59% vs. 34%, P = 0.015). The other side effects were comparable between both groups. CONCLUSIONS: Analgesic efficacies of ketorolac and nefopam that were co-administered with fentanyl for postoperative pain management as adjuvant analgesics were similar. However, postoperative nausea and vomiting incidence was higher in the nefopam-fentanyl combination compared with the ketorolac-fentanyl combination.

Ketorolaco versus metamizol en el tratamiento del dolor posoperatorio en niños / Ketorolac versus Metamizol in the treatment of postoperative pain in children

Evaluar la efectividad de Ketorolaco y Metamizol en el tratamiento del dolor agudo posoperatorio de adenoamigdalectomías en niños de tres a seis años atendidos en el Servicio de Anestesiología en el Hospital Alberto Sabogal Sologuren durante el periodo 2012-2013. MaterialyMétodos:Estudio observacional, descriptivo, retrospectivo y transversal. La investigación incluyó 115 niños que fueron sometidos de forma electiva a adenoamigdalectomías cuyas edades estuvieron comprendidas entre los tres a seis años. Se formaron dos grupos de acuerdo al esquema analgésico que recibieron en sala de operaciones, 58 niños recibieron Metamizol y 57 niños recibieron Ketorolaco.Resultados: En el grupo que recibió Ketorolaco, 56.1%no presentaron dolor en la unidad de recuperación posanestésica según la escala de Oucher y 43.9%presentó dolor de leve a moderado (1a6). El grupo que recibió Metamizol, 19% de los niños no refirió dolor y 74.1%calificó su dolor de leve a moderado. El grado de alivio de dolor medido por escala de Oucher fue superior en los pacientes que recibieron Ketorolaco(p<0.05).Conclusión:La reducción del dolor posoperatorio en adenoamigdalectomías en niños es mayor con Ketorolaco que con Metamizol...

Evaluate the effectiveness of Ketorolac and Metamizol in the treatment of acute postoperative pain of adenotonsillectomy in children three to six years old receiving medical care in the Department of Anesthesiology at the Hospital Alberto Sabogal Sologur enduring the period 2012-2013. Material and Methods: Observational, descriptive, retrospective and cross-sectional study. The study involved 115 children who under went elective adenotonsillectomy whose ages were between tree to six years old. They are according to two groups that received analgesic therapy in the operating room, 58 childrM received Metamizol and 57 children received Ketorolac. Results: In the group receiving Ketorolac, 56.1% had no pain in the postanesthesic recovery unit according to the scale of Oucher and 43.9% had mild to moderate pain (1-6). The group that received Metamizol, 19% of children reported On and 74.1% rated their pain from mild to moderate. The degree of pain relief measured Oucher scale was higher in patients receiving Ketorolac (9 <0.05). Conclusion: Reducing postoperative pain in adenotonsillectomy in children with Ketorolac is higher than Metamizol...

A comparative clinical study on the accuracy and efficacy of Accumate(R) 1100, an infusion pump for patient-controlled analgesia

BACKGROUND: The accuracy and efficacy of patient-controlled analgesia (PCA) devices are crucial because malfunction of the devices may lead to fatal outcomes. The aim of this study is to evaluate the accuracy and efficacy of Accumate(R) 1100, an electronic PCA pump, in comparison with GemStar(R) infusion system. METHODS: Fifty patients scheduled for gastrectomy or colon resection were assigned to the Accumate or GemStar group (n = 25 in each group). Intraoperatively, backflow, siphonage, autoclamp function, and lockout time were tested. Postoperatively, PCA using either Accumate(R) 1100 or GemStar(R) infusion system according to the assigned group was maintained for 48 hours. For PCA, fentanyl 1,500 ug and ketorolac 180 mg in 100 ml were used (demand bolus 1 ml, background infusion 1 ml/h, lockout time 15 minutes). The accuracy of the total infused dose and the level of satisfaction of the patients and users were assessed. The results were compared between the two groups. RESULTS: Although backflow and auto-clamp backflow were less with GemStar(R) infusion system, their extent was negligible in both groups. Siphonage was not different between both pumps. Autoclamp and lockout time worked without abnormalities. The relative error of total infused volume over 48 hours was -0.26 +/- 1.20% and -0.34 +/- 0.48% in the Accumate group and GemStar group, respectively. The Accumate group showed a higher level of satisfaction in terms of the ease of priming (P < 0.05). CONCLUSIONS: The accuracy and clinical efficacy of Accumate(R) 1100 were comparable to those of GemStar(R) infusion system.