Pre-and post-operative intravenous ketoprofen administration for analgesia after tonsillectomy in adults

Various studies have shown that non-steroidal anti-inflammatory drugs are effective in reducing pain after different types of surgery. They decrease the need for opioids, thus reducing the risk of opioid related side effects. Our study was designed to evaluate the safety and efficacy of ketoprofen during tonsillectomy in 50 adult patients receiving standardized general anaesthesia. Twenty patients received intravenous ketoprofen 0.5 mg/kg at induction [Pre-ketoprofen group] and twenty patients after surgery [Post-ketoprofen group] and ten patients received normal saline [Placebo group], Nubain [nalbuphine HCI] was used for rescue analgesia. Patients in both ketoprofen groups experienced less pain than those in the placebo group. There was no difference between the study groups in the proportion of patients who were given nubain during the first 4 hours after surgery, but during the next 20 hours, all patients in placebo group [100%] received nubain compared with patients in the pre-ketoprofen group [70%] and the post-ketoprofen group [65%] [P<0.001]. Patients in the placebo group received significantly more nubain doses than patients in the two ketoprofen groups [P<0.001]. No post-operative bleeding in any patients in all groups. We conclude that pre-and post-operative 0.5 mg/kg intravenous ketoprofen is effective for analgesia after tonsillectomy in adults; without increasing the incidence of post-operative haemorrhage

Double-blind comparison of prophylactic antiemetic effect of ephedrine, metoclopramide and ondansetron on patients undergoing gynacologic laparoscopy: cost-effectiveness analysis

In a randomized, double-blind study, the prophylactic antiemetic cost-efficacy of epphedrine, metoclopramide and ondansetron in 100 patients undergoing general anaesthesia for day-case gynacological laparoscopic surgery were compared. A standard general anaesthetic technique was used for all patients. Ten min. before the end of surgery, patients were classified into 4 groups each [n=25]. Placebo, ephedrine, metoclopramide and ondansetron groups and they receive 3 ml saline i.m, 0.5 mg/kg ephedrine i.m, metoclopramide 10 mg i.v and ondansetron 4 mg i.v respectively. During the first two hours after anaesthesia [early vomiting], the incidence of postoperative nausea and vomiting [PONV] was 68%, 28%, 32% and 20% after administration of saline, ephedrine, metoclopramide and ondansetron respectively [P<0.05]. There was a significant difference between placebo and other groups. However there was no difference between ephedrine, metoclopramide and ondansetron groups in the incidence of PONV. During the time between 2 hours and 24 hours postoperatively [delayed vomiting], the incidence of PONV was 80%, 72%, 44% and 24% in saline ephedrine, metoclopramide and ondansetron group respectively. There was a significant difference between ondansetron group and other groups [P<0.05]. No difference in the incidence of once administration of rescue drug but there is a great difference in the incidence of twice or more administration of rescue drug between ondansetron and other groups [P<0.05]. No difference in the incidence of adverse events was observed between groups. There was a great difference in price between ondansetron and other drugs. This study was concluded that the prophylactic administration of I.V ondansetron was not superior to ephedrine and metoclopramide in preventing early PONV but only in preventing delayed PONV and its cost did not justify as for use in our country as a routine prophylactic antiemetic drug against PONV

Post-operative analgesia for arthroscopic menisectomy by intra-articular, neostagmine, morphine and pethidine

Arthroscopic Surgery of the knee is a common day-case surgery depends on the provision of udequate analgesia. In this study sixcty pataients in similar age, weight, sex and duration of operation were allocated randomaly in four groups each of 15 both sex. The first [control group] received 30ml saline intra-articular, the second [morphine group] received 5mg morphine in 30ml saline,k the third [pethidine group] received 50mg pethidine in 30ml saline, and the fourth [neostagmine group] received 750ug neostagmine in 30ml saline. Above knee tournequet was applied for at least 10 minutes after intra-articular injection. Post-operative pain was assessed using an internal visual analogue scale [VAS] and measuring analgesic scale [VAS] and measuring analgesic requirements. All the three treated groups had highly significant lower pain scores compared with the control group. Patients in pethidine group had a significant lower pain scores than those in the morphine group up to 2 hours postoperative, but after that it had a significant increase pain scores than morphine group, also neostagnine group patients had significant lower pain score than morphine group up to 3 hours postoperatively after that it had a significant increase in pain score than morphine group but it had significant increase in pain score than pethidine up to 2 hours postoperative, after that a significant lower pain score than pethidine group. These exact findings explained by pethidine does its effect through its local anesthetic, peripheral opiate receptor systemic and active metabolite effects. Morphine does its effect through a peripheral opiate receptors and active metaboliotes Neostragmine has long lasting analgesic effect than morphine through a peripheral muscarinic respecters