Intrathecal ketorolac injection in albino rats; pharmacological and histological study

Ketorolac tromethamine is a potent injectable non-steroidal anti-inflammatory drug [NSAID]. Ketorolac provides successful analgesia after intrathecal or epidural injection. It is frequently used to manage post-operative pain, cancer pain, and arthritis either intrathecally, or intramuscular. However, its long term administration could induce renal toxicity and/or gastro-intestinal ulceration. The aim of this study was to assess the analgesic potency of ketorolac after intrathecal injection. Also, we aimed to study the histological effect of ketorolac on the spinal cord and the duodenum after treatment in an animal model. 40 adult male albino rats, weighing 250-350 gm, were used and divided into 4 groups, 10 rats each. Group S [control] received 10 microl normal saline intrathecally, group K50 received 50microg ketorolac intrathecally, group K50 + omeprazole [proton pump inhibitor] received 50microg ketorolac intrathecally plus 0.2 mg omeprazole orally, and finally, group K100 received 100microg ketorolac intrathecally. All animals were treated for four successive days. The rat tail flick latency was longer in K50, K50 + omeprazole, and K100 groups when compared to normal control [P = 0.002]. Also, the hind-paw withdrawal latency was longer in treated groups when compared to those of the control group [P = 0.0001]. Moreover, K50 group showed decreased phase II response by 61%, K50 + omeprazole group showed decreased phase II by 62%, while K100 group showed decreased it by 76%. Histological examination revealed no changes in the spinal cord of all treated animals. Also, examination of the duodenum showed normal duodenal mucosa in group K50 and those of group K50 + omeprazole. On the other hand, cellular infiltration as well as destruction of the mucous acini have been noticed in the duodenum of K100 group. Ketorolac could be a good alternative drug used intrathecally to manage pain

Obstetric perineal lacerations complicating epidural analgesia

Anal sphincter injury and its sequelae are recognized complications of vaginal childbirth. This study was performed to evaluate whether epidural analgesia was a potential independent risk factor for severe perineal laceration. A prospective observational study. Delivery unit at Al-Hammadi hospital, Riyadh, Saudi Arabia. 614 consecutive women delivered vaginally during the period between January 2004 and May 2005, they had vertex presentation, spontaneous or augmented delivery, singleton, live, vaginally delivered neonates of at least 37 weeks' gestation and birth weight less than 4 Kg. This study was restricted to a sample that included all women with uncomplicated pregnancy. Epidural analgesia was set during the first stage of labor, there were third- or fourth-degree perineal lacerations. Overall rate of severe perineal laceration was 6.35% [n = 39]. Epidural analgesia was given to 141 [22.96%] women. Among women who had epidural analgesia, 9.92% [14 of 141] had severe perineal lacerations compared with 5.28% [27 of 473] of women who did not have epidural analgesia. Epidural analgesia is associated with increased risk of instrument use 16.31% of women had epidural analgesia had severe perineal lacerations compared with 6.97% in women without epidural analgesia. Epidural analgesia remained a significant predictor of severe perineal injury [odds ratio [OR] = 1.619, 95% confidence interval [CI] = 1.207-2.201] as detected by using logistic regression analysis. When instrument use was included in the model, epidural analgesia was no longer a statistically significant, independent predictor of severe perineal injury. [OR= 1.378, 95% CI = 0.911-1.799]. Instrument use was found to be a strong predictor of severe laceration [OR=3.326, 95% CI = 2.389-4.543]. A logistic regression model examining predictors of instrument use found that epidural analgesia does significantly predict instrument use [OR = 3.113, 95% CI = 2.314-4.209]. Instrument use in vaginal delivery increases the risk of severe perineal laceration. Consequently, Epidural analgesia, in spite of its benefits in term of pain relief are undeniable, is associated with increase third and fourth degree perineal lacerations as a result of increased risk of instrument use. Patients and clinicians should be informed of the potential drawbacks of epidural analgesia, such as severe perineal laceration and its considerable long-term consequences, like incontinence, dyspareunia, and rectovaginal fistula

Comparaitive study between ebidural fentanyl with epinephrine versus eqidural sufentanil with epinephrine for analgsia in early labour

The use of opioids in labour analgesia has been used as an adjuvant to local anaesthetics. For early labour, satisfactory analgesia with epidural fentanyl or sufentanil alone is possible. This study evaluates the impact of epinephrine on sedative effect and analgesia related to the latter technique. After written conscent 100 ASAI or II obstetric patients with spontaneous onset of labour requesting eqidural analgesia were tested in this study. The patients were randomly divided into 4 groups. Group A received epidural sufentanil, Group B received epidural fentanyl, Group C received epidural sufentenil and epinephrine, Group D received epidural fentanyl and epinephrine. The addition of epinephrine significantly reduced the incidence of sedation [p = 0.005] and prolonged the duration of analgesia [p= = 0.005] maternal satisfaction was higher with addition of epinephrine [Group C and D]