Comparison of the postoperative analgesic effects of naproxen sodium and naproxen sodium-codeine phosphate for arthroscopic meniscus surgery / Comparação dos efeitos analgésicos pós-operatórios de naproxeno sódico e naproxeno sódico-fosfato de codeína em artroscopia de menisco

ABSTRACT BACKGROUND AND OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to control arthroscopic pain. Addition of oral effective opioid "codeine" to NSAIDs may be more effective and decrease parenteral opioid consumption in the postoperative period. The aim of this study was to compare the efficacy and side effects of naproxen sodium and a new preparation naproxen sodium-codeine phosphate when administered preemptively for arthroscopic meniscectomy. METHODS: Sixty-one patients were randomized into two groups to receive either oral naproxen sodium (Group N) or naproxen sodium-codeine phosphate (Group NC) before surgery. The surgery was carried out under general anesthesia. Intravenous meperidine was initiated by patient-controlled analgesia (PCA) for all patients. The primary outcome measure was pain score at the first postoperative hour assessed by the Visual Analogue Scale (VAS). Sedation assessed by Ramsey Sedation Scale, first demand time of PCA, postoperative meperidine consumption, side effects and hemodynamic data were also recorded. RESULTS: The groups were demographically comparable. Median VAS scores both at rest and on movement were significantly lower in Group NC compared with Group N, except 18th hour on movement (p < 0.05). The median time to the first demand of PCA was shorter in Group N compared with Group NC (p < 0.001). Meperidine consumption was higher in Group N compared with Group NC (p < 0.001). There was no difference between groups with respect to side effects (p > 0.05). CONCLUSIONS: The combination of naproxen sodium-codeine phosphate provided more effective analgesia than naproxen sodium and did not increase side effects.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os anti-inflamatórios não esteroides (AINEs) são frequentemente usados para controlar a dor após artroscopia. A adição de um opiáceo oral eficaz (codeína) aos AINEs pode ser mais efetiva e diminuir o consumo de opiáceo parenteral no pós-operatório. O objetivo deste estudo foi comparar a eficácia e os efeitos colaterais de naproxeno sódico e uma nova preparação, naproxeno sódico-fosfato de codeína, quando administrados preventivamente para meniscectomia artroscópica. MÉTODOS: Foram randomicamente divididos em dois grupos 61 pacientes para receber naproxeno sódico por via oral (Grupo N) ou naproxeno sódico-fosfato de codeína (Grupo NC) antes da cirurgia. A cirurgia foi feita sob anestesia geral. Meperidina intravenosa foi iniciada por meio de analgesia controlada pelo paciente (ACP) para todos os pacientes. O desfecho primário foi o escore de dor na primeira hora de pós-operatório, avaliada com a escala visual snalógica (EVA). A sedação foi avaliada com a escala de sedação de Ramsey. A primeira demanda de ACP, o consumo de meperidina no pós-operatório, os efeitos colaterais e os dados hemodinâmicos também foram registrados. RESULTADOS: Os grupos foram demograficamente comparáveis. As medianas dos escores EVA tanto em repouso quanto em movimento foram significativamente menores no Grupo NC comparado com o Grupo N; exceto para movimento na avaliação de 18 horas (p < 0,05). A mediana do tempo até a primeira demanda de ACP foi menor no Grupo N em comparação com o Grupo NC (p < 0,001). O consumo de meperidina foi maior no Grupo N em comparação com o Grupo NC (p < 0,001). Não houve diferença entre os grupos em relação aos efeitos colaterais (p > 0,05). CONCLUSÕES: A combinação de naproxeno sódico-fosfato de codeína forneceu analgesia mais efetiva que naproxeno sódico, sem aumentar os efeitos colaterais.

Eficácia analgésica da associação de 30mg do fosfato de codeína com 500mg do paracetamol após exodontias de terceiros molares inferiores impactados / Analgesic efficacy of codeine phosphate 30mg association with paracetamol 500mg after extraction of impacted lower third molars

Avaliar a eficácia analgésica da associação de 30mg do fosfato de codeína com 500mg do paracetamol após exodontias de terceiros molares inferiores impactados. Foi realizado um estudo clínico bilateral com uma amostra de 47 pacientes. Em um dos lados, todos os pacientes receberam a dosagem de 30mg do fosfato de codeína em associação com 500mg do paracetamol após exodontia (grupo teste). Para a exodontia contralateral, foi disponibilizado outro frasco contendo cápsulas idênticas, porém com a dosagem de 500mg de paracetamol (grupo controle). 100% dos pacientes do grupo teste não necessitaram utilizar a medicação resgate e não consumiram doses adicionais da medicação após as cirurgias. No grupo controle, 44,7% dos participantes relataram o uso do medicamento resgate. O consumo total de comprimidos no grupo teste foi, em média, inferior quando comparados ao lado contralateral. 80,8% dos pacientes relataram maior conforto, quanto ao critério da dor, no lado em que foi utilizado a dosagem de 30mg de fosfato de codeína associado a 500mg de paracetamol. Os efeitos colaterais estiveram mais presentes no grupo teste, sendo mais comum o relato de sonolência (34%) e tontura (31,9%), não havendo relato de abandono desta medicação por nenhum dos pacientes. Concluímos que a dosagem de 30mg do fosfato de codeína associada a 500mg de paracetamol apresentou resultados favoráveis no controle da dor e uma baixa incidência de efeitos colaterais...

To assess the analgesic efficacy of regular dosage of codeine phosphate 30mg association with paracetamol 500mg after extraction of impacted lower third molars. We performed a bilateral clinical study analyzing a sample of 47 patients. All patients received a 30mg codeine phosphate dosage in combination with paracetamol 500mg after extraction (test group). For the contralateral tooth extraction, we had another bottle available containing identical capsules, with a 500mg paracetamol dosage (control group). 100% of the test group patients did not need to use rescue medication and did not consume additional doses of medication after surgeries. In the control group, 44.7% reported the use of rescue medication. Total consumption of pills in the test group was on average lower than the contralateral side. 80.8% of patients reported greater comfort, as the criterion of pain in the side that was used 30mg codeine phosphate dosage associated with paracetamol 500mg. The adverse effects were more present in the test group, with sleepiness being more common (34%) and dizziness (31.9%), without any patient medication abandonment. We conclude that the 30mg codeine phosphate dosage associated with paracetamol 500mg showed favorable results in controlling pain associated with a low incidence of side effects...

Withdrawal effect of codeine and phenobarbitone on the brain and cardiac function enzymes and glucose metabolism in adult albino rats

This study is to elucidate the withdrawal of codeine and phenobarbiton and their effects on some brain, cardiac activity and glucose-insulin-glucagone relations. This may help to clarify the side effect and metabolic changes which may occur as a result of drug administration. For this aim forty adult albino rats were randomly divided to 5 groups each of eight animals. First group was kept as control. Second and third group received codeine orally in therapeutic and double therapeutic dose. Forth and fifth group were given phenobarbiton intramuscular in therapeutic and double therapeutic dose. Drugs were administered day after day for four consecutive weeks. Alterations in serum Monoamine oxidase [MAO] activities, Cholinesterase [ChE] activities, whereas 5' nucleotidase [5'NT] and creatine kinase [CK] activity lactate dehydrogenase [LDH], Aspartat-aminotransferase [AST], glucose, insulin and glucagon were recorded. Such alterations were discussed in relation to doses and levels of drugs in urine of rats that actually stopped drug and exhibited that the analgesic effects symptoms of the drugs are expression of changes of functioning enzymes

Fixed drug eruption: a descriptive study of 100 cases

Fixed drug eruption [FDE] is one kind of drug rashes that is characterized by re-appearance of the lesions on the same sites after re-exposure to the causative drug. This study was performed to evaluate the epidemiologic characteristics of FDE. This descriptive study was done on a series of 100 FDE cases, who were admitted at the outpatient dermatology clinic of Hazrat-e-Rasoul Hospital over a six-year period. The primary diagnosis of FDE was suggested according to clinical findings including a remaining hyperpigmentation at the site of healed skin lesion [s]. Oral challenge test with a single low dose administration of the suspected drug was used to confirm the diagnosis. Recurrence of the lesion [s] at the same body area [s] was considered as positive result. Most commonly causative agents were co-trimoxazole and codein, which were found in 88% and 3% FDE cases; respectively. The most common site of involvement was penile glans in 57.7% of male patients and trunk in 48.3% of females. In one patient, reaction to multiple drugs including co-trimoxazole, codein and tetracycline was observed and after re-challenge with each drug, re-appearance of the skin lesion at the same site was evident. Several patients reported concomitant acetaminophen intake, but there was no reaction to that drug. Co-trimoxazole is the most common cause of FDE

Subtypes of codeine cough syrup abusers.

This paper highlights the abuse potential of the codeine containing cough syrups, which may take two forms. One, experimental abuse in school or college students which later persists in a dependent pattern. Two, pre-existing opioid abusers, as a substitute which starts after the school or college years. The short term treatment outcome is better in the former group in that they are able to maintain abstinence for a relatively longer period.

Avaliaçäo clínica entre o paracetamol e paracetamol mais codeína em cirurgia bucal / Clinic evaluation between acetaminophen and acetaminophen plus codeine in oral surgery

O propósito desta pesquisa é avaliar comparativamente em duplo-cego cruzado randomizado, a eficácia dos analgésicos paracetamol (500 mg) e paracetamol (500 mg) mais codeína (30 mg) no controle da pós-operatória. O efeito das drogas foi mensurado pelos pacientes e investigado, através de escalas visuais análogas e escalas de categorias durante 24 horas. O paracetamol mais codeína apresentou ligeira superioridade em relaçäo ao paracetamol, porém estatisticamente näo significantes