Emergency department analgesia without narcotics for adults with acute sickle cell pain crisis: Case reports and review of crisis management

Vaso-occlusive crises are one of the most debilitating features of sickle cell disease. There appears to be no standardization of care for adults with pain crisis, and some commonly utilized regimens, such as those employing intramuscular meperidine, are pharmacologically unsound. Parenteral narcotic use may be associated with respiratory compromise acutely and with dependence over the long term, but nonopioid preparations are often unsatisfactory in relieving pain. We have recently enjoyed success with a combination of a parenteral nonsteroidal anti-inflammatory medication and an oral tricyclic antidepressant. We report four representative cases and review the salient points of the management of pain crisis in adult patients in the emergency department.     

Ketorolac Versus DHE and Metoclopramide in the Treatment of Migraine Headaches

Ketorolac IM was compared to DHE and metoclopramide IV in migraine patients whose regular abortive medication had failed and who presented to a headache clinic for acute treatment. Pain scale ratings and ratings of ability to function were recorded before and after injection. Ketorolac provided moderate relief in headache in six of nine patients compared to eight of nine given DHE and metoclopramide. The average improvement in patients receiving DHE and metoclopramide was greater in pain (p = .031) and disability scores (p = .057), than in those patients given ketorolac.     

Bench-to-bedside review: treating acid-base abnormalities in the intensive care unit - the role of buffers

The recognition and management of acid-base disorders is a commonplace activity for intensivists. Despite the frequency with which non-bicarbonate-losing forms of metabolic acidosis such as lactic acidosis occurs in critically ill patients, treatment is controversial. This article describes the properties of several buffering agents and reviews the evidence for their clinical efficacy. The evidence supporting and refuting attempts to correct arterial pH through the administration of currently available buffers is presented.     

卡前列素氨丁三醇子宫肌内注射致产妇过敏性休克

1例27岁女性因产后出血,给予卡前列素氨丁三醇注射液250 μg子宫肌内注射.5 min后,患者突然出现胸闷、胸痛、心慌.先后给予地塞米松、麻黄碱、甲泼尼龙静脉滴注.症状未缓解并发展为大汗、意识模糊.心电监测T波振幅增高,血压降至70/40 mm Hg(1 mm Hg=0.133 kPa).诊断为过敏性休克.立即给予硝酸甘油及抗过敏治疗.3 h后症状逐渐缓解,血压升至100/60 mm Hg.     

反相高效液相色谱法测定酮咯酸氨丁三醇滴眼液的含量

目的 采用反相高效液相色谱法测定酮咯酸氨丁三醇滴眼液的含量.方法 采用RP-HPLC法,色谱柱为C8柱(4.6mm×250 mm,5μm);流动相为磷酸盐缓冲液-四氢呋喃(70 ∶ 30);流速为1.2 mL·min-1;检测波长313 nm.结果 酮咯酸氧丁三醇在0.24～0.56 mg·mL-1 (r=0.999 7)与峰面积呈良好线性关系,其平均回收率为100.3％,RSD=0.34％(n=9);仪器精密度RSD=0.23％(n=6);方法重复性RSD=0.43％(n=6).结论 该分析方法灵敏、准确,专属性强,重现性好,可以作为酮咯酸氨丁三醇滴眼液的质量控制方法.     

Neuroprotective effects of ketorolac tromethamine after spinal cord injury in rats: an ultrastructural study

Introduction The aim of this study was to investigate the effects of intrathecally administered ketorolac tromethamine on ultrastructural changes of the spinal cord in spinal cord-traumatised rats. Methods Male Wistar rats were used and divided into three groups for this study. The rats in Group S (n=6) were control animals and received 10 μl of saline. Groups K50 (n=6) and K400 (n=6) received intrathecally 50 μg and 400 μg of ketorolac tromethamine, respectively, immediately after trauma was induced. All rats underwent laminectomy and the spinal cord was traumatised using the clip-compression technique. Electron microscopic examination of the cord samples was carried out 3 days after spinal cord injury. Results Ultrastructural findings showed severe injury with extensive axoplasmic and cytoplasmic oedema in Group S. Minor neural damage occurred in Group K50 and increased ultrastructural protection was observed in the Group K400. Conclusion This study demonstrates that intrathecal administration of ketorolac tromethamine protects the spinal cord following injury in rats.     

Formulation and Optimization of a Sustained-Release Tablet of Ketorolac Tromethamine

The objective of our study was to formulate a sustained-release tablet of Ketorolac tromethamine, which is a nonsteroidal anti-inflammatory agent. A 2 3 full factorial design (8 runs) was selected. The variables studied were the amount of drug (30 and 40 mg), ratio of hydroxypropyl methylcellulose (HPMC)/sodium carboxymethylcellulose (NaCMC) (240/40 and 140/140 mg), and amount of ethylcellulose (140 and 180 mg). Swelling-controlled matrix tablets were manufactured by direct compression of formulation ingredients using a Stokes single punch tablet press. Dissolution tests were performed using USP apparatus 3 (Bio-Dis II), at various pHs to mimic the conditions that exist in the gastrointestinal tract. Responses studied included time for 50% of the drug to dissolve (T 50), diffusional exponent (n) that characterizes the release mechanism, and percent friability of the tablets. Analysis of variance indicated that the release rate (T 50) was affected by the HPMC/NaCMC ratio, amount of drug, and two-way and three-way interactions; whereas the amount of drug, HPMC/NaCMC ratio, ethylcellulose, and the interaction between drug and HPMC/NaCMC and HPMC/NaCMC and ethylcellulose and also three-way interactions were significantly affecting the diffusional exponent (n) . The release mechanism was found to be super-case II transport. The friability of the tablets was significantly affected by all three factors: amount of drug, HPMC/NaCMC ratio, and amount of ethylcellulose. The formulation giving the best release characteristics was identified.     

Comparison of analgesic effect of locally and systemically administered ketorolac in mastectomy patients

Background: Ketorolac is a parenteral nonsteroidal antiinflammatory drug (NSAID). Two features have limited its clinical utility: tendency to elicit kidney failure and inability to produce complete analgesia. Because most NSAIDs are weak acids (pKa 3–5) and become concentrated in acidic tissues, such as injured and inflamed tissues, we hypothesized that local administration may enhance its analgesic efficacy while lowering the potential for systemic complications. Methods: We conducted a randomized, placebo-controlled study of 60 group I–III (American Society of Anesthesiology criteria) mastectomy patients, 20 in each group. Near the end of surgery and every 6 h postoperatively, 20 ml of the study solution containing normal saline with or without 30 mg of ketorolac were administered simultaneously either via a Jackson-Pratt drain or intravenously in a double-blind fashion. The quality of pain control, the amount and character of the drain fluid, incidence of nausea and vomiting, length of stay in the postoperative care unit, and amount of morphine used for treatment of breakthrough pain were recorded. Results: Intraoperative administration of ketorolac resulted in better quality of pain control in the immediate postoperative period regardless of route of administration. The incidence of nausea was significantly higher in the placebo group, and drain output in the ketorolac groups did not exceed the output in the placebo group. Conclusion: Analgesic of the locally administered ketorolac is equally effective to the efficacy of ketorolac administered intravenously. Presented at the 48th Annual Meeting of the Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

Efficacy and safety of ketorolac tromethamine 0.5% and levocabastine 0.05%: a multicenter comparison in patients with seasonal allergic conjunctivitis

This multicenter, double-masked, randomized, parallel-group study compared the efficacy and safety of ketorolac tromethamine 0.5% ophthalmic solution with levocabastine 0.05% and ketorolac tromethamine vehicle in patients with seasonal allergic conjunctivitis. One drop of ketorolac, levocabastine, or vehicle was instilled in each eye four times daily for 6 weeks. In the majority of efficacy variables, ketorolac produced the greatest improvements, followed by levocabastine and vehicle. Ketorolac was significantly more effective (P<.05) than vehicle in reducing mean itching scores, palpebral hyperemia, bulbar hyperemia, and edema. Patients treated with ketorolac reported significant improvements (P<.05) in their ability to sleep and to concentrate on work, compared with those who received vehicle. No significant differences were noted among the treatment groups in safety or tolerability. Ketorolac tromethamine 0.5% ophthalmic solution instilled four times daily is effective and safe in reducing the signs and symptoms of seasonal allergic conjunctivitis.