Comparative analgesic efficacy and tolerability of ketorolac tromethamine and glafenine in patients with post-operative pain

Summary

In a randomized, single-dose, double-blind, parallel comparative trial of analgesic efficacy, 96 adult patients received either 10?mg ketorolac tromethamine or 400?mg glafenine orally the morning after surgery if they requested pain relief medication. Each patient provided a baseline pain assessment and then received the assigned medication. Patients assessed pain intensity and pain relief and reported any adverse events in interviews held 30 minutes after drug administration and then hourly for 6 hours. The demographic characteristics, baseline pain intensity, and surgical categories of the 47 patients who received ketorolac tromethamine and the 49 who received glafenine were similar. Both drugs provided prompt, sustained pain relief throughout the 6-hour observation period, and there were no statistically significant differences between the two groups in any of the efficacy measures analyzed. The global assessment recorded by patients suggested a slight clinical advantage for ketorolac tromethamine (32.6% of ‘excellent’ responses) as compared to glafenine (12.5% ‘excellent’). The differences in overall response were statistically significant (p = 0.017). Fourteen (30%) patients who received ketorolac tromethamine and 17 (35%) who received glafenine reported adverse experiences that began or seemed to worsen after administration of the study drugs. The most prominent were drowsiness and sleeping, both of which are common in post-surgical patients.     

Biodegradable microspheres of ketorolac tromethamine for parenteral administration

Ketorolac tromethamine loaded microspheres were prepared using two different polyesters, namely poly (lactic acid) and poly (glycolic acid) by solvent evaporation technique. The morphology of microspheres was analysed by scanning electron microscopy. In vitro release profiles of these microspheres were studied in phosphate buffered saline pH 7.4. The release kinetics of ketorolac tromethamine from the microspheres was evaluated by fitting the release data to the zero-order, Higuchi and korsemeyer-peppas equations. All microspheres showed initial burst release, followed by fickian diffusion of drug through microspheres. These microspheres were formulated as parenterals to have controlled release system.     

临床药师干预对规范酮铬酸氨丁三醇 注射液合理使用的效果分析

〔摘 要〕 目的：分析临床药师干预对规范酮铬酸氨丁三醇注射液合理使用的效果。方法：收集南京医科大学康达 学院附属涟水人民医院 2021 年 1 月至 2021 年 5 月（干预前）和 2022 年 1 月至 2022 年 5 月（干预后）住院患者的酮 咯酸氨丁三醇注射液使用资料，其中 2022 年 1 月至 2022 年 5 月临床药师通过分析酮咯酸氨丁三醇注射液应用不合理 用药的原因并进行干预。随机抽取两个时间段酮咯酸氨丁三醇注射液使用患者的病历各 100 份，比较干预前后住院患 者的酮咯酸氨丁三醇注射液的使用数量、使用合理率和不合理用药类型情况。结果：干预后，酮咯酸氨丁三醇注射液 使用量下降幅度达 81.33 %；用药合理率明显高于干预前，差异具有统计学意义（P ＜ 0.001）。结论：临床药师干预 有利于规范酮咯酸氨丁三醇注射液的合理使用，促进临床合理用药。     

The effect of post-operative NSAID administration on bone healing after elective foot and ankle surgery

BackgroundPost-operative pain is a common concern following elective foot and ankle surgery. NSAIDs used for pain relief have led to bone-healing complications in animal models and in vitro studies. This retrospective study examined the rate of bone-healing complications in post-surgical patients using NSAIDs.MethodsParticipants underwent elective foot surgeries between January 2016 and May 2018. Radiographs were used to identify bony nonunion at osteotomy sites 12 weeks post-surgery.ResultsTwo-hundred thirty-two patients were evaluated; 59 (25.43%) were prescribed ibuprofen, 62 (27%) ketorolac, 15 (6.47%) acetaminophen, and 92 (40%) hydrocodone-acetaminophen. Two-hundred and twelve (91.38%) patients exhibited radiographic evidence of osseous union at 12 weeks and 20 (8.62%) had radiographic evidence of non-union of the osteotomy sites. There was no significant relationship between NSAID use and osseous non-union (p < 0.05).ConclusionsShort-term use of oral ibuprofen and ketorolac in the post-operative period was not associated with bony non-union.     

Preoperative ketorolac has a preemptive effect for postoperative third molar surgical pain

There is uncertainty regarding the role of preemptive analgesia in preventing postoperative pain. Most previous studies were of parallel design completed under general anesthesia with many confounding inter-patient's variables. The present study evaluated the efficacy of preemptive ketorolac in a crossover design in patients undergoing bilateral mandibular third molar surgery. This was a double blind, randomized, placebo-controlled study where 34 patients had each of their identical impacted mandibular third molars removed under local anesthesia on two occasions. Each patients acted as their own control; one side was pretreated with intravenous ketorolac 30 mg before surgery followed by placebo injection after surgery, and for the other side, the patient was given placebo injection before surgery and post-treated with intravenous ketorolac 30 mg after surgery. The difference in postoperative pain between pretreated and post-treated side in each patient was assessed by four primary end-points: pain intensity as measured by a 100-mm visual analogue scale hourly for 12 h, time to rescue analgesic, postoperative analgesic consumption, and patient's global assessment. Throughout the 12-h investigation period, patients reported significantly lower pain intensity scores in the ketorolac pretreated sides when compared with the post-treated sides (P = 0.003). Patients also reported a significantly longer time to rescue analgesic (8.9 h versus 6.9 h, P = 0.005), lesser postoperative analgesic consumption (P = 0.007) and better global assessment for the ketorolac pretreated sides (P = 0.01). Pretreatment with intravenous ketorolac has a preemptive effect for postoperative third molar surgery and extended the analgesia by approximately 2 h.     

Influence of ultrasound on the percutaneous absorption of ketorolac tromethamine in vitro across rat skin

The influence of ultrasound on percutaneous absorption of ketorolac tromethamine was studied in vitro across rat skin. Sonication was carried out with a continuous mode, at an intensity of 1-3 W/cm² and a frequency of 1 MHz for 30 min. A significant increase in permeation of ketorolac through rat skin was observed with the applied sonication at 3 W/cm² when compared with permeation at 1 and 2 W/cm². Enhanced ketorolac penetration at 3 W/cm² can be explained by the mechanical and/or thermal action of ultrasound waves. The distance of the ultrasound probe from the skin surface did not influence the flux of the drug. Pretreatment of skin by 5% d-limonene in ethanol for 2 hr followed by sonication at 3 W/cm² (30 min) significantly enhanced the permeation of ketorolac when compared with passive flux with or without enhancer pretreatment.     

In vitro iontophoretic transport of ketorolac: synthetic membrane as a barrier

The effect of different factors on the iontophoretic transport of ketorolac was analyzed. In vitro experiments were performed in a diffusion cell with a cellulose membrane as a barrier. The results indicated that an increase in current density or drug concentration enhanced the transmembrane permeation of the drug. The presence of extraneous ions (such as NaCl) or an increase in viscosity of the donor medium slowed down the iontophoretic transport of the drug. The pH does not seem to be an important factor determining iontophoretic transport of ketorolac as statistically insignificant difference was observed in flux at pH 5.6, 7.2, and 8. Also, the relative importance of the transport contributions involved in iontophoresis, namely diffusive iontophoretic and electro-osmotic fluxes, was investigated using glucose as a nonionizable drug. The results indicated that the total flux of ketorolac is a result of two contributions: passive diffusion and iontophoretic flux. The contribution of electro-osmosis appears to be negligible.     

A randomized, controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage

Objective

The purpose of this study was to determine whether postcesarean section administration of ketorolac tromethamine reduces pain and narcotic usage.

Study design

A double-blinded randomized, placebo-controlled trial of ketorolac tromethamine was performed. Patients were randomly assigned to receive either ketorolac tromethamine or placebo. Patient-controlled analgesia (PCA) was used for pain control. Visual analog scales (VAS) were administered postoperatively to assess pain levels. Morphine equivalents and attempts were recorded.

Results

There were 22 patients in each arm of the study. There was no significant difference between patient demographics, blood loss, and type of anesthesia. Pain scores were significantly different at 2, 3, 4, 6, 12, and 24 hours by analysis of variance (ANOVA) (P = .033). There was a significant decrease in pain medication usage (P = .008) in the study group.

Conclusion

Ketorolac tromethamine is efficacious in reducing postoperative pain and narcotics usage after cesarean section.     

酮洛酸氨丁三醇滴眼液制备工艺及稳定性研究

目的 :研究酮洛酸氨丁三醇滴眼液合理的处方及制备工艺 ,并进行稳定性考察。方法 :以含量、有关物质、pH值为考察指标 ,筛选处方及制备工艺 ;考察3批样品的稳定性。结果与结论 :处方合理 ,工艺可行 ,制备的3批样品在市售包装条件下经加速试验6个月、室温留样9个月考察 ,质量稳定     

吉法酯与安贺拉眼液联合应用治疗碱灼伤干眼的实验研究

目的探讨吉法酯(Gefarnate)与安贺拉眼液联合应用对碱灼伤干眼兔模型的治疗作用。方法新西兰白兔20只(40眼),制作碱灼伤干眼模型,随机分成对照组和实验组,分别滴生理氯化钠、1%Gefarnate联合0.5%安贺拉滴眼液。行定期裸眼、结膜荧光素染色、虎红染色、泪膜破裂时间(Tear break-up time,BUT)、泪液蕨样变试验(Tear ferningtest,TFT)等检查,第7、28天分别取结膜免疫组织化学检测黏蛋白5AC(MUC5AC)表达和炎性细胞浸润情况。结果实验组裸眼体征缓解,结膜荧光素染色、虎红染色逐渐减轻,与对照组比较有统计学意义(P<0.05);BUT术后逐渐下降,第7天最明显,随后逐渐升高,与对照组比较有统计学意义(P<0.05);TFT显示实验组Ⅲ、Ⅳ级结晶逐渐减少;结膜杯状细胞密度第7天开始增加,MUC5AC阳性率和积分在第28天升高,与对照组比较有统计学意义(P<0.05);实验组第7、28天炎症细胞浸润密度减少,与对照组比较有统计学意义(P<0.05)。结论Gefarnate联合安贺拉滴眼液是治疗碱灼伤所致干眼症的一种好而有效的方法。