Effect of paracetamol and coxib with or without dexamethasone after laparoscopic cholecystectomy

Background: Pain after laparoscopic cholecystectomy (LCC) is multifactorial. Effective post-operative pain control is necessary in LCC performed as day-case surgery. We studied the efficacy of paracetamol or valdecoxib with or without dexamethasone after LCC.
Methods: One hundred sixty patients were randomized to four groups of 40 patients. Groups 1 and 3 received parecoxib 40 mg intravenously (IV) during surgery and valdecoxib 40 mg × 1 per os (PO) for 7 post-operative days. Groups 2 and 4 received paracetamol 1 g × 4 IV during surgery and 1 g × 4 PO for 7 days. In addition, Groups 3 and 4 were given dexamethasone 10 mg IV intra-operatively. Propofol and remifentanil were used during surgery. The patients were given oxycodone 0.05 mg/kg IV in phase 1 post-anaesthesia care unit (PACU 1) or 0.15 mg/kg PO in phase 2 post-anaesthesia care unit (PACU 2) as needed to keep visual analogue scale <3/10. The patients were supplied with the study drugs for 7 post-operative days.
Results: Pain intensity, nausea and the need of oxycodone in phase 1 PACU were similar in all groups. Dexamethasone reduced the need of oral oxycodone in phase 2 PACU (7.0 ± 1.0 mg vs. 9.1 ± 1.0 mg, P <0.05). Pain intensity was similar in all groups at home. More patients in the parecoxib/valdecoxib groups needed rescue medication on the 1st post-operative day ( P <0.001) than paracetamol-treated patients.
Conclusion: Paracetamol was as effective as parecoxib/valdecoxib for pain after LCC. Dexamethasone decreased the need of oxycodone in phase 2 PACU. The effect of dexamethasone was similar in paracetamol and parecoxib/valdecoxib patients.     

小儿氨酚黄那敏片质量标准的完善

目的:完善小儿氨酚黄那敏片质量标准.方法:采用薄层色谱法对人工牛黄中的胆红素、贝斯素、胆酸、猪去氧胆酸进行鉴别;采用高效液相色谱法对小儿氨酚黄那敏片中对乙酰胺基酚和马来酸氯苯那敏进行含量测定.结果:薄层色谱鉴别方法专属性强;含量测定方法简便,重复性好.结论:建立的方法可准确、快速地进行定性、定量测定,可用于该制剂的质量控制.     

基于QbD理念的对乙酰氨基酚双释双层片制备工艺的设计及优化

目的：基于"质量源于设计"（QbD）理念设计并优化对乙酰氨基酚双释双层片（简称为"双层片"）的制备工艺。方法：采用Plackett-Burman考察法确定双层片制备工艺的关键工艺参数（CPPs）;采用Box-Behnken响应面设计,以缓释层的释放度、速释层的溶出度作为关键质量属性（CQAs）,优化双层片的最佳处方、工艺参数;在二次多项式回归模型的基础上建立双层片工艺设计空间,并加以验证。结果：对乙酰氨基酚双层片最佳工艺为：崩解剂量所占比例为9.5%,制粒目数为22目,缓材比例为5∶1;设计空间以Overlay plot方式展示,并加入95%置信区间,设计空间工艺稳定可靠。结论：所制定的工艺对乙酰氨基酚双释双层片制备工艺简单,制剂稳定,适合大工业生产。     

零交导数与多波长系数分光光度法测定复方阿司匹林中3组分的含量

 用零交导数及多波长系数分光光度法测定了复方阿司匹林片中阿司匹林、扑热息痛、咖啡因的含量。２种方法简单、快速且均不需分离样品。多波长系数法３组分回收率分别为９９．８１％，１００．３８％，９９．８７％。ＲＳＤ分别为１．０％，０．３％，０．９％。零交导数法３组分回收率分别为９９．１８％，１００．８１％，９８．８７％，ＲＳＤ分别为１．１％，０．８％，１．４％。     

Recent advances in the management of late paracetamol poisoning

Management of early paracetamol poisoning is dependent on prompt administration of N‐acetylcysteine to patients whose plasma concentrations of paracetamol exceed the normal‐risk or high‐risk treatment lines. Paracetamol poisoning presenting after 15 h since ingestion, especially as fulminant hepatic failure, requires meticulous supportive care of organ dysfunction. The putative mechanisms of action of N‐acetylcysteine and its practical use are discussed. The best prognostic marker for paracetamol poisoning in ‘established hepatotoxicity’ is the prothrombin time. Indications for liver transplantation in paracetamol poisoning and exclusion criteria are also discussed.     

Pain management following dental trauma and surgical procedures

Surgical procedures and post-traumatic management of dental patients require effective pain management during treatment, but being considerably more invasive than conservative treatments, pain management is required into the postoperative period. Clinical trials on pain intensity following dental surgical procedures (e.g., 3rd molar extraction, implant placement, periodontal, and endodontic surgery) have shown that pain is most intense approximately 5–6 h after completion of the procedure, reaching its peak levels during the first postoperative day. Greatest consumption of analgesics occurs during the first 48–72 h after 3rd molar extraction. For the management of perioperative pain associated with either conservative or surgical dental treatment, the local anesthetics articaine, lidocaine, mepivacaine, and prilocaine are preferred. These drugs, with a vasoconstrictor, provide a rapid onset and a duration of pulpal anesthesia adequate to complete most dental and surgical procedures painlessly. For management of post-traumatic and postsurgical pain, bupivacaine—administered by an appropriate nerve block—near the conclusion of a surgical procedure, can provide the patient with a pain-free period of up to 12 h. Nonsteroidal anti-inflammatory drugs represent the most effective drugs for the management of dental postsurgical pain. NSAIDs, as a group in therapeutic doses, have numbers needed to treat (NNTs) ranging from 2 to 3, while opioid analgesics do not approach those for NSAIDs. A protocol for management of pain following surgical procedures and traumatic injuries is discussed in this paper and includes preemptive NSAID; perioperative pain management; postoperative pain management—local anesthesia; postoperative pain management—analgesics; postoperative telephone call.     

Protective Effects of a Purified Saponin Mixture from Astragalus corniculatus Bieb., in vivo Hepatotoxicity Models

In this study, the in vivo effects of a purified saponin mixture (PSM), obtained from Astragalus corniculatus Bieb., were investigated using two in vivo hepatotoxicity models based on liver damage caused by paracetamol (PC) and carbon tetrachloride (CCl₄). The effects of PSM were compared with silymarin. Male Wistar rats were challenged orally with 20% CCl₄ or PC (2 g/kg) four days after being pre‐treated with PSM (100 mg/kg) or silymarin (200 mg/kg). A significant decrease of aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase (LDH) activities and glutathione (GSH) levels and an increase of malondialdehyde (MDA) quantity was observed after CCl₄ and PC administration alone. PSM pre‐treatment decreased serum transaminases and LDH activities and MDA levels and increased the levels of cell protector GSH. Biotransformation phase I enzymes were also assessed in both models. In the CCl₄ hepatotoxicity model, pre‐treatment with PSM or silymarin resulted in significantly increased activities of ethylmorphine‐N‐demethylase and aniline 4‐hydroxylase activity and cytochrome P450, compared to the CCl₄ only group. Neither silymarin nor PSM influenced PC biotransformation. Our results suggest that PSM, obtained from A. corniculatus, Bieb. showed in vivo hepatoprotective and antioxidant activities against CCl₄ and PC‐induced liver damage comparable to that of silymarin. Copyright © 2012 John Wiley & Sons, Ltd.     

Introducing the editorial board

One of the most important contributions made to any medical journal is that of its board of editorial consultants. In the February issue we introduced several of the members of our Editorial Board. Each month we will publish brief profiles of a few more of these distinguished physicians so that all of you may become a little more familiar with those whose dedicated labor does so much to make this journal possible.