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Dönmez S, Sener A, Ishak Isık N, Akbas İ, Yenal K, Kaya B. Comparison of analgesic efficacy of ibuprofen and dexketoprofen in pain management of long bone fractures: a prospective, randomized, double-blind study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02515-w. [PMID: 38653816 DOI: 10.1007/s00068-024-02515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Long bone fractures (LBF) often cause severe pain, impacting patients' quality of life. This prospective, randomized, double-blind study aimed to compare the analgesic efficacy of dexketoprofen (Dex) and ibuprofen (Ibu) in LBF patients in the emergency department. METHODS Conducted between August 10, 2023, and January 17, 2024, the study included 100 eligible patients randomized into Dex and Ibu groups. Visual analog scale (VAS) scores were measured at baseline and at 30, 60, and 120 min. DeltaVAS (ΔVAS) values and ΔVAS percentages (ΔVAS%) were calculated. Primary endpoints were ΔVAS scores (ΔVAS 30-60-120) and ΔVAS% for comparative analysis. RESULTS Statistical analysis showed no significant difference in ΔVAS30 (p = 0.359). However, ΔVAS60 exhibited a significant difference (p = 0.027), as did ΔVAS120 (p = < 0.001). ΔVAS%30 showed no significance (p = 0.224), but ΔVAS%60 and ΔVAS%120 were clinically and statistically significant (p = 0.017 and p = < 0.001, respectively). CONCLUSION Ibuprofen 800 mg demonstrated superior analgesic efficacy at 60 and 120 min compared to Dex in long bone fractures. These findings suggest ibuprofen's potential as an effective pain management option in emergency departments.
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Affiliation(s)
- Safa Dönmez
- Ministry of Health Ankara Bilkent City Hospital, Emergency Medicine, Ankara, Turkey.
| | - Alp Sener
- Ministry of Health Ankara Bilkent City Hospital, Emergency Medicine, Ankara, Turkey
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Emergency Medicine, Ankara, Turkey
| | - Nurullah Ishak Isık
- Ministry of Health Ankara Etlik City Hospital, Emergency Medicine, Ankara, Turkey
| | - İlker Akbas
- Kahramanmaraş Sütçü İmam University, Faculty of Medicine, Emergency Medicine, Kahramanmaraş, Turkey
| | - Kadir Yenal
- Ministry of Health Ankara Bilkent City Hospital, Emergency Medicine, Ankara, Turkey
| | - Bekir Kaya
- Ministry of Health Ankara Bilkent City Hospital, Emergency Medicine, Ankara, Turkey
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Stroud S, Katyal T, Gornitzky AL, Swarup I. Effect of non-steroidal anti-inflammatory drugs on fracture healing in children: A systematic review. World J Orthop 2022; 13:494-502. [PMID: 35633742 PMCID: PMC9125002 DOI: 10.5312/wjo.v13.i5.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/14/2021] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed medications in the United States. Although they are safe and effective means of analgesia for children with broken bones, there is considerable variation in their clinical use due to persistent concerns about their potentially adverse effect on fracture healing.
AIM To assess whether NSAID exposure is a risk factor for fracture nonunion in children.
METHODS We systematically reviewed the literature reporting the effect of NSAIDs on bone healing. We included all clinical studies that reported on adverse bone healing complications in children with respect to NSAID exposure. The outcomes of interest were delayed union or nonunion. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. A final table was constructed summarizing the available evidence.
RESULTS A total of 120 articles were identified and screened, of which 6 articles were included for final review. Nonunion in children is extremely rare; among the studies included, there were 2011 nonunions among 238822 fractures (0.84%). None of the included studies documented an increased risk of nonunion or delayed bone healing in those children who are treated with NSAIDs in the immediate post-injury or peri-operative time period. Additionally, children are likely to take these medications for only a few days after injury or surgery, further decreasing their risk of adverse side-effects.
CONCLUSION This systematic review suggests that NSAIDS can be safely prescribed to pediatric orthopaedic patients absent other contraindications without concern for increased risk of fracture non-union or delayed bone healing. Additional prospective studies are needed focusing on higher risk fractures and elective orthopaedic procedures such as osteotomies and spinal fusion.
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Affiliation(s)
- Sarah Stroud
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Toshali Katyal
- Department of Orthopaedic Surgery, University of California, San Francisco Benioff Children’s Hospital, San Francisco, CA 94143, United States
| | - Alex L Gornitzky
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California, San Francisco Benioff Children’s Hospital Oakland, Oakland, CA 94609, United States
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BAYRAM ERHAN, YUNLU MEHMET, GULABI DENIZ, BOZDAG ERGUN, YILMAZ MURAT, ATLIHAN DOGAN. EFFECT OF TRANEXAMIC ACID ON FRACTURE HEALING IN RATS. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e245670. [PMID: 35431630 PMCID: PMC8979354 DOI: 10.1590/1413-785220223001e245670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/03/2021] [Indexed: 11/21/2022]
Abstract
Introduction In this study we investigated the effect of tranexamic acid (TXA) on fracture healing in an established animal model, when used to stop bleeding in orthopedic trauma surgery. Materials and Methods This study was a randomized, controlled, laboratory study. Eighteen Sprague-Dawley rats were randomly assigned to three groups, either receiving TXA intravenously (Group 1), TXA topically (Group 2), or isotonic TXA intravenously and TXA topically in the same amounts for the control group (Group 3). First, a Kirschner wire was inserted retrogradely into the femoral intramedullary canal. Then the femurs were fractured at the midshaft region with blunt guillotine. After 4 weeks, the rats were sacrified and the femurs harvested. Cortical bone volume, callus volume, and bone mineral density were calculated using computer tomography scans. Torsion tests were performed. Groups were compared by maximum torque to failure and callus stiffness. Results There were no statistical differences in torque to failure and stiffness between the 3 groups. There were no differences in mean total bone volume, callus volume, percent bone volume, or callus density between the groups. Conclusions A single dose of topical or intravenous TXA has no negative effect on fracture healing when used in traumatic femur fracture surgery in an animal model. Evidence level II; Randomized controlled experimental study.
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Affiliation(s)
| | | | - DENIZ GULABI
- Kanuni Sultan Süleyman Training and Research Hospital, Turkey
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Al-Waeli H, Reboucas AP, Mansour A, Morris M, Tamimi F, Nicolau B. Non-steroidal anti-inflammatory drugs and bone healing in animal models-a systematic review and meta-analysis. Syst Rev 2021; 10:201. [PMID: 34238360 PMCID: PMC8268344 DOI: 10.1186/s13643-021-01690-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/26/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAID) have excellent anti-inflammatory and analgesic properties and are extensively used to treat post-traumatic or surgical musculoskeletal pain. Although an extensive literature exists on the administration of NSAID on animal bone healing, no systematic review and meta-analysis of animal studies that investigate the effect of NSAID administration on bone fracture healing. Objective of this study is to conduct a systematic review and meta-analysis to estimate the effect of NSAIDs administration on bone healing biomechanical and histomorphometric measurements in different animal models after bone fracture surgery. METHODS We performed a systematic review and meta-analysis of animal studies to estimate the effect of NSAID administration after bone fracture on healing outcomes. We searched eight databases without limiting the search to starting date up to 1 February 2021 for articles on fractured bone healing in animal models in which NSAID were administered. RESULTS Out of 6732 articles screened, 47 were included and 3 common bone healing outcomes were analysed: biomechanical properties (maximum force to break, stiffness, and work-to-failure), micro-computed tomography (μ-CT), and histomorphometric measurements. The studies were generally of low-quality scores because crucial information, especially concerning randomization, blinding, and allocation concealment, was poorly reported. Our results show that the negative effects of NSAID after bone fracture on certain biomechanical properties of the healing bones was not statistically significant in mice compared with other animals, in females compared with males, and in younger compared with older animals. CONCLUSION The findings demonstrated that NSAIDs administration decreased the biomechanical properties of healing bones after fracture surgery in comparison to the control group. Moreover, different effect on certain outcomes was detected among different sites, sex of the animals, and the time of assessment. TRIAL REGISTRATION Protocol published and registered in SYstematic Review Center for Laboratory animal Experimentation (SYRCLE) in 2017, https://www.radboudumc.nl/getmedia/757ec408-7a9e-4635-8233-ae951effea54/Non-Steroidal-Anti-inflammatory-Drugs-and-bone-healing-in-animal-Models-Systematic-Review-and-Meta-Analysis.aspx.
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Affiliation(s)
- Haider Al-Waeli
- Faculty of Dentistry, Dalhousie University, 5981 University Ave, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Ana Paula Reboucas
- Faculty of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
- College of Dental Medicine, Qatar University, University Street, Doha, Qatar
| | - Alaa Mansour
- School of Dental Medicine, University at Buffalo, Buffalo, NY, 14214, USA
| | - Martin Morris
- Schulich Library, McGill University, 2001 Avenue McGill College Suite 500, Montréal, QC, H3A 1G1, Canada
| | - Faleh Tamimi
- College of Dental Medicine, Qatar University, University Street, Doha, Qatar
| | - Belinda Nicolau
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College Suite 500, Montréal, QC, H3A 1G1, Canada
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OZTURK BURHAN, INAL SERMET, DULGEROGLU TCIHAN, UZUMCUGIL AOKTAR, DEGER AYSENUR, KUYUBASI SNUMAN, KARAYEL HBASRI, GOK KADIR. HISTOPATHOLOGICAL AND BIOMECHANICAL INVESTIGATION OF THE EFFECT OF MOMORDICA CHARANTIA ON FRACTURE HEALING, KIDNEY, AND LIVER: AN EXPERIMENTAL RAT MODEL. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Momordica charantia (MC) is a plant belonging to the family Cucurbitaceae. MC has antidiabetic, antibacterial, antioxidant, antimutagenic, antiulcerative, antiinflammatory and antilipidemic effects. However, information on the effect of MC on fracture union is lacking. This study aimed to examine the effect of MC on fracture union histopathologically and biomechanically. A total of 42 male Wistar-Albino rats were randomly divided into 3 groups, 14 in each group. A diaphyseal fracture was created on the right tibia of all rats. All fractures were fixed with a Kirschner (K) wire. The rats in Group I did not undergo any further procedures (Control group). Group II rats were treated with 0.9% saline oral gavage at a dose of [Formula: see text]L/day for 28 days [Saline (S) group]. The rats in Group III were given 300[Formula: see text]mg/kg MC extract per day, dissolved in [Formula: see text]L 0.9% saline by oral gavage for 28 days [MC (Extract) group]. After 28 days, all rats were sacrificed. Each group was randomly divided into two subgroups. The histopathological examination was performed on the right tibia of rats in the first subgroup and the biomechanical examination in the second subgroup. The kidneys and livers of all rats were evaluated histopathologically. Fracture union was significantly better in the Extract group compared with the Control and S groups histopathologically. The fracture inflammation values were lower in the Extract group than in the other groups. No statistically significant difference was found between the groups in terms of possible side effects to kidneys and livers. In terms of biomechanics, fracture union was significantly better in the Extract group compared with the Control and S groups except yield displacement values. MC had a positive effect on fracture union histopathologically and biomechanically.
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Affiliation(s)
- BURHAN OZTURK
- Department of Orthopaedics and Traumatology, Kutahya Health Sciences University Evliya Çelebi, Education and Research Hospital, Kutahya, Turkey
| | - SERMET INAL
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - T. CIHAN DULGEROGLU
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - A. OKTAR UZUMCUGIL
- Department of Orthopaedics and Traumatology, Park Hayat Hospital, Kutahya, Turkey
| | - AYSENUR DEGER
- Department of Pathology, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - S. NUMAN KUYUBASI
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - H. BASRI KARAYEL
- Department of Medicinal and Aromatic Plants, Vocational School, Dumlupinar University, Gediz, Turkey
| | - KADIR GOK
- Department of Biomedical Engineering, Faculty of Engineering And Architecture, Izmir Bakırçay University, İzmir, Turkey
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Effect of NSAID Use on Bone Healing in Pediatric Fractures: A Preliminary, Prospective, Randomized, Blinded Study. J Pediatr Orthop 2020; 40:e683-e689. [PMID: 32555047 DOI: 10.1097/bpo.0000000000001603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to investigate if nonsteroidal anti-inflammatory drugs (NSAIDs) used in the acute phase of bone healing in children with fractures result in delayed union or nonunion as compared with patients who do not take NSAIDs for pain control during this same time period. METHODS In this prospective, randomized, parallel, single-blinded study, skeletally immature patients with long bone fractures were randomized to 1 of 2 groups for their postfracture pain management. The NSAID group was prescribed weight-based ibuprofen, whereas the control group was not allowed any NSAID medication and instead prescribed weight-based acetaminophen. Both groups were allowed to use oxycodone for breakthrough pain. The primary outcome was fracture healing assessed at 2, 6, and 10 weeks. RESULTS One-hundred-two patients were enrolled between February 6, 2014 and September 23, 2016. Ninety-five patients (with 97 fractures) completed a 6-month follow-up (46 patients with 47 fractures in the control group and 49 patients 50 fractures in the NSAID group). None achieved healing at 1 to 2 weeks. By 6 weeks, 37 of 45 patients (82%) of control group and 46 out of 50 patients (92%) of ibuprofen group had healed fractures (P=0.22). At 10 to 12 week follow-up, 46 (98%) of the control group fractures were healed and 50 (100%) of the ibuprofen group fractures were healed. All were healed by 6 months. Healing was documented at a mean of 40 days in the control group and 31 days in the ibuprofen group (P=0.76). The mean number of days breakthrough oxycodone was used was 2.4 days in the control group and 1.9 days in the NSAID group (P=0.48). CONCLUSION Ibuprofen is an effective medication for fracture pain in children and its use does not impair clinical or radiographic long bone fracture healing in skeletally immature patients. LEVEL OF EVIDENCE Level I-therapeutic.
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Rothe R, Schulze S, Neuber C, Hauser S, Rammelt S, Pietzsch J. Adjuvant drug-assisted bone healing: Part I – Modulation of inflammation. Clin Hemorheol Microcirc 2020; 73:381-408. [DOI: 10.3233/ch-199102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Rebecca Rothe
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
| | - Sabine Schulze
- University Center of Orthopaedics & Traumatology (OUC), University Hospital Carl Gustav Carus, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christin Neuber
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
| | - Sandra Hauser
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
| | - Stefan Rammelt
- University Center of Orthopaedics & Traumatology (OUC), University Hospital Carl Gustav Carus, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
| | - Jens Pietzsch
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
- Technische Universität Dresden, School of Science, Faculty of Chemistry and Food Chemistry, Dresden, Germany
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Huss MK, Felt SA, Pacharinsak C. Influence of Pain and Analgesia on Orthopedic and Wound-healing Models in Rats and Mice. Comp Med 2019; 69:535-545. [PMID: 31561753 DOI: 10.30802/aalas-cm-19-000013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The surgical stress response and resulting physiologic changes can lead to postoperative complications and negatively impact animal welfare. Although appropriate pain management is crucial to reduce the pain and stress response to surgery, analgesic choice can significantly affect bone and wound healing. This review aims to summarize data from rat and mouse studies and to provide recommendations for integrating analgesia into orthopedic and wound healing models in these species. Data from other species, such as humans, rabbits and other rodents, is included, where available. From these data, we conclude that for orthopedic surgical models, opioids, local anesthetics and dissociative agents have minimal impact on fracture healing; cyclooxygenase 2 (COX2) selective nonsteroidal antiinflammatory drugs (NSAID) may be used in the shortterm; and steroids should be avoided. For wound healing models, short-term systemic or topical opioids have negligible impact on wound healing; NSAID or local anesthetics may be used short-term; and systemic steroids should be avoided. Alternative analgesics such as tramadol, gabapentin, ketamine, and acetaminophen warrant consideration and further evaluation for both orthopedic and wound healing models. In all cases, researchers and veterinarians should work together to determine the appropriate analgesic plan to minimize pain, as well as to minimize unwanted effects on the orthopedic and wound healing models themselves.
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Affiliation(s)
- Monika K Huss
- Department of Comparative Medicine, Stanford University, Stanford, California;,
| | - Stephen A Felt
- Department of Comparative Medicine, Stanford University, Stanford, California
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Chumpitaz-Cerrate V, Chávez-Rimache L, Franco-Quino C, Aguirre-Siancas E, Caldas-Cueva V, Ruíz-Ramírez E. Effects of NSAIDs and environmental oxygen pressure on bone regeneration. JOURNAL OF ORAL RESEARCH 2019. [DOI: 10.17126/joralres.2019.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: To evaluate the effects of administering diclofenac and ketoprofen, as well as the effects of environmental oxygen pressure variation on mandibular bone regeneration. Methods: Thirty-six guinea pigs were distributed into two equal groups. Mandibular bone defects were performed on both groups. Group A was monitored under oxygen pressure at altitude (3320msl, 107mm Hg). Group B was monitored at sea level oxygen pressure (150msl, 157mm Hg). Each group was subdivided into 3 equal groups (A1, A2, A3 and B1, B2, B3). Subgroups A1 and B1 were given diclofenac; subgroups A2 and B2 ketoprofen; subgroups A3 and B3 NaCl. Bone regeneration was evaluated histologically on days 15 and 30. Results: After 15 days in the group controlled at sea level, the level of osteoblasts presented by the control subgroup was significantly higher (28.00±2.65) compared to the diclofenac subgroup (16.00±6.25) and to the ketoprofen subgroup (18.00±4.36); (p=0.041). After 15 days in the group controlled at altitude, the level of osteoblasts was significantly higher in the control subgroup (38.00±5.29) compared to the diclofenac subgroup (21.67±6.35) and to the ketoprofen subgroup (19.33±2.52); p=0.007. After 30 days in the group at sea level there was no difference found in the cell counting; p>0.05. After 30 days in the group controlled at altitude, the level of osteoblast was significantly higher in the control subgroup (58.00±4.58) compared to the diclofenac subgroup (34.33±4.73) and the ketoprofen subgroup (34.00±11.14); (p=0.003). Conclusion: The administration of diclofenac and ketoprofen produced lower mandibular bone regeneration, the effect being significantly more negative at sea level.
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Tekeli AE, Yamurdu H, Ongen E, Tekeli A, Take G, Erdoan D, Dikmen B. Effect of Dexketoprofen Trometamol as Immunohistochemical and Electron Microscopy on Kidney in Rats. INT J PHARMACOL 2018. [DOI: 10.3923/ijp.2019.31.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mennillo E, Krøkje Å, Pretti C, Meucci V, Arukwe A. Biotransformation and oxidative stress responses in rat hepatic cell-line (H4IIE) exposed to racemic ketoprofen (RS-KP) and its enantiomer, dexketoprofen (S(+)-KP). ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2018; 59:199-207. [PMID: 29626791 DOI: 10.1016/j.etap.2018.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/15/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
Pharmaceuticals such as racemate ketoprofen (RS-KP) and its enantiomer, dexketoprofen (S(+)-KP) are highly detectable non-steroidal anti-inflammatory drugs (NSAIDs) in the aquatic environment and therefore are designated as one of the most emerging groups of pollutants that can affect environmental and human health. The potential impact of these pharmaceuticals was assessed for the first time in vitro using a rat hepatocellular carcinoma cell line (H4IIE). Cells were exposed to low and high concentrations of these drugs. Cytotoxicity was determined by MTT reduction assay; CYP1A1 transcriptional and enzymatic levels together with canonical oxidative stress responsive markers (GPx, GR, GST and CAT) were also investigated. Cells exposed to RS-KP and S(+)-KP did not show cytotoxicity effect at the concentrations tested. However, this study highlighted differences between RS-KP and S(+)-KP in most of the evaluated markers, showing compound-, concentration- and time-specific effect patterns which suggest a potential stereo-selective toxicity of these drugs.
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Affiliation(s)
- Elvira Mennillo
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado (PI), 56122, Italy; Department of Biology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Åse Krøkje
- Department of Biology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Carlo Pretti
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado (PI), 56122, Italy; Interuniversitary Center of Marine Biology (CIBM) "G. Bacci", Leghorn, 57128, Italy
| | - Valentina Meucci
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado (PI), 56122, Italy
| | - Augustine Arukwe
- Department of Biology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Pascali JP, Fais P, Vaiano F, Pigaiani N, D'Errico S, Furlanetto S, Palumbo D, Bertol E. Internet pseudoscience: Testing opioid containing formulations with tampering potential. J Pharm Biomed Anal 2018; 153:16-21. [PMID: 29455092 DOI: 10.1016/j.jpba.2018.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/06/2018] [Accepted: 02/06/2018] [Indexed: 12/30/2022]
Abstract
Drug tampering practices, with the aim to increase availability of drug delivery and/or enhance drug effects, are accessible on Internet and are practiced by some portion of recreational drug users. Not rarely, recreational misuse may result in toxic and even fatal results. The aim of the present study was to assess the tampering risk of medicaments containing different formulations of an opioid in combination with paracetamol or dexketoprofen, following the procedures reported in dedicated forums on the web. Tablets and suppositories containing codeine, tramadol and oxycodone were extracted following the reported "Cold water extraction"; dextromethorphan was extracted from cough syrup following the procedure reported as "Acid/base extraction" and fentanyl was extracted from transdermal patches according the procedure reported in Internet. The tampered products and opportunely prepared calibrators in water were analysed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). The separation of the analytes was carried on Agilent ZORBAX Eclipse Plus C18 (RRHT 2.1 mm × 50 mm, 1.8 μm) by the gradient elution of 0.01% formic acid in water and 0.01% formic acid in methanol. Acquisition was by MRM mode considering at least two transitions for compound. Declared recoveries for these home-made extractions claimed to exceed 99% for the opioid and to complete remove paracetamol, often associated to liver toxicity and thus to obtain a "safer" preparation. In this study, the authors demonstrated that rarely the recoveries for the opioid reached 90% and that up to 60% of the paracetamol amount remained in solution. Thus, high risks for health remained both for the potential lethality of the opioid content, but also for the sub-lethal chronic use of these mixtures, which contained still uncontrolled, ignored, but often important amounts of paracetamol.
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Affiliation(s)
- Jennifer P Pascali
- Forensic Toxicology Division, Department of Health Sciences, University of Florence, Largo Brambilla 3, Florence, Italy.
| | - Paolo Fais
- University of Bologna, Department of Medical and Surgical Sciences, Unit of Legal Medicine, Via Irnerio 49, Bologna, Italy
| | - Fabio Vaiano
- Forensic Toxicology Division, Department of Health Sciences, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Nicola Pigaiani
- Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy
| | | | - Sandra Furlanetto
- Department of Chemistry "U. Schiff", University of Florence, Via della Lastruccia, 3-13 Sesto Fiorentino, Florence, Italy
| | - Diego Palumbo
- Forensic Toxicology Division, Department of Health Sciences, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Elisabetta Bertol
- Forensic Toxicology Division, Department of Health Sciences, University of Florence, Largo Brambilla 3, Florence, Italy
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Gorissen BMC, Uilenreef JJ, Bergmann W, Meijer E, van Rietbergen B, van der Staay FJ, Weeren PRV, Wolschrijn CF. Effects of long-term use of the preferential COX-2 inhibitor meloxicam on growing pigs. Vet Rec 2017; 181:564. [PMID: 29066475 DOI: 10.1136/vr.104175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 07/03/2017] [Accepted: 09/04/2017] [Indexed: 01/11/2023]
Abstract
Meloxicam, a preferential COX-2 inhibitor, is a commonly used NSAID in pigs. Besides having potential side effects on the gastrointestinal tract, this type of drug might potentially affect osteogenesis and chondrogenesis, processes relevant to growing pigs. Therefore, the effects of long-term meloxicam treatment on growing pigs were studied. Twelve piglets (n=6 receiving daily meloxicam 0.4 mg/kg orally from 48 until 110 days of age; n=6 receiving only applesauce (vehicle control)) were subjected to visual and objective gait analysis by pressure plate measurements at several time points. Following euthanasia a complete postmortem examination was performed and samples of the talus and distal tibia, including the distal physis, were collected. Trabecular bone microarchitecture was analysed by microCT scanning, bone stiffness by compression testing and growth plate morphology using light microscopy. Animals were not lame and gait patterns did not differ between the groups. Pathological examination revealed no lesions compatible with known side effects of NSAIDs. Trabecular bone microarchitecture and growth plate morphology did not differ between the two groups. The findings of this in vivo study reduce concerns regarding the long-term use of meloxicam in young, growing piglets.
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Affiliation(s)
- Ben M C Gorissen
- Department of Pathobiology, Anatomy and Physiology Division, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Joost J Uilenreef
- Department of Clinical Sciences of Companion Animals, Anaesthesiology Division, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Wilhelmina Bergmann
- Department of Pathobiology, Division of Pathology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Ellen Meijer
- Department of Farm Animal Health, Behaviour and Welfare Group, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Orthopaedic Biomechanics Division, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Franz Josef van der Staay
- Department of Farm Animal Health, Behaviour and Welfare Group, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - P René van Weeren
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Claudia F Wolschrijn
- Department of Pathobiology, Anatomy and Physiology Division, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Sivaganesan A, Chotai S, White-Dzuro G, McGirt MJ, Devin CJ. The effect of NSAIDs on spinal fusion: a cross-disciplinary review of biochemical, animal, and human studies. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2719-2728. [PMID: 28283838 DOI: 10.1007/s00586-017-5021-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 02/19/2017] [Accepted: 02/25/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Non-steroidal anti-inflammatory drugs (NSAIDs) play an important role in postoperative pain management. However, their use in the setting of spine fusion surgery setting has long been a topic of controversy. In this review we examined relevant research, including in vivo, animal, and clinical human studies, with the aim of understanding the effect of NSAIDs on spinal fusion. STUDY DESIGN/SETTING Systematic review of study designs of all types from randomized controlled trials and meta-analyses to single-institution retrospective reviews. METHODS A search of PubMed and Embase was conducted using the keywords: "spine," "spinal fracture," NSAIDs, anti-inflammatory non-steroidal agents, bone, bone healing, fracture, fracture healing, yielding a total of 110 studies. Other 28 studies were identified by cross-referencing, resulting in total 138 studies. RESULTS There is no level I evidence from human studies regarding the use of NSAIDs on spinal fusion rates. The overall tone of the spine literature in the early 2000s was that NSAIDs increased the rate of non-union; however, nearly all human studies published after 2005 suggest that short-term (<2 weeks) postoperative use have no such effect. The dose dependency that is seen with a 2-week postoperative course is not present when NSAIDs are only used for 48 h after surgery. CONCLUSIONS NSAID appear to have dose-dependent and duration-dependent effects on fusion rates. The short-term use of low-dose NSAIDs around the time of spinal fusion surgery is reasonable. Spine surgeons can consider the incorporation of NSAIDs into pain control regimens for spinal fusion patients with the goal of improving pain control and reducing the costs and complications associated with opioids.
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Affiliation(s)
- Ahilan Sivaganesan
- Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA.
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA.,Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
| | - Clinton J Devin
- Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA.,Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Moro MG, Sanchez PKV, Gevert MV, Baller EM, Tostes AF, Lupepsa AC, Baglie S, Franco GCN. Gastric and renal effects of COX-2 selective and non-selective NSAIDs in rats receiving low-dose aspirin therapy. Braz Oral Res 2016; 30:e127. [PMID: 27901208 DOI: 10.1590/1807-3107bor-2016.vol30.0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/22/2016] [Indexed: 01/26/2023] Open
Abstract
The consumption of low-dose aspirin (LDA) to prevent cardiovascular disease continues to increase worldwide. Consequently, the number of chronic LDA users seeking dental procedures that require complementary acute anti-inflammatory medication has also grown. Considering the lack of literature evaluating this interaction, we analyzed the gastric and renal effects caused by a selective COX-2 inhibitor (etoricoxib) and a non-selective COX-2 inhibitor (ibuprofen) nonsteroidal anti-inflammatory drug (NSAID) in rats receiving chronic LDA therapy. Male Wistar rats were divided into six experimental groups (carboxymethylcellulose (CMC) - vehicle; LDA; LDA + ibuprofen; ibuprofen; LDA + etoricoxib; and etoricoxib) and submitted to long-term LDA therapy with a subsequent NSAID administration for three days by gavage. After the experimental period, we analyzed gastric and renal tissues and quantified serum creatinine levels. The concomitant use of LDA with either NSAID induced the highest levels of gastric damage when compared to the CMC group (F = 20.26, p < 0.05). Treatment with either LDA or etoricoxib alone was not associated with gastric damage. No significant damage was observed on kidney morphology and function (F = 0.5418, p > 0.05). These results suggest that even the acute use of an NSAID (regardless of COX-2 selectivity) can induce gastric damage when combined with the long-term use of low-dose aspirin in an animal model. Additional studies, including clinical assessments, are thus needed to clarify this interaction, and clinicians should be careful of prescribing NSAIDs to patients using LDA.
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Affiliation(s)
- Marcella Goetz Moro
- Universidade Estadual de Ponta Grossa - UEPG, Department of Dentistry, Ponta Grossa, PR, Brazil
| | | | - Mayara Vitorino Gevert
- Universidade Estadual de Ponta Grossa - UEPG, Department of Dentistry, Ponta Grossa, PR, Brazil
| | - Emeline Maria Baller
- Universidade Estadual de Ponta Grossa - UEPG, Department of Pharmaceutical Sciences, Ponta Grossa, PR, Brazil
| | - Ana Flávia Tostes
- Universidade Estadual de Ponta Grossa - UEPG, Department of Pharmaceutical Sciences, Ponta Grossa, PR, Brazil
| | - Ana Caroline Lupepsa
- Universidade Estadual de Ponta Grossa - UEPG, Department of Pharmaceutical Sciences, Ponta Grossa, PR, Brazil
| | - Sinvaldo Baglie
- Universidade Estadual de Ponta Grossa - UEPG, Department of Pharmaceutical Sciences, Ponta Grossa, PR, Brazil
| | - Gilson Cesar Nobre Franco
- Universidade Estadual de Ponta Grossa - UEPG, Department of General Biology, Ponta Grossa, Paraná - Brazil
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16
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Hatipoglu MG, Inal S, Kabay S, Cayci MK, Deger A, Kuru HI, Altikat S, Akkas G. The Influence of Different Nonsteroidal Anti-Inflammatory Drugs on Alveolar Bone in Rats: An Experimental Study. Acta Stomatol Croat 2016; 49:325-30. [PMID: 27688417 DOI: 10.15644/asc49/4/8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
THE AIM The aim of this study was to investigate the effect of dexketoprofen trometamol, meloxicam, diclofenac sodium on any untreated alveolar bone when they are used as drugs for another indication. MATERIALS AND METHODS Twenty eight male Spraque-Dawley rats were randomized into four groups as dexketoprofen trometamol (Group I), meloxicam (Group II), diclofenac sodium (Group III) and control group. Nonsteroidal anti-inflammatory drugs (NSAID) were administered after a fibula fracture for 10 days. Untreated alveolar bone was histopathologically examined for spongious bone density, osteoclastic density and osteoblastic density. RESULTS Spongious bone density was lower in study groups (Group I, group II and group III) than the control group (p<0.05). In contrast, the increase in osteoclastic density was observed in other groups apart from the control group (p<0.05). Osteoblastic density was evaluated and it was determined that group II and group III had lower results than the control group (p<0.05) but group I was equal to the control group. CONCLUSION This study showed that systemically administrated NSAIDs have the potential to affect untreated alveolar bone. This should also be considered in long term use of NSAIDs.
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Affiliation(s)
- Mujgan Gungor Hatipoglu
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Dumlupinar University, Kutahya, Turkey
| | - Sermet Inal
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Dumlupinar University, Kutahya. Turkey
| | - Sahin Kabay
- Department of Urology, Medical Faculty, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Muhammet Kasim Cayci
- Department of Biology, Faculty of Arts and Science, Dumlupinar University, Kutahya,Turkey
| | - Ayşenur Deger
- Department of Pathology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Halil Isa Kuru
- Department of Medical Laboratory Techniques, Simav Vocational High School, Dumlupinar University, Kutahya, Turkey
| | - Sayit Altikat
- Department of Department of Biochemistry, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Gizem Akkas
- Department of Pathology, Ministry of Health, Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Kutahya, Turkey
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17
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Memetoğlu OG, Ozkan FU, Boy NS, Aktas I, Kulcu DG, Taraktas A. Sacroiliitis or insufficiency fracture? Osteoporos Int 2016; 27:1265-1268. [PMID: 26501559 DOI: 10.1007/s00198-015-3363-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
Sacral stress fracture and sacroiliitis are two conditions that present with pain. Sacral stress fractures are a rare cause of lumbar and hip pain. Sacral insufficiency fractures are a type of sacral stress fractures. Sacroiliitis represents inflammation of the sacroiliac joints. Coexistence of sacroiliitis and sacral insufficiency fracture (SIF) has not been reported before. Case 1: A 39-year-old woman reporting inflammatory back pain. Imaging revealed bilateral chronic sacroiliitis and bilateral SIF. Case 2: A 31-year-old woman presenting with left hip and inguinal pain. Imaging revealed left sacroiliitis and ipsilateral SIF. Calcium and vitamin D supplementation together with nonsteroidal anti-inflammatory drug (NSAID) treatment were given. Sulfasalazine was added to the treatment of the second patient who developed peripheral arthritis during follow-ups. Early diagnosis is best made with magnetic resonance imaging (MRI) since roentgenograms may be negative initially. Furthermore, MRI findings of both entities share common features leading to a diagnostic dilemma. Interpretation of radiological findings assisted by detailed history and clinical findings is crucial for diagnosis and treatment.
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Affiliation(s)
- O G Memetoğlu
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - F U Ozkan
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - N S Boy
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - I Aktas
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - D G Kulcu
- Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - A Taraktas
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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18
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El-Megharbel SM, Hamza RZ, Refat MS. Synthesis, spectroscopic and thermal studies of Mg(II), Ca(II), Sr(II) and Ba(II) diclofenac sodium complexes as anti-inflammatory drug and their protective effects on renal functions impairment and oxidative stress. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2015; 135:915-928. [PMID: 25163458 DOI: 10.1016/j.saa.2014.07.101] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/12/2014] [Accepted: 07/29/2014] [Indexed: 06/03/2023]
Abstract
The main task of our present study is the preparation of newly complexes of Mg(II), Ca(II), Sr(II) and Ba(II) with diclofenac which succeeded to great extent in alleviating the side effects of diclofenac alone and ameliorating the kidney function parameters and antioxidant capacities with respect to diclofenac treated group alone. The Mg(II), Ca(II), Sr(II) and Ba(II) with diclofenac have been synthesized and characterized using infrared, electronic and (1)H NMR spectral, thermogravimetric and conductivity measurements. The diclofenac ligand has been found to act as bidentate chelating agent. Diclofenac complexes coordinate through the oxygen's of the carboxyl group. The molar ratio chelation is 1:2 (M(2+)-dic) with general formula [M(dic)2(H2O)2]⋅nH2O. Antibacterial screening of the alkaline earth metal complexes against Escherichia coli (Gram-ve), Bacillus subtilis (Gram+ve) and anti-fungal (Asperagillus oryzae, Asperagillus niger, Asperagillus flavus) were investigated. The kidney functions in male albino rats were ameliorated upon treatment with metal complexes of dic, which are represented by decreasing the levels of urea and uric acid to be located within normal values. The other looks bright spot in this article is the assessment of antioxidant defense system including SOD, CAT and MDA with the help of Sr(2+), Mg(2+) and Ca(2+)-dic complexes. The hormones related to kidney functions and stresses have been greatly ameliorated in groups treated with dic complexes in comparable with dic treated group.
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Affiliation(s)
- Samy M El-Megharbel
- Department of Chemistry, Faculty of Science, Taif University, Al-Haweiah, P.O. Box 888, Zip Code 21974, Taif, Saudi Arabia; Department of Chemistry, Faculty of Science, Zagazig University, Zagazig, Egypt
| | - Reham Z Hamza
- Department of Zoology, Faculty of Science, Zagazig University, Zagazig, Egypt
| | - Moamen S Refat
- Department of Chemistry, Faculty of Science, Taif University, Al-Haweiah, P.O. Box 888, Zip Code 21974, Taif, Saudi Arabia; Department of Chemistry, Faculty of Science, Port Said University, Port Said, Egypt.
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