1
|
Demirsoy MS, Erdil A, Çolak S, Duman E, Sümbül O, Aygun H. Acute treatment with dexketoprofen reduces penicillin induced epileptiform activity in wistar albino rats (dexketoprofen in penicillin induced seizure model). Epilepsy Res 2021; 178:106827. [PMID: 34847424 DOI: 10.1016/j.eplepsyres.2021.106827] [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: 05/15/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022]
Abstract
AIM Dexketoprofen trometamol is one of the most commonly used anti-inflammatory analgesic agents for pain control. This study aims to investigate the effect of dexketoprofen on penicillin-induced epileptiform activity in rats. METHOD In this study, 28 male Wistar rats weighing 220-240 g were used. Tripolar electrodes were implanted under urethane anesthesia. Epileptiform activity was induced by micro-injection of 500 units (IU) penicillin into the rats' left somatomotor cortex. Dexketoprofen (5, 25, and 50 mg/kg) was administrated intraperitoneally after 30 min of penicillin injection. Epileptiform activity was evaluated by electrocorticography (ECoG). RESULTS The low dose of dexketoprofen administration (5 mg/kg) reduced the mean spike frequency of epileptiform activity 60 min after its injection. However, 25 and 50 mg/kg dexketoprofen significantly reduced the mean spike frequency 30 min after the dexketoprofen injection compared to the control group (p < 0.05). The amplitudes of epileptiform discharges in all groups were unaffected (p > 0.05). CONCLUSION This study revealed that dexketoprofen had a significant anti-seizure effect when applied at 5 mg/kg, 25 mg/kg, and 50 mg/kg (especially at 25 and 50 mg/kg), in the penicillin-induced seizure model. The obtained data revealed that dexketoprofen might play an essential role against epileptic seizures.
Collapse
Affiliation(s)
- Mustafa Sami Demirsoy
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Sakarya University, Sakarya, Turkey
| | - Aras Erdil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Usak University, Usak, Turkey.
| | | | - Esra Duman
- Department of Veterinary Medicine, Laboratory and Veterinary Health Program, Artova Vocational School, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Orhan Sümbül
- Department of Neurology Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Hatice Aygun
- Department of Physiology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| |
Collapse
|
2
|
Gur STA, Ahiskalioglu EO, Aydin ME, Kocak AO, Aydin P, Ahiskalioglu A. Intravenous lidocaine vs. NSAIDs for migraine attack in the ED: a prospective, randomized, double-blind study. Eur J Clin Pharmacol 2021; 78:27-33. [PMID: 34528122 DOI: 10.1007/s00228-021-03219-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/09/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Although different forms of lidocaine are used for migraine attack headaches, the effect of intravenous lidocaine is still limited. This study aimed to investigate the effects of intravenous lidocaine infusion for the treatment of migraine attack headaches. METHODS A hundred patients with migraine attacks, aged between 18 and 65, were randomly divided into two groups. The lidocaine group (n = 50) received a 1.5 mg/kg lidocaine bolus and a 1 mg/kg infusion (first 30 min), followed by a 0.5 mg/kg infusion for a further 30 min intravenously. The non-steroidal anti-inflammatory drug (NSAID) group (n = 50) received 50 mg dexketoprofen trometamol and saline at the same volume as the lidocaine at the same time intervals intravenously. The Visual Analog Scale (VAS) pain scores, additional analgesia requirement, side effects, and revisits to the emergency department were recorded. RESULTS The VAS score was significantly lower in the lidocaine group than in the NSAID group for the first 20th and 30th minutes (p = 0.014 and p = 0.024, respectively). There was no difference between the VAS scores for the remaining evaluation times (p > 0.05). In terms of secondary outcomes, rescue medication requirement was not different between the two groups at both the 60th and 90th minutes (p > 0.05). However, the number of patients revisiting ED within 48-72 h was statistically less in the lidocaine group than in the NSAID group (1/50 vs. 8/50; p = 0.031). CONCLUSION Intravenous lidocaine may be an alternative treatment method for patients with migraine attack headaches in the emergency department.
Collapse
Affiliation(s)
- Sultan Tuna Akgol Gur
- Department of Emergency Medicine, Ataturk University School of Medicine, Erzurum, Turkey
| | - Elif Oral Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, 25070, Erzurum, Turkey. .,Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, 25240, Erzurum, Turkey.
| | - Muhammed Enes Aydin
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, 25070, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, 25240, Erzurum, Turkey
| | - Abdullah Osman Kocak
- Department of Emergency Medicine, Ataturk University School of Medicine, Erzurum, Turkey
| | - Pelin Aydin
- Department of Anesthesiology and Reanimation, Erzurum State Hospital, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, 25070, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, 25240, Erzurum, Turkey
| |
Collapse
|
3
|
Koksal E, Ustun YB, Bilgin S, Aksoy A, Das YK, Yarim M, Ozkan F, Kaya C, Dost B. The effects of dexketoprofen on renal ischemia-reperfusion injury: an experimental study. Braz J Anesthesiol 2021; 72:365-371. [PMID: 34411625 PMCID: PMC9373263 DOI: 10.1016/j.bjane.2021.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/03/2021] [Accepted: 07/24/2021] [Indexed: 12/01/2022] Open
Abstract
Objective Ischemia/reperfusion (I/R) may cause irreversible damage to tissues and organs. We evaluated the effects of dexketoprofen on a renal I/R model in rats. Methods The study included 30 male rats. Control group received 1 mL of saline. Dexketoprofen group received 1 mL (25 mg) of dexketoprofen intraperitoneally. After 60 minutes renal ischemia, 23 hours reperfusion was applied. In Sham group, laparotomy was performed with a medial line incision without any additional procedure. Changes in the plasma malondialdehyde (MDA), renal tissue MDA, plasma glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), BUN, creatinine and albumin levels, and histopathological changes were evaluated. Results CAT values were significantly lower in Control as compared with the Sham group. Plasma levels of MDA in the Control group were significantly higher than in the Dexketoprofen group. BUN and creatinine values were significantly higher in the Dexketoprofen group. The severity of tissue injury in the Dexketoprofen group was significantly higher than in Control and Sham groups Conclusion Although dexketoprofen reduces the I/R-induced systemic inflammation, it increases renal tissue damage.
Collapse
Affiliation(s)
- Ersin Koksal
- Ondokuz Mayis University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun, Turkey.
| | - Yasemin Burcu Ustun
- Ondokuz Mayis University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun, Turkey
| | - Sezgin Bilgin
- Ondokuz Mayis University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun, Turkey
| | - Abdurrahman Aksoy
- Ondokuz Mayis University, Faculty of Veterinary Medicine, Department of Pharmacology and Toxicology, Samsun, Turkey
| | - Yavuz Kursad Das
- Ondokuz Mayis University, Faculty of Veterinary Medicine, Department of Pharmacology and Toxicology, Samsun, Turkey
| | - Murat Yarim
- Ondokuz Mayis University, Faculty of Veterinary Medicine, Department of Pathology, Samsun, Turkey
| | - Fatih Ozkan
- Ondokuz Mayis University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun, Turkey
| | - Cengiz Kaya
- Ondokuz Mayis University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun, Turkey
| | - Burhan Dost
- Ondokuz Mayis University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun, Turkey
| |
Collapse
|
4
|
Erdil A, Demirsoy MS, Çolak S, Duman E, Sümbül O, Aygun H. The effect of dexketoprofen trometamol on WAG/Rij rats with absence epilepsy (dexketoprofen in absence epilepsy). Neurol Res 2021; 43:1116-1125. [PMID: 34278977 DOI: 10.1080/01616412.2021.1952510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM Epilepsy is one of the most common neurological diseases. Dexketoprofen (DEX) is a nonselective nonsteroidal anti-inflammatory drug that is used as an analgesic. The present study aimed to assess the efficiency of DEX on WAG/Rij rats by electrophysiologically and behaviorally. MATERIAL AND METHODS Twenty-eight male WAG/Rij rats were used. The effects of acute treatment with DEX (5, 25, and 50 mg/kg, i.p) on absence-like seizures, and related psychiatric comorbidity were assessed. The ECoG recording was taken for 180 min before and after drug injection. After drug injection and EcoG recording, anxiety-depression-like behavior was tested with the open field test for 5 min. RESULTS The 5 mg/kg DEX significantly reduced the number and duration of SWDs percentage (p < 0.05) between 120 and 180 min, but 25 and 50 mg/kg DEX significantly increased the number and duration of SWDs percentage between 0 and 30 min (p < 0.05), and after 30 min the increase stopped (p > 0.05). And also, the 5 mg/kg DEX decreased the number and duration of SWDs percentage (p < 0.05) for 180 min (p < 0.05), but 25 and 50 mg/kg DEX administration did not alter (p > 0.05). The 5, 25, and 50 mg/kg doses of DEX significantly increased the duration of grooming (p < 0.05) but did not change the number of squares crossed (p > 0.05). CONCLUSION Low dose DEX reduced absence-like seizures, but care should be taken when using high doses in absence epilepsy. Also, it may be beneficial for painful diseases accompanied by anxiety-depression.
Collapse
Affiliation(s)
- Aras Erdil
- TR Ministry of Health, Sivas Dental Health Hospital, Sivas, Turkey
| | - Mustafa Sami Demirsoy
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Sakarya University, Sakarya, Turkey
| | | | - Esra Duman
- Department of Veterinary Medicine, Laboratory and Veterinary Health Program Vocational School University of Gazi Osmanpasa, Tokat, Turkey
| | - Orhan Sümbül
- Department of Neurology, Faculty of Medicine University of Gaziosmanpasa, Tokat, Turkey
| | - Hatice Aygun
- Department of Physiology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| |
Collapse
|
5
|
Flores-Arriaga JC, Chavarría-Bolaños D, Pozos-Guillén ADJ, Escobar-Barrios VA, Cerda-Cristerna BI. Synthesis of a PVA drug delivery system for controlled release of a Tramadol-Dexketoprofen combination. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:56. [PMID: 33961138 PMCID: PMC8105240 DOI: 10.1007/s10856-021-06529-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
The local administration of analgesic combinations by means of degradable polymeric drug delivery systems is an alternative for the management of postoperative pain. We formulated a Tramadol-Dexketoprofen combination (TDC) loaded in poly(vinyl alcohol) (PVA) film. Films were prepared by the solvent casting method using three different molecular weights of PVA and crosslinking those films with citric acid, with the objective of controlling the drug release rate, which was evaluated by UV-vis spectrometry. Non-crosslinked PVA films were also evaluated in the experiments. Differential scanning calorimetry (DSC) analysis of samples corroborated the crosslinking of PVA by the citric acid. Blank and loaded PVA films were tested in vitro for its impact on blood coagulation prothrombin time (PT) and partial thromboplastin time (PTT). The swelling capacity was also evaluated. Crosslinked PVA films of higher-molecular weight showed a prolonged release rate compared with that of the lower-molecular-weight films tested. Non-crosslinked PVA films released 11-14% of TDC. Crosslinked PVA films released 80% of the TDC loaded (p < 0.05). This suggests that crosslinking films can modify the drug release rate. The blank and loaded PVA films induced PT and PTT in the normal range. The results showed that the polymeric films evaluated here have the appropriate properties to allow films to be placed directly on surgical wounds and have the capacity for controlled drug release to promote local analgesia for the control of postoperative pain.
Collapse
Affiliation(s)
- Juan Carlos Flores-Arriaga
- Advanced Polymers Lab, Instituto Potosino de Investigación Científica y Tecnológica (IPICYT), Camino a la Presa 2055, Lomas 4a, 78216, San Luis Potosí, SLP, Mexico
| | - Daniel Chavarría-Bolaños
- Diagnostic and Surgical Sciences Department, Faculty of Dentistry, Universidad de Costa Rica, San Jose, Costa Rica
| | - Amaury de Jesús Pozos-Guillén
- Basic Science Laboratory, Faculty of Dentistry, San Luis Potosi University, Manuel Nava 2, Zona Universitaria, 78290, San Luis Potosí, SLP, México
| | - Vladimir Alonso Escobar-Barrios
- Advanced Polymers Lab, Instituto Potosino de Investigación Científica y Tecnológica (IPICYT), Camino a la Presa 2055, Lomas 4a, 78216, San Luis Potosí, SLP, Mexico.
| | - Bernardino Isaac Cerda-Cristerna
- Facultad de Odontología, Región Orizaba-Córdoba, Universidad Veracruzana, Abasolo Sur, SN, Tenango de Río Blanco, 94732, Veracruz, México.
| |
Collapse
|
6
|
Biocompatibility and Pharmacological Effects of Innovative Systems for Prolonged Drug Release Containing Dexketoprofen in Rats. Polymers (Basel) 2021; 13:polym13071010. [PMID: 33805954 PMCID: PMC8037047 DOI: 10.3390/polym13071010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 01/14/2023] Open
Abstract
The present study reports on the in vivo biocompatibility investigation and evaluation of the effects of liposomes containing dexketoprofen in somatic sensitivity in rats. Method: The liposomes were prepared by entrapping dexketoprofen in vesicular systems stabilized with chitosan. The in vivo biocompatibility was evaluated after oral administration in white Wistar rats: Group I (DW): distilled water 0.3 mL/100 g body weight; Group II (DEX): dexketoprofen 10 mg/kg body weight (kbw); Group III (nano-DEX): liposomes containing dexketoprofen 10 mg/kbw. Blood samples were collected from caudal lateral vein one day and seven days after the substance administration, to assess the eventual hematological, biochemical, and immunological changes. The investigation of somatic pain reactivity was performed using the hot plate test, to count the latency time response evoked by the thermal paws’ noxious stimulation. Results: Original liposomes entrapping dexketoprofen, with mean size of 680 nm and good stability, were designed. Laboratory analysis indicated no substantial variances between the three treated groups. The treatment with liposomes containing dexketoprofen resulted in a prolongation of the latency time response, statistically significant in the interval between 90 min and 10 h, in the hot plate test. Conclusions: The use of liposomes with dexketoprofen proved a good in vivo biocompatibility in rats and prolonged analgesic effects in the hot plate test.
Collapse
|
7
|
Kaya C, Atalay YO, Meydan BC, Ustun YB, Koksal E, Caliskan S. [Evaluation of the neurotoxic effects of intrathecal administration of (S)-(+)-Ketoprofen on rat spinal cords: randomized controlled experimental study]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2019; 69:403-412. [PMID: 31371174 PMCID: PMC9391909 DOI: 10.1016/j.bjan.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/08/2019] [Accepted: 03/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Intrathecal administration of non-steroidal anti-inflammatory drugs is more efficacious for post-operative pain management. Cyclooxygenase inhibiting non-steroidal anti-inflammatory drugs like (S)-(+)-Ketoprofen, may be effective at lower intrathecal doses than parenteral ones. Preclinical safety regarding possible neurotoxicity associated with the intrathecal (S)-(+)-Ketoprofen was not evaluated. Here we analysed the neurotoxicity of intrathecally administered (S)-(+)-Ketoprofen in rats. METHODS A randomized placebo-controlled experimental study was conducted. Sprague-Dawley rats (250-300g) aged 12-16 weeks were randomly divided into 2 treatments [100 and 800μg (S)-(+)-Ketoprofen] and control (sterile water) groups. Intrathecal catheters were placed via the atlantoaxial space in anesthetized rats. Pinch-toe tests, motor function evaluations and histopathological examinations of the spinal cord and nerve roots were performed at days 3, 7 and 21. Spinal cord sections were evaluated by light microscopy for the dorsal axonal funiculus vacuolation, axonal myelin loss, neuronal chromatolysis, neuritis, meningeal inflammation, adhesions, and fibrosis. RESULTS Rats in all the groups exhibited normal pinch-toe testing response (score=0) and normal gait at each observed time (motor function evaluation score=1). Neurotoxicity was higher with treatments on days 3 and 7 than that on day 21 (2, 3, 0, p=0.044; 2, 5, 0, p=0.029, respectively). On day 7, the total scores reflecting neuronal damage were higher in the 800μg group than those in the 100μg and Control Groups (5, 3, 0, p=0.048, respectively). CONCLUSION Intrathecal (S)-(+)-Ketoprofen caused dose-dependent neurohistopathological changes in rats on days 3 and 7 after injection, suggesting that (S)-(+)-Ketoprofen should not be intrathecally administered.
Collapse
Affiliation(s)
- Cengiz Kaya
- Ondokuz Mayis University, School of Medicine, Department of Anesthesiology, Kurupelit, Turquia.
| | - Yunus O Atalay
- Ondokuz Mayis University, School of Medicine, Department of Radiology, Kurupelit, Turquia
| | - Bilge C Meydan
- Ondokuz Mayis University, School of Medicine, Department of Pathology, Kurupelit, Turquia
| | - Yasemin B Ustun
- Ondokuz Mayis University, School of Medicine, Department of Anesthesiology, Kurupelit, Turquia
| | - Ersin Koksal
- Ondokuz Mayis University, School of Medicine, Department of Anesthesiology, Kurupelit, Turquia
| | - Sultan Caliskan
- Ondokuz Mayis University, School of Medicine, Department of Pathology, Kurupelit, Turquia
| |
Collapse
|
8
|
Kaya C, Atalay YO, Meydan BC, Ustun YB, Koksal E, Caliskan S. Evaluation of the neurotoxic effects of intrathecal administration of (S)-(+)-Ketoprofen on rat spinal cords: randomized controlled experimental study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 31371174 PMCID: PMC9391909 DOI: 10.1016/j.bjane.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background and objectives Intrathecal administration of non-steroidal anti-inflammatory drugs is more efficacious for post-operative pain management. Cyclooxygenase inhibiting non-steroidal anti-inflammatory drugs like (S)-(+)-Ketoprofen, may be effective at lower intrathecal doses than parenteral ones. Preclinical safety regarding possible neurotoxicity associated with the intrathecal (S)-(+)-Ketoprofen was not evaluated. Here we analysed the neurotoxicity of intrathecally administered (S)-(+)-Ketoprofen in rats. Methods A randomized placebo-controlled experimental study was conducted. Sprague-Dawley rats (250–300 g) aged 12–16 weeks were randomly divided into 2 treatments [100 and 800 μg (S)-(+)-Ketoprofen] and control (sterile water) groups. Intrathecal catheters were placed via the atlantoaxial space in anesthetized rats. Pinch-toe tests, motor function evaluations and histopathological examinations of the spinal cord and nerve roots were performed at days 3, 7 and 21. Spinal cord sections were evaluated by light microscopy for the dorsal axonal funiculus vacuolation, axonal myelin loss, neuronal chromatolysis, neuritis, meningeal inflammation, adhesions, and fibrosis. Results Rats in all the groups exhibited normal pinch-toe testing response (score = 0) and normal gait at each observed time (motor function evaluation score = 1). Neurotoxicity was higher with treatments on days 3 and 7 than that on day 21 (2, 3, 0, p = 0.044; 2, 5, 0, p = 0.029, respectively). On day 7, the total scores reflecting neuronal damage were higher in the 800 μg group than those in the 100 μg and Control Groups (5, 3, 0, p = 0.048, respectively). Conclusion Intrathecal (S)-(+)-Ketoprofen caused dose-dependent neurohistopathological changes in rats on days 3 and 7 after injection, suggesting that (S)-(+)-Ketoprofen should not be intrathecally administered.
Collapse
|
9
|
Gay-Escoda C, Hanna M, Montero A, Dietrich T, Milleri S, Giergiel E, Zoltán TB, Varrassi G. Tramadol/dexketoprofen (TRAM/DKP) compared with tramadol/paracetamol in moderate to severe acute pain: results of a randomised, double-blind, placebo and active-controlled, parallel group trial in the impacted third molar extraction pain model (DAVID study). BMJ Open 2019; 9:e023715. [PMID: 30782886 PMCID: PMC6377526 DOI: 10.1136/bmjopen-2018-023715] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To compare efficacy/safety of oral tramadol 75 mg/dexketoprofen 25 mg (TRAM/DKP) and TRAM 75 mg/paracetamol 650 mg (TRAM/paracetamol) in moderate to severe pain following surgical removal of impacted lower third molar. DESIGN Multicentre, randomised, double-blind, placebo-controlled, phase IIIb study. PARTICIPANTS Healthy adult patients scheduled for surgical extraction of at least one fully/partially impacted lower third molar requiring bone manipulation. 654 patients were randomised and 653 were eligible for analysis. INTERVENTIONS Surgery was performed under local anaesthetic. No sedation was permitted. Patients rated pain intensity (PI) using an 11-Numerical Rating Scale (NRS) (0 no pain; 10 worst pain). Participants experiencing moderate/severe pain (≥4) within 4 hours of surgery were randomised (2:2:1 ratio) to a single oral dose of TRAM/DKP 75/25 mg, TRAM/paracetamol 75/650 mg or placebo. MAIN OUTCOME MEASURES Efficacy was based patients' electronic diaries. Analgesia and pain were recorded as follows: pain relief (PAR) on a 5-point Verbal Rating Scale (0='no relief', 1='a little (perceptible) relief', 2='some (meaningful) relief', 3='lot of relief', 4='complete relief') at the predefined postdose time points t15 min, t30 min, t1 hour, t1.5 hour, t2 hour, t4 hour, t6 hour and t8 hour and PI on the 11-point NRS at t0 and at the same predefined postdose time points. Onset of analgesia documented using double stopwatch method over a 2-hour period. Primary endpoint was total pain relief over 6 hours (TOTPAR6). Rescue medication was available during the treatment period. RESULTS TRAM/DKP was superior to TRAM/paracetamol and placebo at the primary endpoint TOTPAR6 (p<0.0001). Mean (SD) TOTPAR6 in the TRAM/DKP group was 13 (6.97), while those in the active control and placebo groups were 9.2 (7.65) and 1.9 (3.89), respectively. Superiority of TRAM/DKP over active comparator and placebo was observed at all secondary endpoints. Incidence of adverse events was comparable between active groups. CONCLUSIONS TRAM/DKP (75/25 mg) is effective and superior to TRAM/paracetamol (75/650 mg) in relieving moderate to severe acute pain following surgical removal of impacted lower third molar, with a faster onset of action, greater and durable analgesia, together with a favourable safety profile. TRIAL REGISTRATION NUMBER EudraCT 2015-004152-22 and NCT02777970.
Collapse
Affiliation(s)
- Cosme Gay-Escoda
- Department of Oral and Maxillofacial Surgery, Bellvitge Biomedical Research Institute (IDIBELL), School of Dentistry, Hospital Duran i Reynals, Barcelona, Spain
| | - Magdi Hanna
- Analgesics & Pain Research (APR) Ltd, Beckenham, UK
| | - Antonio Montero
- Department of Anaesthesiology Pain Treatment and Critical Care, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Thomas Dietrich
- Department of Oral Surgery, School of Dentistry, University of Birmingham and Birmingham Dental Hospital, Birmingham Community NHS Foundation Trust, Birmingham, UK
| | - Stefano Milleri
- University Hospital G.B. Rossi, Verona, Italy
- Centro Ricerche Cliniche di Verona S.r.l, Verona, Italy
| | - Ewa Giergiel
- Ars-Dent Spokka Partnerska Fitonowicz Giergiel, Białystok, Poland
| | | | | |
Collapse
|
10
|
Abstract
OBJECTIVE Dexketoprofen trometamol is a modified non-selective COX inhibitor with a rapid onset of action that is available as both oral and parenteral formulations. The aim of this narrative review was to assess the efficacy and tolerability/safety of dexketoprofen trometamol in acute pain states using the best available published scientific evidence (randomized controlled clinical trials and systematic reviews/meta-analyses). METHODS Literature retrieval was performed via Medline, Embase and the Cochrane Library (from inception up to March 2017) using combinations of the terms "randomized controlled trials", "dexketoprofen", "celecoxib", "etoricoxib", "parecoxib" and "acute pain". RESULTS Single-dose dexketoprofen trometamol provides effective analgesia in the treatment of acute pain, such as postoperative pain (dental and non-dental surgery), renal colic, acute musculoskeletal disorders and dysmenorrhea, and reduces opioid consumption in the postoperative setting. It has a rapid onset of action (within 30 minutes) and is well tolerated during short-term treatment. Direct comparisons with COX-2 inhibitors are lacking; however, the efficacy and tolerability of single-dose dexketoprofen trometamol appears to be consistent with that seen with celecoxib, etoricoxib and parecoxib in the acute pain setting. CONCLUSION In conclusion, dexketoprofen trometamol appears to provide similar analgesic efficacy to COX-2 inhibitors when used to treat acute pain, has a rapid onset of action, is well tolerated, and has an opioid-sparing effect when used as part of a multimodal regimen in the acute pain setting.
Collapse
Affiliation(s)
- Magdi Hanna
- a Analgesics and Pain Research (APR) , Beckenham, Kent , UK
| | - Jee Y Moon
- b Department of Anesthesiology and Pain Medicine , Seoul National University Hospital College of Medicine and the Integrated Cancer Management Center, Seoul National University Cancer Hospital , Seoul , Korea
| |
Collapse
|
11
|
Cigerim L, Kaplan V. Evaluation of the analgesic efficacies of Dexketoprofen Trometamol and Dexketoprofen Trometamol + Thiocolchicoside combinations in the impacted third molar surgery: Randomised clinical trial. Med Oral Patol Oral Cir Bucal 2019; 24:e114-e122. [PMID: 30573719 PMCID: PMC6344008 DOI: 10.4317/medoral.22590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 11/27/2018] [Indexed: 12/03/2022] Open
Abstract
Background Postoperative pain is one of the most common complications. The aim of this study is to evaluate the analgesic efficacies of dexketoprofen trometamol and two different dosages of dexketoprofen trometamol + thiocolchicoside combination in the impacted third molar tooth operation. Material and Methods This randomized, double-blind study included 75 patients who did not have any disease. Patients were assigned to 3 groups. Group 1 received 25 mg dexketoprofen trometamol + 4 mg thiocholchicoside, Group 2 received 25 mg dexketoprofen trometamol +8 mg thiocholchicoside, and Group 3 received 25 mg dexketoprofen trometamol. In each group, the analgesic medication was administered twice a day, starting 1 hour before the operation. The level of pain was assessed with VAS. Results Patient age varied from 18 to 36 years. Of all patients, 59.2% (n=42) were female and 40.8% (n=29) were male. Drug side effects were observed in 28.17% (n=20) of the patients. Mean 24th hour VAS score was lower in dexketoprofen trometamol + 8 mg thiocolchicoside group compared to dexketoprofen trometamol group (p<0.05). There was no statistically significant difference between the three groups regarding drug side effects (p>0.05). Conclusions Dexketoprofen trometamol + 8 mg thiocolchicoside combination has higher analgesic efficacy compared to dexketoprofen trometamol. More studies are needed to interpret the analgesic and anti-inflammatory effects of thiocholchicoside + dexketoprofen trometamol combination. Key words:Analgesic, dexketoprofen trometamol, thiocolchicoside, third molar surgery.
Collapse
Affiliation(s)
- L Cigerim
- Van Yuzuncu Yil University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Van, TURKEY,
| | | |
Collapse
|
12
|
Bach-Rojecky L, Vađunec D, Žunić K, Kurija J, Šipicki S, Gregg R, Mikula I, Primorac D. Continuing war on pain: a personalized approach to the therapy with nonsteroidal anti-inflammatory drugs and opioids. Per Med 2018; 16:171-184. [PMID: 30484741 DOI: 10.2217/pme-2018-0116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Successful pain management requires the delivery of analgesia with minimal risk of adverse drug reactions. Nonsteroidal anti-inflammatory drugs and opioids remain the mainstay of treatment for the majority of patients. Unfortunately, almost 50% of all patients experience inadequate pain relief and serious side effects. Allelic variants in genes coding for target proteins, transporters and enzymes, which govern analgesic drugs action and their fate in the organism, might explain inter-individual variability in pain severity and in drug-induced pain relief and toxicities. Additionally, it seems that epigenetic changes contribute to the highly variable response to pain treatment. Therefore, pharmacogenomic testing might be a valuable tool for personalization of pain treatment, with a multidisciplinary team approach involved.
Collapse
Affiliation(s)
- Lidija Bach-Rojecky
- Department of Pharmacology, University of Zagreb Faculty of Pharmacy & Biochemistry, A Kovačića 1, 10000 Zagreb, Croatia
| | - Dalia Vađunec
- Department of Pharmacology, University of Zagreb Faculty of Pharmacy & Biochemistry, A Kovačića 1, 10000 Zagreb, Croatia
| | - Katarina Žunić
- Department of Pharmacology, University of Zagreb Faculty of Pharmacy & Biochemistry, A Kovačića 1, 10000 Zagreb, Croatia
| | - Jelena Kurija
- Department of Pharmacology, University of Zagreb Faculty of Pharmacy & Biochemistry, A Kovačića 1, 10000 Zagreb, Croatia
| | - Sara Šipicki
- Department of Pharmacology, University of Zagreb Faculty of Pharmacy & Biochemistry, A Kovačića 1, 10000 Zagreb, Croatia
| | - Ryan Gregg
- OneOme LLC, 807 Broadway St NE #100, Minneapolis, MN 55413, USA
| | - Ivan Mikula
- St Catherine Specialty Hospital, 10000 Zagreb & 49210 Zabok, Croatia
| | - Dragan Primorac
- St Catherine Specialty Hospital, 10000 Zagreb & 49210 Zabok, Croatia.,Department of Forensic Sciences, Eberly College of Science, 517 Thomas St, State College, Penn State University, PA 16803, USA.,Department of Pediatrics, School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia.,Department of Pediatrics, School of Medicine, University of Osijek, Ulica Cara Hadrijana 10, 31000 Osijek, Croatia.,Department of Pediatrics, Faculty of Dental Medicine and Health, University ofOsijek, Crkvena 21, 31000 Osijek, Croatia.,Children's Hospital Srebrnjak, Srebrnjak 100, 10000 Zagreb, Croatia
| |
Collapse
|
13
|
Esparza-Villalpando V, Chavarria-Bolaños D, Zapata-Morales JR, Vértiz-Hernández A, Pozos-Guillén A. Antinociceptive local effect of the combination of dexketoprofen trometamol and chlorhexidine gluconate in a formalin test: an additive effect. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000217799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
14
|
Esparza-Villalpando V, Pozos-Guillén A, Masuoka-Ito D, Gaitán-Fonseca C, Chavarría-Bolaños D. Analgesic efficacy of preoperative dexketoprofen trometamol: A systematic review and meta-analysis. Drug Dev Res 2017; 79:47-57. [DOI: 10.1002/ddr.21419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/26/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Vicente Esparza-Villalpando
- Materials Engineering and Science Doctorate Program; Universidad Autónoma de San Luis Potosí; San Luis Potosí SLP México
| | - Amaury Pozos-Guillén
- Basic Sciences Laboratory; Universidad Autónoma de San Luis Potosí; San Luis Potosí SLP México
| | - David Masuoka-Ito
- Stomatology Department; Universidad Autónoma de Aguascalientes; Aguascalientes Ags. México
| | - César Gaitán-Fonseca
- Maestría en Ciencias Biomédicas, Área Ciencias de la Salud; Universidad Autónoma de Zacatecas “Francisco García Salinas”
| | - Daniel Chavarría-Bolaños
- Diagnostic and Surgical Sciences Department, Facultad de Odontología; Universidad de Costa Rica; Costa Rica
| |
Collapse
|
15
|
Varrassi G, Hanna M, Macheras G, Montero A, Montes Perez A, Meissner W, Perrot S, Scarpignato C. Multimodal analgesia in moderate-to-severe pain: a role for a new fixed combination of dexketoprofen and tramadol. Curr Med Res Opin 2017; 33:1165-1173. [PMID: 28326850 DOI: 10.1080/03007995.2017.1310092] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Untreated and under-treated pain represent one of the most pervasive health problems, which is worsening as the population ages and accrues risk for pain. Multiple treatment options are available, most of which have one mechanism of action, and cannot be prescribed at unlimited doses due to the ceiling of efficacy and/or safety concerns. Another limitation of single-agent analgesia is that, in general, pain is due to multiple causes. Combining drugs from different classes, with different and complementary mechanism(s) of action, provides a better opportunity for effective analgesia at reduced doses of individual agents. Therefore, there is a potential reduction of adverse events, often dose-related. Analgesic combinations are recommended by several organizations and are used in clinical practice. Provided the two agents are combined in a fixed-dose ratio, the resulting medication may offer advantages over extemporaneous combinations. CONCLUSIONS Dexketoprofen/tramadol (25 mg/75 mg) is a new oral fixed-dose combination offering a comprehensive multimodal approach to moderate-to-severe acute pain that encompasses central analgesic action, peripheral analgesic effect and anti-inflammatory activity, together with a good tolerability profile. The analgesic efficacy of dexketoprofen/tramadol combination is complemented by a favorable pharmacokinetic and pharmacodynamic profile, characterized by rapid onset and long duration of action. This has been well documented in both somatic- and visceral-pain human models. This review discusses the available clinical evidence and the future possible applications of dexketoprofen/tramadol fixed-dose combination that may play an important role in the management of moderate-to-severe acute pain.
Collapse
Affiliation(s)
- Giustino Varrassi
- a European League Against Pain, Zurich and Rome , Switzerland and Italy
| | - Magdi Hanna
- b Analgesics and Pain Research Unit (APRU), King's College Hospital , London , UK
| | | | - Antonio Montero
- d Anaesthesiology & Surgery Department , Hospital Arnau de Vilanova , Lleida , Spain
| | - Antonio Montes Perez
- e Anaesthesiology Department , Hospitales Mar-Eseranza , Barcelona , Spain
- f Universitat Autonoma de Barcelona
| | - Winfried Meissner
- g Department of Anaesthesiology and Intensive Care , Jena University Hospital , Jena , Germany
| | - Serge Perrot
- h Centre de la Douleur, Université Paris Descartes, INSERM U987, Hopital Cochin , Paris , France
| | - Carmelo Scarpignato
- i Clinical Pharmacology & Digestive Pathophysiology Unit, Department of Clinical & Experimental Pharmacology , University of Parma , Parma , Italy
| |
Collapse
|
16
|
Esparza-Villalpando V, Chavarria-Bolaños D, Gordillo-Moscoso A, Masuoka-Ito D, Martinez-Rider R, Isiordia-Espinoza M, Pozos-Guillen A. Comparison of the analgesic efficacy of preoperative/postoperative oral dexketoprofen trometamol in third molar surgery: A randomized clinical trial. J Craniomaxillofac Surg 2016; 44:1350-5. [DOI: 10.1016/j.jcms.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 04/20/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022] Open
|
17
|
Birol Muhammet E, Kocamanoğlu İS, Bozkurt A, Bilge S, Çetinoğlu EÇ. Evaluation of Postoperative Anti-nociceptive Efficacy of Intrathecal Dexketoprofen in Rats. Balkan Med J 2016; 33:245-51. [PMID: 27308067 DOI: 10.5152/balkanmedj.2016.140986] [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: 12/04/2014] [Accepted: 09/30/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Some studies have suggested that the intrathecal use of cyclooxygenase enzyme inhibitors provides an anti-nociceptive effect. Therefore, the occurrence of side effects seen in systemic usage can be eliminated. AIMS The primary objective of this experimental, randomized, controlled trial was to test the hypothesis asserting that intrathecal dexketoprofen trometamol would demonstrate an analgesic effect during postoperative period. STUDY DESIGN Animal experimentation. METHODS Forty rats were randomized into 4 groups 7 days after intrathecal catheterization; the following drugs were given through catheter lumens: Group Lidocaine (Group L): Lidocaine 20 μg; Group Lidocaine-Morphine (Group LM): Lidocaine 20 μg and morphine 0.5 μgr; Group Lidocaine-Dexketoprofen (Group LD): Lidocaine 20 μg and dexketoprofen trometamol 100 μg; and Group Dexketoprofen (Group D): Dexketoprofen trometamol 100 μg. Paw incision was achieved under ether inhalation. To measure analgesic potential, hot plate and tail immersion tests were used as nociceptive tests during the postoperative period. RESULTS The mean reaction times detected in groups during hot plate and tail immersion tests were shortest in Group L at 15, 30, 45, 60, 75, 90, 105, and 120 minutes after start of surgery (p<0.01, all others). In the groups using dexketoprofen, as in the morphine group, longer reaction times were detected than in the lidocaine group at all measurement times except 120 minutes (p<0.01). CONCLUSION Intrathecal dexketoprofen in the optimal perioperative pain management is effective, and can be administered as an adjuvant in clinics after neurotoxicity studies in animals, and effective dose studies in volunteers.
Collapse
Affiliation(s)
- Er Birol Muhammet
- Department of Anesthesiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | | | - Ayhan Bozkurt
- Department of Physiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Sırrı Bilge
- Department of Pharmacology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Erhan Çetin Çetinoğlu
- Department of Anesthesiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| |
Collapse
|
18
|
Moore RA, McQuay HJ, Tomaszewski J, Raba G, Tutunaru D, Lietuviete N, Galad J, Hagymasy L, Melka D, Kotarski J, Rechberger T, Fülesdi B, Nizzardo A, Guerrero-Bayón C, Cuadripani S, Pizà-Vallespir B, Bertolotti M. Dexketoprofen/tramadol 25 mg/75 mg: randomised double-blind trial in moderate-to-severe acute pain after abdominal hysterectomy. BMC Anesthesiol 2016; 16:9. [PMID: 26801905 PMCID: PMC4724087 DOI: 10.1186/s12871-016-0174-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dexketoprofen trometamol plus tramadol hydrochloride is a new oral combination of two analgesics, which have different mechanisms of action for the treatment of moderate to severe acute pain. METHODS Randomised, double-blind, parallel, placebo and active-controlled, single and multiple-dose study to evaluate the analgesic efficacy and safety of dexketoprofen/tramadol 25 mg/75 mg in comparison with the single agents (dexketoprofen 25 mg and tramadol 100 mg) in moderate to severe acute pain after abdominal hysterectomy. Patients received seven consecutive doses of study drug within a 3-day period, each dose separated by an 8-hour interval. A placebo arm was included during the single-dose phase to validate the pain model. Efficacy assessments included pain intensity, pain relief, patient global evaluation and use of rescue medication. The primary endpoint was the mean sum of pain intensity differences over the first 8 h (SPID8). RESULTS The efficacy analysis included 606 patients, with a mean age of 48 years (range 25-73). The study results confirmed the superiority of the combination over the single agents in terms of the primary endpoint (p <0.001). Secondary endpoints were generally supportive of the superiority of the combination for both single and multiple doses. Most common adverse drug reactions (ADRs) were nausea (4.6%) and vomiting (2.3%). All other ADRs were experienced by less than 2% of patients. CONCLUSIONS The study results provided robust evidence of the superiority of dexketoprofen/tramadol 25 mg/75 mg over the single components in the management of moderate to severe acute pain, as confirmed by the single-dose efficacy, repeated-dose sustained effect and good safety profile observed. TRIAL REGISTRATION EU Clinical Trials Register (EudraCT number 2012-004545-32, registered 04 October 2012); Clinicaltrials.gov ( NCT01904149, registered 17 July 2013).
Collapse
Affiliation(s)
- R A Moore
- Pain Research & Nuffield Division of Anaesthetics, University of Oxford, The Churchill, Oxford, UK.
| | - H J McQuay
- Balliol College, University of Oxford, Oxford, UK
| | - J Tomaszewski
- Obstetrics-Gynaecology Private Clinic, Bialystok, Poland
| | - G Raba
- Division of Gynaecology, Provincial Hospital in Przemysl, Przemysl, Poland
| | - D Tutunaru
- Genesys Fertility Center, Bucharest, Romania
| | - N Lietuviete
- Gynaecology, Riga East University Hospital Gynaecology Clinic, Riga, Latvia
| | - J Galad
- GYNPOR, s.r.o., Sliac, Slovakia
| | - L Hagymasy
- Gynaecological Department, St. George Fejer County Teaching Hospital, Szekesfehervar, Hungary
| | - D Melka
- Gynaecological Department, Latvian marine Medical Center, Riga, Latvia
| | - J Kotarski
- I Department of Gynaecological Oncology and Gynaecology, Medical University Hospital No 1, Lublin, Poland
| | - T Rechberger
- II Department of Gynaecology, Medical University Hospital No 4, Lublin, Poland
| | - B Fülesdi
- Department of Anaesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - A Nizzardo
- Clinical Research, Menarini Ricerche S.p.A - Menarini Group, Florence, Italy
| | - C Guerrero-Bayón
- Clinical Research, Laboratorios Menarini S.A. - Menarini Group, Badalona, Spain
| | - S Cuadripani
- Clinical Research, Laboratorios Menarini S.A. - Menarini Group, Badalona, Spain
| | - B Pizà-Vallespir
- Clinical Research, Laboratorios Menarini S.A. - Menarini Group, Badalona, Spain
| | - M Bertolotti
- Clinical Research, Menarini Ricerche S.p.A - Menarini Group, Florence, Italy
| |
Collapse
|
19
|
Bolat Ö, Erhan E, Deniz MN. The effect of preoperative intravenous dexketoprofen trometamol on postoperative pain in minor outpatient urologic surgery. Turk J Urol 2013; 39:175-80. [PMID: 26328104 DOI: 10.5152/tud.2013.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/12/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this prospective double-blind randomized study was to compare the effectiveness of preoperative dexketoprofen trometamol for acute postoperative pain in patients undergoing minor outpatient urologic surgery. MATERIAL AND METHODS Sixty male patients (ASA I and II) undergoing varicocelectomy and testicular sperm extraction (TESE) with standard laryngeal mask airway (LMA) anesthesia were randomly divided into two groups. Patients in Group I (n=30) received 50 mg of dexketoprofen trometamol iv before induction, whereas patients in Group II (n=30) received saline. All patients received standard LMA anesthesia (propofol, sevoflurane and N2O/O2). Analgesic efficacy was evaluated by self-assessment of pain intensity (VAS) at regular intervals. Vital signs, side effects and time to reach a postanesthesia discharge score (PADS) of ≥9 were also recorded. Paracetamol 1 gr iv and tramadol 100 mg iv were used for rescue analgesia. RESULTS Demographic data and duration of surgery were similar in both groups. There was no significant difference between groups with respect to postoperative pain scores and side effects. Although more patients in Group II (60%) required rescue analgesia compared to Group I (33.3%), the difference did not reach statistical significance. CONCLUSION Preoperative IV use of dexketoprofen trometamol iv did not decrease the need for rescue analgesia in patients undergoing minor outpatient urological surgery.
Collapse
Affiliation(s)
- Özgür Bolat
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Elvan Erhan
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Mustafa Nuri Deniz
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, Turkey
| |
Collapse
|
20
|
Efficacy and tolerability of fixed-dose combination of dexketoprofen and dicyclomine injection in acute renal colic. PAIN RESEARCH AND TREATMENT 2012; 2012:295926. [PMID: 22577544 PMCID: PMC3347880 DOI: 10.1155/2012/295926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 02/01/2012] [Accepted: 02/04/2012] [Indexed: 11/17/2022]
Abstract
Objective. To evaluate the efficacy and tolerability of a fixed-dose combination of dexketoprofen and dicyclomine (DXD) injection in patients with acute renal colic. Patients and Methods. Two hundred and seventeen patients were randomized to receive either DXD (n = 109) or fixed-dose combination of diclofenac and dicyclomine injection (DLD; n = 108), intramuscularly. Pain intensity (PI) was self-evaluated by patients on visual analogue scale (VAS) at baseline and at 1, 2, 4, 6, and 8 hours. Efficacy parameters were proportion of responders, difference in PI (PID) at 8 hours, and sum of analogue of pain intensity differences (SAPID). Tolerability was assessed by patients and physicians. Results. DXD showed superior efficacy in terms of proportion of responders (98.17% versus 81.48; P < 0.0001), PID at 8 hours (P = 0.002), and SAPID(0-8 hours) (P = 0.004). The clinical global impression for change in pain was significantly better for DXD than DLD. The incidence of adverse events was comparable in both groups. However, global assessment of tolerability was rated significantly better for DXD. Conclusion. DXD showed superior efficacy and tolerability than DLD in patients clinically diagnosed to be suffering from acute renal colic.
Collapse
|
21
|
Abstract
SUMMARY Dexketoprofen trometamol is the dextrorotary enantiomer of the NSAID ketoprofen formulated as a tromethamine salt. The purpose of administering 50% of the racemic mixture is to keep the same analgesic and anti-inflammatory effect while reducing the adverse events due to both enantiomers. This article describes the pharmacological properties and evaluates the analgesic effects of dexketoprofen trometamol reported in acute and chronic pain conditions. The main conclusions are that dexketoprofen trometamol appears as effective as the double dose of the racemic drug. However, the reduction of adverse effects still has to be demonstrated. In addition, the formulation as tromethamine salt appears beneficial regarding fast onset of analgesia in acute pain conditions.
Collapse
Affiliation(s)
- Jean-Sébastien Walczak
- Anesthesia Research Department & Alan Edwards Center for Research on Pain, McGill University, 3655 Promenade Sir William Osler, H3G 1Y6, Montréal, Québec, Canada
| |
Collapse
|
22
|
Efficacy and Tolerability of Intramuscular Dexketoprofen in Postoperative Pain Management following Hernia Repair Surgery. Anesthesiol Res Pract 2011; 2011:579038. [PMID: 21716733 PMCID: PMC3119460 DOI: 10.1155/2011/579038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 03/14/2011] [Indexed: 11/17/2022] Open
Abstract
Objective. To evaluate the safety and efficacy of intramuscular dexketoprofen for postoperative pain in patients undergoing hernia surgery. Methodology. Total 202 patients received single intramuscular injection of dexketoprofen 50 mg or diclofenac 50 mg postoperatively. The pain intensity (PI) was self-evaluated by patients on VAS at baseline 1, 2, 4, 6, and 8 hours. The efficacy parameters were number of responders, difference in PI (PID) at 8 hours, sum of analogue of pain intensity differences (SAPID), and onset and duration of analgesia. Tolerability assessment was done by global evaluation and adverse events in each group. Results. Dexketoprofen showed superior efficacy in terms of number of responders (P = .007), PID at 8 hours (P = .02), and SAPID( 0-8 hours ) (P < .0001). It also showed faster onset of action (42 minutes) and longer duration of action (6.5 hours). The adverse events were comparable in both groups. Conclusion. Single dose of dexketoprofen trometamol 50 mg given intramuscularly provided faster, better, and longer duration of analgesia in postoperative patients of hernia repair surgery than diclofenac 50 mg, with comparable safety.
Collapse
|
23
|
Parkhutik V, Lago A, Tembl JI, Rubio C, Fuset MP, Vallés J, Santos MT, Moscardo A. Influence of COX-inhibiting analgesics on the platelet function of patients with subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2011; 21:755-9. [PMID: 21550266 DOI: 10.1016/j.jstrokecerebrovasdis.2011.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/03/2011] [Accepted: 04/03/2011] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Platelet function of patients with subarachnoid hemorrhage (SAH) may play an important part in both rebleeding and delayed cerebral ischemia, but little is known about aggregation pathways during the acute phase of stroke. Analgesics are used regularly in the first days after bleeding, and some can potentially inhibit the cyclooxygenase (COX) enzyme. We examined the platelet function of patients with SAH in order to describe their basal situation and determine whether the administration of intravenous nonsteroidal antiinflammatory drugs (NSAIDs) affected platelet aggregation. METHODS Arachidonic acid (AA)-induced aggregation and the platelet function analyzer (PFA)-100 test with collagen/epinephrine cartridges were used to study a group of SAH patients that was treated with dexketoprofen and dipyrone and to compare them to patients that had received no analgesia. RESULTS Ninety-six consecutive SAH patients prospectively enrolled in platelet studies. Twenty-seven patients were taking NSAIDs (10 on dexketoprofen and 17 on dipyrone), and there were 15 cases in the control group. AA-induced aggregation was 10% ± 3.2% for NSAIDs (mean ± standard error), specifically 17.2% ± 7% for dexketoprofen and 5.7% ± 1% for dipyrone. Aggregation in the control group was 72.4% ± 6% (P = .001). Both analgesics slowed the platelet plug formation during the PFA-100 test, with closure times of 237.2 ± 25 seconds for dexketoprofen and 198.4 ± 22 seconds for dipyrone and 138.1 ± 21 seconds in controls (P = .02). CONCLUSIONS The administration of COX-inhibiting analgesics leads to an hypoaggregability state in the first days of SAH. Further insight into their impact on complications such as rebleeding and delayed cerebral ischemia is needed in order to optimize the headache treatment of SAH.
Collapse
Affiliation(s)
- Vera Parkhutik
- Department of Neurology, La Fe University Hospital, Valencia, Spain.
| | | | | | | | | | | | | | | |
Collapse
|