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Solheim N, Gregersen I, Halvorsen B, Bjerkeli V, Stubhaug A, Gordh T, Rosseland LA. Randomized controlled trial of intra-articular ketorolac on pain and inflammation after minor arthroscopic knee surgery. Acta Anaesthesiol Scand 2018; 62:829-838. [PMID: 29512121 DOI: 10.1111/aas.13104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/29/2018] [Accepted: 02/07/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ketorolac is an effective non-steroidal anti-inflammatory drug, commonly used with local anaesthetics as part of local infiltration analgesia protocols following orthopaedic surgery. However, systemic uptake and drug action may be the major mechanism after local infiltration. The aims of this project were to study the effects of a small, systemically ineffective dose of ketorolac given intra-articularly for post-operative pain and also to study synovial inflammatory biomarkers. We investigated whether ketorolac affects pro-inflammatory biomarkers in an in vitro model, as well. METHODS In this placebo-controlled, blind, randomized study, we analysed intra-articular ketorolac (5 mg) in ambulatory minor knee surgery patients with moderate or severe pain (n = 44). We assessed post-operative pain intensity (n = 44) and analysed microdialysis samples taken from knee synovial tissue every 20 min (n = 34). We also tested cyclooxygenase-independent effects of ketorolac in synovial cells stimulated by prostaglandin E2 and chondroitin sulphate in vitro. RESULTS Intra-articular ketorolac (5 mg) administration did not reduce pain or synovial pro-inflammatory cytokines CXCL1, IL-8, and MCP-1, 0-120 min after knee arthroscopy. Female gender was a risk factor for moderate or severe pain (relative risk 1.45, 95% confidence interval 1.04-2.01). Paradoxically, ketorolac increased the release of CXCL1 and IL-8 in prostaglandin E2 and chondroitin sulphate-stimulated synovial cells in vitro. CONCLUSION Ketorolac prescribed at a low dose intra-articularly does not produce any detectable analgesic effect after minor knee surgery.
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Affiliation(s)
- N. Solheim
- Lovisenberg Diakonal Hospital; Oslo Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - I. Gregersen
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Research Institute of Internal Medicine; Oslo University Hospital; Oslo Norway
| | - B. Halvorsen
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Research Institute of Internal Medicine; Oslo University Hospital; Oslo Norway
| | - V. Bjerkeli
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Research Institute of Internal Medicine; Oslo University Hospital; Oslo Norway
| | - A. Stubhaug
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Division of Emergencies and Critical Care; Department of Pain Medicine and Research; Oslo University Hospital; Oslo Norway
| | - T. Gordh
- Department of Surgical Sciences, Pain Medicine; Uppsala University; Uppsala Sweden
| | - L. A. Rosseland
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Division of Emergencies and Critical Care; Department of Research and Development; Oslo University Hospital; Oslo Norway
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Trøseid M, Ueland T, Hov JR, Svardal A, Gregersen I, Dahl CP, Aakhus S, Gude E, Bjørndal B, Halvorsen B, Karlsen TH, Aukrust P, Gullestad L, Berge RK, Yndestad A. Microbiota-dependent metabolite trimethylamine-N-oxide is associated with disease severity and survival of patients with chronic heart failure. J Intern Med 2015; 277:717-26. [PMID: 25382824 DOI: 10.1111/joim.12328] [Citation(s) in RCA: 311] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Recent metabolomic, experimental and clinical studies have demonstrated that trimethylamine-N-oxide (TMAO), a microbiota-dependent metabolite from dietary phosphatidylcholine and carnitine, is a strong predictor of coronary artery disease (CAD). This finding suggests a link between the gut microbiota and atherosclerosis. The potential impact of TMAO in chronic heart failure (HF) is unknown. We hypothesized that TMAO levels would provide prognostic information about adverse outcomes in chronic HF. DESIGN Prospective, observational study including 155 consecutive patients with chronic HF. In addition, 100 patients with stable CAD without HF and 33 matched healthy individuals were included as controls. Plasma levels of TMAO and its precursors choline and betaine were measured, and associations with symptoms, aetiology and transplant-free survival in the patients with HF were explored. RESULTS Plasma levels of TMAO (P = 0.01), choline (P < 0.001) and betaine (P < 0.001) were elevated in patients with chronic HF compared to control subjects, with the highest levels in patients with New York Heart Association (NYHA) classes III and IV. Furthermore, TMAO levels were highest in individuals with ischaemic HF, followed by those with stable CAD and nonischaemic HF. TMAO, but not choline or betaine, was associated with reduced transplant-free survival: approximately 50% of patients in the upper tertile of TMAO levels died or received a heart transplant during 5.2 years of follow-up (unadjusted Cox-regression: hazard ratio 2.24, 95% confidence interval 1.28-3.92, P = 0.005). CONCLUSIONS TMAO levels were elevated in patients with HF and associated with NYHA class, ischaemic aetiology and adverse outcomes. Future studies should focus on gut microbiota, dietary composition and intestinal dysfunction in relation to TMAO levels and clinical outcome in HF.
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Affiliation(s)
- M Trøseid
- Department of Infectious Diseases, Oslo University Hospital, Ullevål, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway
| | - T Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
| | - J R Hov
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway.,Department of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital, Norway.,Norwegian PSC Research Center, Norway
| | - A Svardal
- Department of Clinical Science, University of Bergen, Norway
| | - I Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
| | - C P Dahl
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.,Centre for Heart Failure Research, Oslo University Hospital, Norway
| | - S Aakhus
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
| | - E Gude
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
| | - B Bjørndal
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - B Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
| | - T H Karlsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway.,Department of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital, Norway.,Norwegian PSC Research Center, Norway.,Division of Gastroenterology, Institute of Medicine, University of Bergen, Bergen, Norway
| | - P Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway
| | - L Gullestad
- Institute of Clinical Medicine, University of Oslo, Norway.,Department of Clinical Science, University of Bergen, Norway.,Centre for Heart Failure Research, Oslo University Hospital, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,K.G. Jebsen Cardiac Research Center, University of Oslo, Oslo, Norway
| | - R K Berge
- Department of Clinical Science, University of Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - A Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway.,Centre for Heart Failure Research, Oslo University Hospital, Norway
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