Assessment of Relationships Between External Load Metrics and Game Performance in Women's Lacrosse

The purpose of this study was to analyse the relationship between external load metrics with game performance for Division I collegiate female lacrosse. Data were collected using microtechnology during 26 games with 13 athletes (attackers n = 5, midfielders n = 8). External load variables included: total distance (TD), distance rate (DR), high-intensity (HI) distance, speed, HI sprints, accelerations, decelerations, metabolic equivalent distance (MED), and sprints. For attackers, goals, points, shots, and shots on goal (SOG) had low, positive associations with TD (r = 0.32 to 0.42) and MED (r = 0.39 to 0.45). For midfielders, goals, shots, and draw controls had low, positive relationships with TD (r = 0.34 to 0.41), DR (r = 0.33 to 0.45), and decelerations (r = 0.30 to 0.35). Points and SOG had low associations with TD (r = 0.35), DR (r = 0.33), accelerations (r = 0.31), and decelerations (r = 0.32 to 0.35). Turnovers demonstrated low, positive relationships with HI distance (r = 0.31) and HI sprints (r = 0.41). Though the correlations were low, they still revealed insights into workload metrics and offensive game statistics in the sport of lacrosse. Training for attackers should focus on agility and a training base for TD. Training for midfielders should focus on HI endurance and sprinting.

Transplantation of cultured human neuronal cells for patients with stroke

Transplantation of cultured neuronal cells is safe in animal models and improves motor and cognitive deficits in rats with stroke. The authors studied the safety and feasibility of human neuronal cellular transplantation in patients with basal ganglia stroke and fixed motor deficits, including 12 patients (aged 44 to 75 years) with an infarct 6 months to 6 years previously (stable for at least 2 months). Serial evaluations (12 to 18 months) showed no adverse cell-related serologic or imaging-defined effects. The total European Stroke Scale score improved in six patients (3 to 10 points), with a mean improvement 2.9 points in all patients (p = 0. 046). Six of 11 PET scans at 6 months showed improved fluorodeoxyglucose uptake at the implant site. Neuronal transplantation is feasible in patients with motor infarction.

Evaluation of the safety and efficacy of ketorolac versus morphine by patient-controlled analgesia for postoperative pain

STUDY OBJECTIVE

To compare ketorolac tromethamine with morphine for pain management after major abdominal surgery.

DESIGN

Double-blind, randomized study.

SETTING

Hospital recovery room and postoperative surgical unit.

PATIENTS

One hundred ninety-one patients with at least moderate pain after major abdominal surgery.

INTERVENTIONS

Patients received ketorolac by patient-controlled analgesia (PCA) bolus alone (Ket B), ketorolac by bolus plus infusion (Ket I), or morphine by PCA bolus (morphine), with injectable morphine available for supplementation.

MEASUREMENTS AND MAIN RESULTS

Levels of sedation, pain intensity, pain relief, and adverse events were recorded at baseline, at 2, 4, and 6 hours, and at termination. Supplemental morphine was required by 71% of Ket B patients, 67% of Ket I patients, and 38% of morphine patients (p < or = 0.001 for Ket B vs morphine). Although patients receiving ketorolac required more supplemental morphine than the morphine group (6.0 mg Ket I, 6.2 mg Ket B, 4.0 mg morphine), there was a large morphine-sparing effect in both ketorolac groups (total morphine 6.0 mg Ket I, 6.2 mg Ket B, 33.3 mg morphine). Overall pain relief scores were similar for morphine and Ket I groups, and were lower for Ket B than for morphine (p = 0.002). There were no differences among groups in numbers of patients with adverse events.

CONCLUSION

Ketorolac may be effective when administered by PCA device, and has a clear morphine-sparing effect.

The effect of intravenous ketorolac given intraoperatively versus postoperatively on outcome from gynecologic abdominal surgery

STUDY OBJECTIVES

To examine the effect of timing of an intravenous (i.v.) dose (intraoperative vs. postoperative) of ketorolac tromethamine on pain scores and overall outcome after total abdominal hysterectomy (TAH) and myomectomy.

DESIGN

Prospective, randomized, placebo-controlled study.

PATIENTS

248 ASA physical status I and II adult female patients scheduled for elective hysterectomy or myomectomy.

INTERVENTIONS

General anesthesia was administered that consisted of thiopental sodium for induction, enflurane or isoflurane in nitrous oxide-oxygen for maintenance, and small doses of fentanyl and midazolam. Patients were randomized into three groups to receive toradol/placebo on a dosing schedule of dose 1 given one-half hour prior to expected end of surgery, dose 2 given on awakening in the postanesthesia care unit, and doses 3, 4, and 5 given at 6, 12, and 18 hours, respectively, after dose 2; Group 1 patients received placebo (saline) for dose 1, ketorolac 60 mg i.v. for dose 2, and ketorolac 30 mg i.v. for doses 3, 4, and 5. Group 2 patients received ketorolac 60 mg i.v. for dose 1, placebo for dose 2, and ketorolac 30 mg i.v. for doses 3, 4, and 5. Group 3 patients received placebo for all doses. All patients were given i.v. morphine PCA postoperatively, and morphine usages, visual analog pain intensity (VAS) scores, as well as adverse events and median times to recovery milestones were recorded.

MEASUREMENTS AND MAIN RESULTS

VAS scores (mean) before dose 2 were significantly lower in Group 2 than Group 1, as were at-rest evaluations at 15 minutes and one hour. Group 2 patients also had decreased morphine requirements as compared to placebo. Both ketorolac groups (Groups 1 and 2) had significantly higher values for patient and observer overall ratings, case of nursing care, and tolerability as compared to placebo (Group 3). There were no significant differences among groups in adverse events or median times to recovery milestones.

CONCLUSIONS

Although it is possible to demonstrate an improvement in early postoperative pain scores with intraoperative ketorolac and better overall ratings of ketorolac both intraoperatively and postoperatively as compared with placebo, the lack of clinically significant differences in analgesic efficacy in the two active study groups indicates the need for a careful consideration by the clinician of the risks versus benefits involved in the administration of antiplatelet medication in the perioperative period.

Comparison of intravenous ketorolac, meperidine, and both (balanced analgesia) for renal colic

STUDY OBJECTIVE

To compare the analgesic efficacy and safety of IV ketorolac, the only nonsteroidal antiinflammatory drug indicated for parenteral use in acute pain in the United States, with IV meperidine and with a combination of the two agents in renal colic.

METHODS

We carried out a double-blind, randomized, multicenter clinical trial in the emergency departments of four urban tertiary care teaching hospitals. Our study subjects were 154 patients with suspected renal colic. Each subject received an initial IV dose of ketorolac 60 mg, meperidine 50 mg, or both supplemented as needed beyond 30 minutes with additional doses of meperidine.

RESULTS

The main outcome measures were changes in pain-intensity and pain-relief scores, amount of supplemental meperidine required, end-of-study drug tolerability, and adverse events. Analyses of 106 subjects with confirmed renal colic indicated that ketorolac and the combination were significantly better than meperidine alone by all efficacy measures, including pain relief and time elapsed before the need for supplemental meperidine. By 30 minutes, 75% of the ketorolac group and 74% of the combination group had a 50% reduction in pain scores, compared with 23% of the meperidine group (P < .001). The ketorolac and combination groups did not differ significantly in any of the efficacy measures.

CONCLUSION

IV ketorolac, alone or in combination with meperidine, was superior to IV meperidine alone in moderate and severe renal colic. Because many subjects in all three treatment groups received supplemental meperidine and because response to ketorolac alone cannot be predicted, clinicians may choose to initiate treatment with a ketorolac-meperidine combination.

New formulation of aqueous flunisolide nasal spray in the treatment of allergic rhinitis: comparative assessment of safety, tolerability, and efficacy

This 6-week, multicenter, double-blind, randomized, placebo-controlled, parallel-group trial compared the safety, efficacy, and tolerability of a new formulation of flunisolide nasal spray with the original formulation in the treatment of allergic rhinitis due to mountain cedar pollenosis. It was conducted at three clinical centers in close geographic proximity. A total of 216 patients, ranging in age from 14 to 77 years (mean, 44 years), took at least one dose of study drug and therefore were evaluable for the safety analysis. A total of 185 patients (85%) completed the study, and 136 patients were evaluable for the efficacy analysis. Both formulations of flunisolide were comparable in terms of relief of rhinitis symptoms, and the new flunisolide formulation was better tolerated than the original formulation. Both active formulations were superior to their respective vehicles (P < 0.001) using multiple measures of allergic rhinitis symptoms relief. Use of escape medication (chlorpheniramine maleate) was significantly (P < or = 0.034) greater in the placebo group when compared with their respective active treatment groups. No therapeutic effect was observed with symptoms of allergic conjunctivitis. Significantly fewer patients who were treated with the new formulation flunisolide reported nasal burning and stinging when compared with the original formulation (P = 0.006). In conclusion, the new formulation showed similar efficacy and improved tolerability in the treatment of allergic rhinitis compared with the original formulation. This new formulation not only offers clinicians a useful therapeutic addition for the treatment of allergic rhinitis, but may also improve patient compliance.

Ketorolac versus meperidine for pain relief after orthopaedic surgery

In this double-blind, randomized, multicenter study, 244 patients with at least moderate pain after major orthopaedic surgery received intramuscular Ketorolac (60 mg followed by 30 mg) or intramuscular meperidine (100 mg or placebo) every 2 to 6 hours as needed for as many as 5 days. Analgesic response was evaluated for 6 hours after initial study drug administration and thereafter each night at bedtime. Both active treatment groups had similar 3-hour summed pain intensity difference and 3-hour total pain relief scores after the first dose that were superior to placebo. The 6-hour summed pain intensity difference and total pain relief scores were significantly higher with Ketorolac than with meperidine or placebo. The mean daily categorical pain intensity scores were comparable with Ketorolac and meperidine, and both were significantly superior to placebo. Patient ratings of overall medication efficacy were significantly better with Ketorolac than with meperidine. In both patient and observer evaluations, Ketorolac was significantly better tolerated than meperidine, and the number of patients reporting adverse events was lower with Ketorolac than with meperidine. Following major orthopaedic surgery, Ketorolac provided effective analgesia that was superior to placebo and at least comparable with meperidine. Ketorolac was better tolerated than meperidine.

Evaluation of the antipyretic effect of ketorolac, acetaminophen, and placebo in endotoxin-induced fever

The authors studied the antipyretic effect of three intramuscular doses of ketorolac (15, 30, and 60 mg), acetaminophen 650 mg PO, and placebo in healthy male volunteers using an endotoxin-induced fever model. In this double-blind, double-dummy, parallel study, subjects were assigned randomly with equal probability to one of the above treatment groups. Thirty minutes after study medication administration, a 20 unit per kilogram dose of reference standard endotoxin (RSE) was administered intravenously, and temperature was determined every 15 minutes for an 8-hour period. Compared with placebo, all active treatment groups demonstrated a statistically significant reduction in both adjusted area under the temperature-by-time curve (AAUC) and the maximum increase over baseline temperature (dTmax). Furthermore, the 30 mg intramuscular dose of ketorolac demonstrated approximately the same antipyretic activity as the 650 mg oral dose of acetaminophen, and there was a statistically significant dose response across the three ketorolac doses studied (P < .0001). The majority of side effects reported during this study were symptoms associated with fever, including chills, headache, myalgia, and dizziness, all of which are effects of RSE. The frequency of side effects tended to be less in the treatment groups with the greatest antipyretic activity.

Comparison of oral ketorolac, intramuscular morphine, and placebo for treatment of pain after orthopedic surgery

Using a randomized, double-blind, placebo-controlled, parallel, single-dose, single-center, 6-hour study, we compared the analgesic response and tolerability of oral ketorolac tromethamine and intramuscular morphine sulfate and placebo. The study group comprised 176 patients with moderate, severe, or very severe pain after hip or knee surgery at a teaching hospital. Patients received either 10 mg of ketorolac orally, 10 mg of morphine intramuscularly, 5 mg of morphine IM, or placebo. Patients rated pain intensity at baseline and pain intensity and pain relief at 30 minutes, 1 hour, and hourly thereafter for 6 hours. At study completion, we evaluated overall patient ratings of pain relief and occurrence of adverse events. Summed pain intensity difference scores and total pain relief scores showed the active medications to be significantly superior to placebo and not significantly different from each other. The 10-mg dose of morphine showed a small advantage over ketorolac in peak analgesic effect, but the onset of pain relief was comparable among the active agents. The incidence of adverse events among the active-treatment groups was similar, though there was a numerical trend favoring ketorolac over 10 mg of morphine. We found oral ketorolac to be an effective alternative to parenteral opioids for the treatment of pain after hip or knee surgery in patients who can tolerate oral medication.

The use of ketorolac in the management of postoperative pain

Ketorolac tromethamine (Toradol) is a nonsteroidal antiinflammatory drug (NSAID) available in intramuscular (IM) and oral formulations for the management of acute pain. Intramuscular ketorolac is the only parenteral NSAID available for analgesic use in the US. The clinical profile is reviewed, and clinical studies most applicable to a postoperative patient are discussed in detail. The results of a clinical study performed at Emory University School of Medicine are presented. In this single-dose study, 176 patients received either 10 mg of oral ketorolac, 5 mg or 10 mg of IM morphine, or placebo after orthopedic surgery. The analgesic efficacy of ketorolac was comparable to both doses of morphine and significantly superior to placebo. Ketorolac, when administered intramuscularly or orally, is a safe and effective analgesic agent for the short-term management of acute postoperative pain and can be used as an alternative to opioid therapy.

Comparison of ketorolac and meperidine in patients with postoperative pain--impact on health care utilization

A double-blind, randomized study was conducted to compare the effects of intramuscular ketorolac tromethamine and meperidine hydrochloride, and subsequent oral pain medication, on health care utilization and postoperative recovery. Following abdominal hysterectomy or cholecystectomy, 210 patients (aged 18 to 70 years; 189 women, 21 men) were randomly assigned to therapy and evaluated for efficacy, safety, nursing care requirements, functional independence, recovery milestones, and quality of life. The patients received 30 mg of ketorolac intramuscularly every 3 to 6 hours as needed, followed by 10 mg of ketorolac every 4 to 6 hours, or 100 mg of meperidine intramuscularly every 3 to 6 hours as needed, followed by acetaminophen/codeine (600 mg/60 mg) orally every 4 to 6 hours. Patients receiving ketorolac had lower nursing utilization scores and achieved a higher level of functioning than patients receiving meperidine during the first 3 postoperative days. Times to first bowel movement, walking without assistance, and first oral fluids were significantly shorter after ketorolac than meperidine. Mean pain intensity difference (from baseline) scores and pain relief scores when adjusted for baseline pain severity were comparable between ketorolac and meperidine. Most adverse events reported by the patients were mild to moderate; 12 patients in each group withdrew from treatment because of adverse events (nausea, rash, or headache). It is concluded that ketorolac is an effective alternative to meperidine in the management of postoperative pain.

Pain relief after dental impaction surgery using ketorolac, hydrocodone plus acetaminophen, or placebo

In a double-blind, placebo-controlled study, 207 patients with moderate pain after surgical removal of impacted third molars were randomly assigned to receive a single oral dose of 10 mg of ketorolac tromethamine, 10 mg of hydrocodone plus 1000 mg of acetaminophen, or placebo. Analgesic effect as assessed by summed pain intensity difference at 3 and 6 hours was significantly (P < or = 0.01) greater after ketorolac than after hydrocodone/acetaminophen. Total pain relief at 3 and 6 hours was significantly (P < 0.026) greater after ketorolac than after hydrocodone/acetaminophen or placebo. Patients taking hydrocodone/acetaminophen remedicated significantly (P = 0.027) sooner than those taking ketorolac. In this single-dose study, adverse events were reported more frequently by patients taking hydrocodone/acetaminophen than with ketorolac or placebo. It is concluded that, in this pain model, 10 mg of ketorolac affords better pain relief with fewer side effects than hydrocodone/acetaminophen.

Comparison of the efficacy and safety of ketorolac and meperidine in the relief of dental pain

A single-dose, randomized, double-blind study of parallel design was conducted to determine the analgesic efficacy and safety of ketorolac tromethamine in patients who experience moderate or severe pain after the surgical removal of three or more third molars, one of which was a bony-impacted mandibular molar. Meperidine hydrochloride was used as the control analgesic. In this 8-hour study, assessments were made of pain intensity, pain relief, and overall rating of the medication in 145 patients, each of whom had received an intramuscular injection of 10 mg, 30 mg, or 90 mg of ketorolac, or 50 mg or 100 mg of meperidine. The summed pain intensity and total pain relief scores showed that, at 3 and 8 hours, the effectiveness of 30 mg of ketorolac was similar to that of 90 mg ketorolac and that both of these doses were significantly more efficacious than 10-mg ketorolac, 50-mg meperidine, or 100-mg meperidine. Patients who received 30 mg or 90 mg of ketorolac gave the study medication significantly higher ratings overall than did patients who received 50 mg or 100 mg of meperidine. Significantly fewer patients treated with ketorolac reported adverse events in comparison with those treated with meperidine (17% and 59%, respectively), which suggests that it possesses a better therapeutic index than meperidine. Thus, ketorolac appears to represent an important advance in analgesic therapy.

Pharmacokinetics of ketorolac and p-hydroxyketorolac following oral and intramuscular administration of ketorolac tromethamine

Ketorolac tromethamine (KT), a potent analgesic with cyclooxygenase inhibitory activity, was administered in an open, randomized, single-dose study of Latin-square design to 12 healthy male volunteers. Doses of 30 mg oral (po) and 30, 60, and 90 mg intramuscular (im) KT were administered in solution. Plasma samples were analyzed for ketorolac (K) and its inactive metabolite, p-hydroxyketorolac (PHK), by reversed-phase high-performance liquid chromatography (HPLC). The 30-mg im dose was found to be similar to the 30-mg po dose with respect to total AUC values for both K and PHK. The amount of PHK circulating in plasma was very low as judged by AUC ratios (PHK/K x 100) of 1.9 and 1.5% for the 30-mg po and im doses, respectively. The rate of absorption of K and formation of PHK, as determined by Cmax and Tmax values, was significantly slower following the im doses. Total AUC and Cmax for K and PHK increased linearly with dose after im administration of 30, 60, and 90 mg of KT. The mean plasma half-life of K was remarkably consistent between po and im administration and was independent of dose, ranging from 5.21 to 5.56 hr. The plasma metabolic profile was similar following both routes of administration and graded im doses.

Absorption of naproxen controlled-release tablets in fasting and postprandial volunteers

The absorption of naproxen in a new controlled-release (CR) formulation (1000 mg tablet) was studied in fasting and postprandial volunteers. The total area under the plasma concentration-time curve averaged 2221 micrograms.hr/mL in fasting participants and 2111 micrograms.hr/mL in postprandial participants; whereas the difference was statistically significant (P = .025), the 95% confidence intervals indicated equivalent values. The peak plasma concentration was lower in the fasting state (63.1 micrograms/mL) than in the fed state (86.1 micrograms/mL) (P = .0001). There were no statistically significant differences between fasting versus postprandial values for the mean absorption time (9.7 hr vs. 7.7 hr) or plasma half-life (17.3 hr vs. 17.6 hr). Hence, the rate and extent of absorption of CR naproxen was not substantially altered by the ingestion of food.

Pharmacokinetics of ketorolac tromethamine in humans after intravenous, intramuscular and oral administration

The pharmacokinetics of ketorolac tromethamine, a potent non-narcotic analgesic agent used for relief of moderate to severe pain, has been studied in 15 healthy volunteers who received single 10 mg doses intravenously (i.v.), intramuscularly (i.m.) and orally (p.o.) in a three-way cross-over design. The kinetics of i.v. ketorolac were characterized by a terminal half-life of 5.09 h, a small plasma clearance (CL = 0.35 ml.min-1.kg-1) and a small tissue distribution (Vss = 0.11 l.kg-1, V beta = 0.17 l.kg-1; mean (SD). Following i.m. and p.o. administration, peak levels of approximately 0.8 microgram/ml were rapidly attained (tmax = 0.8 and 0.9 h, respectively) and the systemic bioavailability was essentially complete.

Specificity of PGE2 analogs interaction between food intake and antisecretory effect

We evaluated the degree of acid suppression that occurred when enprostil, a dehydro-prostaglandin E2 (PGE2) methyl ester analog, was administered before (anti-cibum AC) or after a meal (post-cibum PC). A double-blind, randomized, single-dose, parallel-group design compared enprostil, 35 mcg, 25 min AC or 5 min PC, with placebo AC or PC in 30 healthy adults. Enprostil or placebo was administered at time 0 and a standard beef test meal was ingested at 25 min, followed 5 min later by enprostil or placebo. A second test meal was consumed at 210 min. Intragastric titration was performed from 30 to 390 min. Subjects receiving enprostil-AC or enprostil-PC secreted less (P less than 0.05) acid compared to placebo; however, the antisecretory effects of enprostil-AC or enprostil-PC were similar throughout the duration of study. Minor adverse reactions were present in 13/30 subjects and confined to those receiving enprostil. In contrast to the previously reported potentiation of trimoprostil, a trimethyl-desoxy-PGE2 analog, antisecretory activity by food, enprostil-PC did not result in more prominent or prolonged suppression of gastric acid secretion than enprostil-AC. There is an apparent specificity of different oral PGE2 analogs with regard to their antisecretory activity in the presence or absence of food.

Bacterial endotoxin isolated from a water spray air humidification system as a putative agent of occupation-related lung disease

Outbreaks of hypersensitivity pneumonitis or humidifier fever were attributed to the inhalation of organic material aerosolized by a chilled-water spray humidification system. The purpose of this study was to isolate and characterize the serologically detectable antigen(s) present in extracts obtained from the humidification system. By using bicarbonate or phenol-water extractions or both, the antigen was isolated and characterized, using colorimetry, gas-liquid chromatography, reverse-phase high-performance liquid chromatography, and X-ray fluorescence. Carbohydrates, hexosamines, phosphorus, and even-numbered saturated and unsaturated fatty acids were constituents of the serologically detectable antigen. When tested in in vivo and in vitro assays, the antigen had demonstrable endotoxin activity. All subjects with biopsy-proven lung disease and a majority of subjects suspected of having lung disease had antibodies directed toward the purified endotoxin. The data strongly suggest that an aerosolized bacterial endotoxin is a putative agent inducing lung disease.

Comparison of bronchodilator effectiveness of fenoterol and isoetharine

The present study was undertaken to compare efficacy and duration of action of fenoterol and isoetharine in patients who subjectively required urgent therapy. Analysis of the resulting data showed that in this population fenoterol had a longer duration of action and was more effective at the later time periods.