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How to control postoperative pain: intravenous route
Intravenous administration of analgesic drugs is one of the most common ways to control post-operative pain. It can be used in almost all kinds of surgical interventions and particularly those of medium and high complexity. Besides, when other techniques are contraindicated because of clinical and/or managing problems, intravenous way finds its best application. Among analgesic drugs NSAID (ketorolac) and opioids (Tramadol ( Generic Ultram ), morphine, buprenorphine) are most frequently used. As to administration techniques, elastomeric pump is, according to personal experience, a simple-to-manage, practical and precise device with lower cost respect to other administration set. Elastomeric pump is a single use reservoir that allows continuous administration of drugs with a uniform pre-set infusion speed. Finally, guide-lines, showing pre-load and infusion doses of analgesic drugs, based on pain intensity, are presented.
Nonsteroidal antirheumatics (NSAR; NSAID) are often used in patients with fractured bones for analgetic reasons. This animal experiment was performed to determine the influence of NSAR on the process of fracture healing. As an alternative, Tramadol ( Generic Ultram ), the centrally acting analgetic without peripheral effects, was included in this experiment. MATERIALS AND METHODS: Wistar rats were operated on by a transverse osteotomy of the proximal tibia of the left leg. The fracture was stabilized by intramedullary nailing (healing period 21 days). All drugs were applied orally twice a day. The animals were divided into four groups with 10 rats each: Group 1 was treated with placebo (P), group 2 with Tramadol ( Generic Ultram ) (T; 20 mg/kg body weight/day), group 3 with diclofenac sodium (DS; 5 mg/kg bw/day) for 7 days followed by 14 days of placebo, group 4 with diclofenac sodium (DL; 5 mg/kgbw/day) over 21 days. On day 21 the rats were killed, and each leg was examined by X-ray, then the tibia was examined by CT scan, three-point bending, and histology. RESULTS: The results of CT and three-point bending showed that rats treated by diclofenac presented with delayed fracture healing compared with those treated by placebo or Tramadol ( Generic Ultram ). Bone density in CT was highest in group 1 (mean 611.4+/-50.1 mg/ml), followed by group 2 (mean 542.5+/-29.5 mg/ml). Groups 3 (mean 411+/-34.0 mg/ml; p=0.006) and 4 (mean 395.2+/-15.4 mg/ml; p=0.009) were significantly lower. The stability of the bones, as measured by the breaking force ( F(max)), was highest in group 1 (mean 45.8+/-19.0 N), followed by group 2 (mean 39.0+/-7.9 N; NS); group 3 (mean 20.6+/-7.8 N; p=0.01) was significantly lower than the placebo animals, followed by group 4 (mean 26.5+/-8.3 N; p=0.03). Similar results were shown for bending stiffness: group 1 (mean 1404.6+/-611.4 Nmm/mm), group 2 (mean 1033.2+/-232.1 Nmm/mm; NS), group 3 (mean 564.2+/-457 Nmm/mm; p=0.045), and group 4 (mean 494.8+/-340.2 Nmm/mm; p=0.028). There were no significant differences between groups 1 and 2 and between groups 3 and 4, respectively. Diclofenac serum levels on day 21 in rats with long-term diclofenac application (mean 301.4+/-83.3 ng/ml) were comparable to those in humans. CONCLUSION: Oral application of diclofenac significantly delayed fracture healing in rats. This effect might be comparable to other NSAR and fracture healing in humans.
Use of Tramadol ( Generic Ultram ) versus pethidine versus denaverine suppositories in labor--a contribution to noninvasive therapy of labor pain
Because Tramadol ( Generic Ultram ) does not exhibit an depressive effect on ventilatory activity it is often be used in the obstetrical analgesia, at most in form of an intramuscularly injection. In a prospective study on at all 49 women under labour the clinical effect of the noninvasive rectal application of Tramadol ( Generic Ultram ), Pethidin, and Denaverin has been compared. The first dosage was 100 mg of all substances. Around the half of the women said that analgetic effect was good or very good. On only every fifth it was sufficient or not enough. The effect was at near the same in all treatment groups. Because of a low incidence of maternal side effects, the absence of side effects on the newborn, and near the same results on the analgetic effect of parenteral application in other studies, Tramadol ( Generic Ultram ) suppositories can be recommended for obstetrical analgesia.
Highlights of the 22nd French pharmacovigilance meeting.
(1) The 22nd French pharmacovigilance meeting, held in July 2001, presented data on adverse effects notified by health professionals to regional pharmacovigilance centres in France. (2) Non specific "immunostimulants" are not harmless placebos, as might be concluded from the relative lack of data. There have been 315 notifications of severe adverse effects, some with positive rechallenge, reporting cutaneous, gastrointestinal, respiratory, haematological and other disorders. Attributability was considered "likely" in 68% of cases. Three deaths occurred. (3) Other well known adverse effects continue to occur: convulsions with camphor, visual hallucinations with oxybutynin, headache with antimigraine drugs, liver damage with dextropropoxyphene, neuropsychological disorders after buflomedil overdose (especially in patients with renal failure), hyperkalaemia during spironolactone combination with an angiotensin-converting-enzyme inhibitor (ACE inhibitor), and severe infections after intravesical BCG. (4) Rare adverse effects of old drugs were identified, such as oedema with valproic acid, interstitial pneumonia with flecainide, and a bleeding risk due to Tramadol ( Generic Ultram ) interaction with oral anticoagulants. (5) The adverse effects of new drugs are better documented: celecoxib is now implicated in visual disorders. (6) Overall, the meeting confirmed that only a small proportion of adverse drug reactions are notified, that a large number of hospitalised patients suffer from drug induced complications, and that summaries of product characteristics (SPC) are often too brief or reassuring regarding pharmacovigilance data. The poor risk-benefit ratios of some drugs call for their immediate market withdrawal.
In vitro metabolism of the analgesic agent, Tramadol ( Generic Ultram )-N-oxide, in mouse, rat, and human.
Tramadol ( Generic Ultram )-N-oxide (TNO, RWJ-38705) is a new analgesic agent, which is believed to produce its analgesic effect following metabolic conversion to Tramadol ( Generic Ultram ). In the present study, API ionspray-MS and MS/MS techniques were used to profile the in vitro metabolism of TNO in mouse, rat, and human hepatic S9 fractions in the presence of an NADPH generating system. Unchanged TNO represented 60, 24, and 26% of the sample in mouse, rat, and human, respectively. Tramadol ( Generic Ultram ), and seven other metabolites were profiled and tentatively identified on the basis of MS analysis and by comparison to synthetic reference samples. TNO metabolites were formed via four Phase I reactions: (1) N-oxide reduction, (2) O-demethylation, (3) N-demethylation, and (4) cyclohexylhydroxylation. TNO was found to be substantially metabolized in hepatic S9 from all three species. The metabolism of TNO to Tramadol ( Generic Ultram ) via N-oxide reduction was greater in rat and human than in mouse.
Evidence of self-synergism in the antinociceptive effect of Tramadol ( Generic Ultram ) in rats.de Pozos-Guillen AJ, Aguirre-Banuelos P, Arellano-Guerrero A, Hoyo-Vadillo C, Perez-Urizar J.Facultad de Estomatologia, Universidad Autonoma de San Luis Potosi, Zona Universitaria CP 78290 San Luis Potosi SLP.Tramadol ( Generic Ultram ) is an atypical opioid with a complex mechanism of action including the synergistic interaction between the parent drug and an active metabolite. However, the local action of the parent drug is poorly documented. This study was designed to evaluate the site-site interaction of the antinociception produced by Tramadol ( Generic Ultram ) given by two different routes. The effects of individual and fixed-ratio combinations of locally (subcutaneous) and systemically (intraperitoneal) dosed Tramadol ( Generic Ultram ) were evaluated using the formalin test in rats. Isobolographic analysis was employed to identify the synergy produced by combinations. In the second phase of the formalin test, Tramadol ( Generic Ultram ) was active not only by the systemic (ED50 7.15+/-0.46 mg/kg i.p.) but also by the local route (ED50 134.6+/-25.1 microg/paw). The isobolographic analysis evidenced a "self-synergism" in the antinociceptive effect between the two routes of administration since the experimental ED50 (30.8+/-0.1 "dose units") of the combination was significantly lower than the theoretical ED50 (70.9+/-12.6 "dose units"). The mechanism underlying this self-synergism appears to be partially opioid since naloxone reversed the potentiation. The observed site-site interaction in the antinociceptive action of Tramadol ( Generic Ultram ) provides insights for alternatives in the management of pain.
Combined general and epidural anesthesia with ropivacaine for renal transplantation.
AIM: To evaluate the effectiveness and safety of epidural ropivacaine anesthesia in association with light general anesthesia during renal transplantation and compare epidural and endovenous analgesia techniques for postoperative pain control. METHODS: Experimental design: prospective randomized study. |
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