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646 ANALGESIC EFFECTS OF RECTAL ACETAMINOPHEN IN PEDIATRIC DAY CASE SURGERY
Topic D: TREATMENT APPROACHES (MEDICAL/INTERVENTIONAL) 644 THE EVALUATION OF ADVERSE EVENTS IN POSTOPERATIVE ANALGESIA WITH INTRAVENOUS PARACETAMOL SOLUTION I. Tekin, E.A. Yentur, K. Erbuyun ° , H. Dasci. Department of Anesthesiology, Medical School of Celal Bayar University, Manisa-Turkey
Background and Aims: The aim of this study is the evaluation of adverse events like heamodynamic parameters and hepatic, renal and coagulation disturbances in postoperative analgesia with intravenous paracetamol therapy for 48hours. Methods: Patients who were undergoing laminectomy and not have renal, gastric, hepatic and coagulation disturbances were included in this study. Analgesic management was standardized in all patients during anaesthesia. In group T (n = 15) patient controlled analgesia (PCA) with tramadol, in group T+P (n = 15) the same PCA protocol and 1 gr.100 ml−1 paracetamol IV infusion, at every 6 hours for 2 days were administered. Preoperatively, postoperatively and at the end of second day, prothrombin time, activated thromboplastin time, thrombocyte-leucocyte count, urea, kreatinine, aspartate aminotransferase, alanine aminotransferase and blood glucose were measured. Mean blood pressure (MBP), heart rate (HR), visual analog scale (VAS) and adverse effects (allergic reactions, local findings, neuseavomiting, gastric irritation) were recorded. Results: Demographig variables, duration of surgery and initial pain intensity in each group were similar. There were no significant difference in hematological and biochemical parameters between groups. Also there were no significant differences between groups with respect to VAS, HR and MAP in any measurement and we did not observe any local reaction or systemic adverse effect. Conclusion: Intravenous paracetamol is a safe and well tolerable agent as a postoperative analgesic in its long term, ceiling dose (4 g/day, 2 days) use. 645 PRECLINICAL TESTING OF BETA-CYCLODEXTRINE MELOXICAM IN EXPERIMENTAL PAIN MODELS M. Janovsky ° , T. Dolezal, M. Krsiak. Dep. of Pharmacology, 3rd Faculty of Medicine, Prague, Czech Republic Objective: The aim of the study was to evaluate and compare the analgesic efficacy of the pure meloxicam and meloxicam associated with betacyclodextrine (BCD). Methods: Two groups (n = 6) of rats were treated perorally with meloxicam and BCD meloxicam at the dose of 3 mg/kg, one group was control. Analgesic efficacy was evaluated as a reaction time to the thermal nociceptive impulse (plantar test), after 1% carrageenan injection to the hindpaw. The same design was used at the dose of 10 mg/kg. In the second part, the efficacy of meloxicam and BCD meloxicam in the abdominal visceral pain was evaluated. Four groups of mice (n = 6) received the intraperitoneal injection of 6% acetic acid and the number of writhes was counted (writhing test) in 20 minutes (5-min intervals). The doses of 1 mg/kg, 7 mg/kg and 15 mg/kg of meloxicam and BCD meloxicam were administered perorally in the three groups, one group was control. Results: In the rats plantar test, BCD meloxicam (3 mg/kg) showed increased analgesic efficacy, compared to meloxicam, with significant difference versus control in fourth hour (P < 0.05). 10 mg/kg BCD meloxicam showed significant difference versus control in third, fourth and fifth hour after drug administration (P < 0.05). In mice, 7 mg/kg and 15 mg/kg BCD meloxicam showed the significant difference versus control. Conclusions: The present results suggest that association with betacyclodextrine improves the analgesic efficacy of meloxicam. This may be mediated by improved systemic bioavailability after oral administration. Acknowledgements: VZ MSM0021620816 and GAUK/74/2005/C/3.LF.
S169 646 ANALGESIC EFFECTS OF RECTAL ACETAMINOPHEN IN PEDIATRIC DAY CASE SURGERY M. Seyyed Hejazie, L. Kalami ° . Anesthesiology, Medical Faculty, Children General Hospital, Tabriz, Iran Pain is an unsepratable complication of surgery which can induces acute and chronic effects if it isn’t controled. Acetaminophen is one of the drugs which is available in rectal, oral and intravenous forms. The aim of this study is to evaluate the effect of rectal Acetaminophen in postoperative pain control which leads to reduction in surgical complications and hospital costs. 100 patients 2−8 yr, ASA = 1.2 were selected. All of patients were evaluated in parameters such as arterial blood pressur, respiratory rate, heart rate and O2 saturation, before, during and every 5 minutes during and after operation. Pain evaluation was performed according to a pain scoring system in which 5 and more score was interpreted pain. 50 cases received rectal Acetaminophen 40 mg/kg after anesthesia induction, 50 cases received caudal bupivacaine /25%. Furthermore pain evaluation was performed according to pain scoring system in which 5 & more score was interpreted pain. The hemodynamic changes, between two groups every five minuts during & after operation were significantly different (p < 0.05). Caudal group required significantly less supplementary analgesia after operation (p = 0.0001). Many studies show close relationship between dose of rectal Acetaminophen and reduction of pain score, they indicate that high and repeatitive doses are effective in pain relief. Our study didn’t prove effect of Acetaminophen in postoperative pain reduction, however different parameters such as dose of drug, route of prescription and site of surgery affect postoperative pain. In our study caudal analgesia preferred to rectal acetaminophen.
647 A RANDOMIZED COMPARISON BETWEEN LORNOXICAM (P.OS) AND PARECOXIB (IV) FOR POSTOPERATIVE ANALGESIA AFTER LAPAROSCOPIC CHOLECYSTECTOMY (LC) V.S. Panaretou, I.K. Kouroukli ° , V. Tsekoura, A. Papadima, S. Hadjilia, A. Louizos, L. Georgiou. Hippocratio General Hospital of Athens, Greece Aim: To compare the efficacy of lornoxicam p.os and parecoxib iv for postoperative analgesia in patients undergoing LC. Material and Methods: 69 patients, scheduled for elective LC were randomized to receive either lornoxicam 8 mg p.os 1 hour before the operation, group A (n = 33), or parecoxib 40 mg iv after induction of anesthesia, group B (n = 36). All patients received pethidine 1 mg/kg im 1 hour before the end of operation and pantoprazole 40 mg x 2 iv. Twelve hours after the first dose: group A received lornoxicam 8 mg p.os, while group B received parecoxib 40 mg iv. All patients received pethidine 1 mg/kg every 6 hours, and paracetamol 1 gr iv – as rescue analgesic dose – when VAS > 4 (max 4 times/24h). We recorded pain score (VAS 0−10) 20 minutes, 6, 12 and 24 hours postoperatively, paracetamol consumption during the first 24 hours and presence of gastric complaints. T-test was used for statistical analysis. Results: There were no differences in patients demographics between the groups. We recorded a statistically significant difference in pain score 6 hours postoperatively with a significant reduction in group B(VASA 3.52±1.6 vsVASB 2.64±1.66) p = 0.029. No other differences were observed neither in pain score nor in paracetamol consumption between the groups. 3 patients in group A and 2 in group B had minor gastric events over the first 6 hours. Conclusion: Supplemental administration of lornoxicam p.os or parecoxib iv succeeded safe and sufficient postoperative analgesia for LC. The difference in pain score 6 hours postoperatively is probably due to the difference in t1/ 2 half life time between them.
Background and Aims: The aim of this study is the evaluation of adverse events like heamodynamic parameters and hepatic, renal and coagulation disturbances in postoperative analgesia with intravenous paracetamol therapy for 48hours. Methods: Patients who were undergoing laminectomy and not have renal, gastric, hepatic and coagulation disturbances were included in this study. Analgesic management was standardized in all patients during anaesthesia. In group T (n = 15) patient controlled analgesia (PCA) with tramadol, in group T+P (n = 15) the same PCA protocol and 1 gr.100 ml−1 paracetamol IV infusion, at every 6 hours for 2 days were administered. Preoperatively, postoperatively and at the end of second day, prothrombin time, activated thromboplastin time, thrombocyte-leucocyte count, urea, kreatinine, aspartate aminotransferase, alanine aminotransferase and blood glucose were measured. Mean blood pressure (MBP), heart rate (HR), visual analog scale (VAS) and adverse effects (allergic reactions, local findings, neuseavomiting, gastric irritation) were recorded. Results: Demographig variables, duration of surgery and initial pain intensity in each group were similar. There were no significant difference in hematological and biochemical parameters between groups. Also there were no significant differences between groups with respect to VAS, HR and MAP in any measurement and we did not observe any local reaction or systemic adverse effect. Conclusion: Intravenous paracetamol is a safe and well tolerable agent as a postoperative analgesic in its long term, ceiling dose (4 g/day, 2 days) use. 645 PRECLINICAL TESTING OF BETA-CYCLODEXTRINE MELOXICAM IN EXPERIMENTAL PAIN MODELS M. Janovsky ° , T. Dolezal, M. Krsiak. Dep. of Pharmacology, 3rd Faculty of Medicine, Prague, Czech Republic Objective: The aim of the study was to evaluate and compare the analgesic efficacy of the pure meloxicam and meloxicam associated with betacyclodextrine (BCD). Methods: Two groups (n = 6) of rats were treated perorally with meloxicam and BCD meloxicam at the dose of 3 mg/kg, one group was control. Analgesic efficacy was evaluated as a reaction time to the thermal nociceptive impulse (plantar test), after 1% carrageenan injection to the hindpaw. The same design was used at the dose of 10 mg/kg. In the second part, the efficacy of meloxicam and BCD meloxicam in the abdominal visceral pain was evaluated. Four groups of mice (n = 6) received the intraperitoneal injection of 6% acetic acid and the number of writhes was counted (writhing test) in 20 minutes (5-min intervals). The doses of 1 mg/kg, 7 mg/kg and 15 mg/kg of meloxicam and BCD meloxicam were administered perorally in the three groups, one group was control. Results: In the rats plantar test, BCD meloxicam (3 mg/kg) showed increased analgesic efficacy, compared to meloxicam, with significant difference versus control in fourth hour (P < 0.05). 10 mg/kg BCD meloxicam showed significant difference versus control in third, fourth and fifth hour after drug administration (P < 0.05). In mice, 7 mg/kg and 15 mg/kg BCD meloxicam showed the significant difference versus control. Conclusions: The present results suggest that association with betacyclodextrine improves the analgesic efficacy of meloxicam. This may be mediated by improved systemic bioavailability after oral administration. Acknowledgements: VZ MSM0021620816 and GAUK/74/2005/C/3.LF.
S169 646 ANALGESIC EFFECTS OF RECTAL ACETAMINOPHEN IN PEDIATRIC DAY CASE SURGERY M. Seyyed Hejazie, L. Kalami ° . Anesthesiology, Medical Faculty, Children General Hospital, Tabriz, Iran Pain is an unsepratable complication of surgery which can induces acute and chronic effects if it isn’t controled. Acetaminophen is one of the drugs which is available in rectal, oral and intravenous forms. The aim of this study is to evaluate the effect of rectal Acetaminophen in postoperative pain control which leads to reduction in surgical complications and hospital costs. 100 patients 2−8 yr, ASA = 1.2 were selected. All of patients were evaluated in parameters such as arterial blood pressur, respiratory rate, heart rate and O2 saturation, before, during and every 5 minutes during and after operation. Pain evaluation was performed according to a pain scoring system in which 5 and more score was interpreted pain. 50 cases received rectal Acetaminophen 40 mg/kg after anesthesia induction, 50 cases received caudal bupivacaine /25%. Furthermore pain evaluation was performed according to pain scoring system in which 5 & more score was interpreted pain. The hemodynamic changes, between two groups every five minuts during & after operation were significantly different (p < 0.05). Caudal group required significantly less supplementary analgesia after operation (p = 0.0001). Many studies show close relationship between dose of rectal Acetaminophen and reduction of pain score, they indicate that high and repeatitive doses are effective in pain relief. Our study didn’t prove effect of Acetaminophen in postoperative pain reduction, however different parameters such as dose of drug, route of prescription and site of surgery affect postoperative pain. In our study caudal analgesia preferred to rectal acetaminophen.
647 A RANDOMIZED COMPARISON BETWEEN LORNOXICAM (P.OS) AND PARECOXIB (IV) FOR POSTOPERATIVE ANALGESIA AFTER LAPAROSCOPIC CHOLECYSTECTOMY (LC) V.S. Panaretou, I.K. Kouroukli ° , V. Tsekoura, A. Papadima, S. Hadjilia, A. Louizos, L. Georgiou. Hippocratio General Hospital of Athens, Greece Aim: To compare the efficacy of lornoxicam p.os and parecoxib iv for postoperative analgesia in patients undergoing LC. Material and Methods: 69 patients, scheduled for elective LC were randomized to receive either lornoxicam 8 mg p.os 1 hour before the operation, group A (n = 33), or parecoxib 40 mg iv after induction of anesthesia, group B (n = 36). All patients received pethidine 1 mg/kg im 1 hour before the end of operation and pantoprazole 40 mg x 2 iv. Twelve hours after the first dose: group A received lornoxicam 8 mg p.os, while group B received parecoxib 40 mg iv. All patients received pethidine 1 mg/kg every 6 hours, and paracetamol 1 gr iv – as rescue analgesic dose – when VAS > 4 (max 4 times/24h). We recorded pain score (VAS 0−10) 20 minutes, 6, 12 and 24 hours postoperatively, paracetamol consumption during the first 24 hours and presence of gastric complaints. T-test was used for statistical analysis. Results: There were no differences in patients demographics between the groups. We recorded a statistically significant difference in pain score 6 hours postoperatively with a significant reduction in group B(VASA 3.52±1.6 vsVASB 2.64±1.66) p = 0.029. No other differences were observed neither in pain score nor in paracetamol consumption between the groups. 3 patients in group A and 2 in group B had minor gastric events over the first 6 hours. Conclusion: Supplemental administration of lornoxicam p.os or parecoxib iv succeeded safe and sufficient postoperative analgesia for LC. The difference in pain score 6 hours postoperatively is probably due to the difference in t1/ 2 half life time between them.