No description available.

Innerhalb der ersten zwei postoperativen Tage nach einer Knieprothesenimplantation zeigt der „Würzburger Schmerztropf“ den geringsten Verbrauch an Ausweichmedikation bei vergleichbarer Schmerzintensität und hoher Patientenzufriedenheit. Parecoxib zeichnete sich aufgrund der tendenziell selteneren unerwünschten Arzneimittelwirkungen aus und gewährleistet aufgrund der standardisierten Applikationszeit eine einfache Handhabung durch das Pflegepersonal. Andererseits benötigten die Patienten, die Parecoxib erhielten, mehr Ausweichmedikation und wiesen eine höhere Rate an Studienabbrüchen auf. Ebenso war im Vergleich der drei Studienarme der Blutverlust in der Parecoxib-Gruppe höher. Anhand unserer Studienergebnisse können wir keine eindeutige Therapieempfehlung rechtfertigen. / Within the first two days after total knee arthroplasty the pain therapy with the Wuerzburg pain drip showed the fewest usage of rescue medication with a comparable pain intensity pain satisfaction. Parecoxib showed a better profile of unwanted side effects and the standardized timing of application makes its usage for the nurse stuff easier. On the other hand the parecoxib group showed a hiher consumption of rescue medication and a hiher drop out rate. The blood loss was also hiher in the parecoxib group compared to both alternative treatments. Based on our study results no tratment recommendation can be given.

Thesis (M Med(Otorhinolaryngology)) -- University of Limpopo, 2011. / Background: Tonsillectomy is one of the commonest operations performed by ENT surgeons. Pain, haemorrhage, delayed feeding and resumption of normal activities are common morbidities. Different groups of analgesics are used to reduce these morbidities. Objective: We examined the effectiveness of the use of three analgesics, some in combinations in reducing these morbidities. The primary outcome measures were pain, resumption of normal diet, resumption of normal physical activities and secondary haemorrhage. The secondary outcome was comparison of pain profile of children and adults. Methods: A prospective randomized double blind controlled study. Subjects were recruited and randomized into three study groups; group A (Paracetamol & Ibuprofen), group B (Ibuprofen) and group C (Paracetamol, Ibuprofen & Tilidine). A diathermy dissection technique was used on all patients in removing tonsils. Pain was measured using a patient morbidity scoring form (PMS) as well as the Smiley scale. The care givers for children and adult patients recorded all other events. Results: Sixty five patients were recruited, 30 were in group A, 20 in group B and 15 in group C. There were 36 females and 29 males. The youngest patient was 4 years of age and the oldest was 38 years. The mean number of days prior to resuming normal daily activities for groups A, B and C was 9.27, 10.60 and 7.67 respectively. Group C patients started their daily activities earlier than those in group B (p≤0.05). The average number of days to stop analgesic use was 12.3, 13.3 and 10.6 for groups A, B and C respectively. Patients in group C stopped using analgesics earlier than group B patients (p≤0.05). There was no statistically significant difference in PMS scores, resumption of normal diet, post-tonsillectomy haemorrhage as well as pain profiles of adults and children. Conclusion: Paracetamol-ibuprofen-tilidine combination appears to be more effective than either paracetamol-ibuprofen combination or ibuprofen in the first two weeks in the treatment of post tonsillectomy pain (p>0.05), however, further studies will have to be carried out to confirm this. Patients treated with a paracetamol-ibuprofen-tilidine combination appear to stop medication and return to their normal daily activities much earlier (p ≤ 0.05). Minor haemorrhage from the use of ibuprofen following tonsillectomy was not a cause for concern.

Erlangen, Nürnberg, Universiẗat, Diss., 2008. / Enth. 1 Sonderabdr. aus: Pain. 2007. - Beitr. teilw. dt., teilw. engl.

>Magister Scientiae - MSc / When used at the recommended and approved therapeutic dose, paracetamol is effective. Paracetamol is available in various forms and easily accessible from general dealers and pharmacies. The liquid form is the preferred form given with a device to children. Paracetamol is effective within a defined therapeutic range; however, are prescribers and caregivers using paracetamol as authorised by regulators? A qualitative review of product specific labelling and the department of health recommendations was conducted and evaluated by means of arithmetic means differences to the regulator requirements. Surveys of healthcare professionals and caregivers determined the quantity administered and to establish if a device was used. The dosing information from product specific labelling, the department of health and the regulator source were reviewed for recommended dose, frequency of administration, maximum daily dose and recommendations for overdose treatment. There are similarities and differences with the null hypothesis being proven. Product labelling and department of health recommendations do not conform to the regulator accepted therapeutic dose. There was no unambiguous legislative medicine guideline on the age of a child with children between six and twelve being underdosed with liquid paracetamol in terms of volume and strength.

No description available.

Paracetamol is the most common drug taken in overdose in the UK. Although it has been used in overdose for about 50 years, there are many aspects of its toxicity and treatment that are not fully understood. In this thesis a series of related studies on paracetamol overdose are reported. The nephrotoxic effects of paracetamol in overdose have long been recognised. To better understand the mechanisms of this effect the effect of acute paracetamol overdose on plasma electrolytes were investigated, both retrospectively and, more intensively, prospectively. The results of these studies showed paracetamol overdose is associated with dose-related hypokalemia, and kaliuresis of short duration (<24h), suggesting a specific renal effect of paracetamol in overdose, perhaps via cyclo-oxygenase inhibition. This effect seems distinct from any nephrotoxic effect of paracetamol. In the third study the possible impact of features at admission, including renal impairment, on outcomes in a large cohort of patients who developed severe liver injury following paracetamol overdose was evaluated retrospectively. The key finding was that plasma creatinine, and gamma glutamyl transpeptidase, at first admission appeared to be useful predictors of poor outcome. The last three studies focus on antidote treatment of paracetamol overdose. Intravenous acetylcysteine (NAC) has been used as treatment of choice for over 30 years in patients who are at risk of hepatotoxicity. There are reports of liver failure and death in patients who have “non-toxic” plasma paracetamol concentrations on the UKL nomogram, and who are therefore not treated. To better understand this, the frequency of liver failure in patients who had low paracetamol was assessed by examining retrospective data from the Scottish Liver Unit over a 12-year period. Similar data was collected in the University of Newcastle upon Tyne by colleagues there. Only a small percentage of patients developed hepatotoxicity when initial paracetamol was low. It was concluded that on a cost-benefit basis the current thresholds for antidote treatment should not be lowered. The final 2 studies examine adverse reactions (ADRs) to NAC, a common clinical problem. The pattern and mechanisms of ADRs in man are not well described or understood. Factors influencing the frequency of adverse effects were studied in a prospective manner. Paracetamol concentration and male gender were protective and family history of allergy was a risk factor for adverse effects in this cohort. In a smaller focussed study the roles of histamine and other biomarkers as underlying pathophysiological mechanisms in ADR occurrence were studied. The severity of ADRs correlated with the extent of histamine release, which was independent of tryptase increase, suggesting a non-mast cell source. The mechanisms by which paracetamol might lessen histamine release require further investigation.

No description available.

Avdelningen för klinisk kemi vid Länssjukhuset i Kalmar analyserar läkemedel och alkoholer med BD Vacutainer® Plus Plastic Serum Tube (Serum Tube), som kräver en koagulationstid i upp till 60 minuter. BD Vacutainer® Rapid Serum Tube (RST™) innehåller trombin och kräver en koagulationstid på endast 5 minuter. Syftet med studien var att undersöka möjligheten att förkorta den preanalytiska väntetiden före centrifugering vid intoxikationsanalyser i serumrör från akutmottagningen. Studien utfördes genom att jämföra RST™ med Serum Tube vid analys av S-Paracetamol och S-Etanol. Totalt analyserades 70 prover för S-Paracetamol, varav 35 RST™ och 35 Serum Tube från 35 patienter. Analys av S-Etanol utfördes på 60 prover, varav 30 RST™ och 30 Serum Tube från 30 patienter. RST™ centrifugerades efter 5 minuter och Serum Tube efter 50 minuter, före kolorimetrisk analys på analysinstrumentet VITROS® 5,1 FS. Resultaten för S-Paracetamol var inom intervallet 74,9 – 198,7 µmol/L för RST™ och inom 76,6 – 195,3 µmol/L för Serum Tube. Resultaten för S-Etanol var inom intervallet 7,5 – 74,5 mmol/L för RST™ och inom 7,5 – 74,8 mmol/L för Serum Tube. Pearsons korrelationskoefficient var 0,9977 för S-Paracetamol och 0,9980 för S-Etanol och det fanns en liten positiv bias vid analys med RST™ för båda analyterna, men ingen signifikant skillnad (p&gt;0,05) mellan provrören påvisades. Användning av RST™ på akutmottagningen medför en förkortad preanalytisk väntetid och en snabbare turnaround time (TAT). Hypotesen att S-Paracetamol och S-Etanol kan analyseras med RST™ på VITROS® 5,1 FS stämmer, med undantag för höga koncentrationer av S-Paracetamol som inte kunde utvärderas. För att RST™ ska kunna användas rutinmässigt bör därför ytterligare studier utföras.

Due to the detrimental side effects of NSAID administration, such as gastrointestinal ulceration and renal papillary necrosis, there is a profound need for clinical pain relief in horses with long term orthopedic disease whereby gastrointestinal side effects are obviated. Acetaminophen is one of the most commonly used analgesic drugs in humans, and is readily available as an inexpensive generic over-the-counter preparation. Acetaminophen has a number of mechanisms of action that differ from NSAIDs, including actions on the serotonergic, opioid, endocannabinoid and lipoxygenase pathways. These alternate pathways may provide greater efficacy against chronic or neuropathic pain in equine patients. Acetaminophen was preferred by physicians over COX-2 and nonselective NSAIDs, even when those drugs were coupled with proton-pump inhibitors to reduce gastrointestinal side effects; due to cost considerations and the occurrence of adverse side effects from those drugs. In horses, acetaminophen has been reported to be efficacious as an adjunct treatment for laminitis in one pony, and was an effective analgesic agent when combined with NSAIDs in a model of inducible foot pain. However, no studies have been performed to validate a dose-response curve in horses. A study recently completed by our group demonstrated rapid absorption following oral administration of acetaminophen. Reported human therapeutic plasma concentrations were achieved within 30 minutes of administration, with no clinical or clinicopathologic evidence of adverse side effects after two weeks of repeated dosing. Dose simulation trials indicate that a change in dosage schedule may be required in order to provide adequate plasma concentrations. / Master of Science / The use of non-steroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone in horses is widespread, and can be associated with detrimental side effects such as gastrointestinal ulceration and kidney damage. The clinical need for pain relief in horses with long-term lameness that minimizes gastrointestinal side effects has led to the development of cyclooxygenase-2 (COX-2) selective NSAIDs, such as firocoxib, but the expense of this therapy is often a major consideration limiting its use and few alternatives are available. Acetaminophen is one of the most commonly used analgesic drugs in humans, and is readily available as an inexpensive generic over-the-counter preparation. Despite the lower efficacy of acetaminophen in trials of human patients with chronic osteoarthritis, acetaminophen remains the preferred analgesic in humans due to its increased tolerance and improved cost-benefit analysis when compared to nonselective and COX2 selective NSAIDs. Acetaminophen has a number of mechanisms of action that differ from the current mainstays of equine analgesic therapy, which may provide greater efficacy against chronic or neuropathic pain in equine patients. A recent study of acetaminophen in horses has shown rapid absorption and achievement of levels reported to be therapeutic in humans, with no adverse side effects after two weeks of repeated dosing. In horses, acetaminophen has demonstrated efficacy as an adjunct treatment for laminitis in one pony, and was an effective analgesic agent when combined with NSAIDs in a model of inducible foot pain.