Aims Multimodal analgesia is thought to produce balanced and effective postoperative pain control. A combined therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and opiates could result in synergistic analgesia by acting through different mechanisms. Currently there are very few parenterally administered NSAIDs suitable for the immediate postoperative period. Therefore, this study was undertaken to assess the analgesic efficacy, relative potency, and safety of parenteral dexketoprofen trometamol following major orthopaedic surgery. Methods One hundred and seventy-two patients elected for prosthetic surgery, were randomized to receive two intramuscular injections (12 hourly) of either dexketoprofen 50 mg, ketoprofen 100 mg or placebo in a double-blind fashion. Postoperatively, the patient's pain was stabilized, then they were connected to a patientcontrolled analgesia system (PCA) of morphine for 24 h (1 mg with 5 min lockout). Results The mean cumulative amount of morphine (CAM) used was of 39 mg in the dexketoprofen group and 45 mg in the ketoprofen group vs 64 mg in the placebo group. (Reduction in morphine use was approximately one-third between the active compounds compared with placebo (adjusted mean difference of -25 mg between dexketoprofen and placebo and -23 mg between ketoprofen and placebo. These differences were statistically significant: P £ 0.0003; 95% CI -35, -14. Painintensity scores were consistently lower with the active compounds, the lowest corresponded to the dexketoprofen-treated patients. Regarding sedation, there were statistically significant differences between the two active compounds and placebo only at the 2nd and 13th hours. Wound bleeding was specifically measured with no statistically significant differences found between all the groups. Conclusions Intramuscular administration of dexketoprofen trometamol 50 mg has good analgesic efficacy both in terms of opioid-sparing effect and control of pain after major orthopaedic surgery.
Nasal sprays, which work on the Venturi principle, have the disadvantage of suck-back which makes them unhygienic for use in more than one patient. In Wrexham we have developed a disposable nasal spray system, which is safe and would be of benefit to other ENT departments.
SummaryIn six maternity hospitals 516 mothers during labour received 50% nitrous oxide and 50% oxygen (Entonox)
Key wordsAnalgesia; inhalational, obstetrics. Anaesthetics, gases; nitrous oxide.A previous study,' under controlled conditions, of 50% nitrous oxide with 50% oxygen (Entonox) administered continuously at 5 litres/minute through a nasal catheter as a supplement to intermittent self-administered Entonox showed improved relief of pain during labour. Mothers who received nasal Entonox reached near equilibrium with inspired nitrous oxide concentrations more quickly than those without the supplement. It was therefore decided to examine the acceptance of a nasal Entonox supplement by a large number of mothers and their supervisory midwives.
MethodsSix maternity hospitals took part in the trial. The hospitals were visited before beginning the trial and the investigations and the purpose of the trial explained to the midwifery staff. The hospitals were also visited regularly by a research nurse who collected the questionnaires and resolved any problems during the conduct of the trial.The mothers studied were those who were offered Entonox according to the practice of the hospital. No mother was compelled to use either self-administered Entonox or the nasal Entonox and was free to stop using this form of analgesia at any time. Two groups of mothers in each hospital were compared; those receiving selfadministered Entonox and those receiving selfadministered Entonox with continuous nasal Entonox supplied from an Entonox flowmeter at 5 litres/minute through a catheter in one nostril.* * The catheters are available from Unoplast (UK) Ltd., Manor Road, Colchester, Essex, C03 3LX.
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