Normal postoperative gastric emptying after orthopaedic surgery with spinal anaesthesia and i.m. ketorolac as the first postoperative analgesic

Petring, O. U.; Dawson, Peter J.; Blake, D.; Jones, David J.; Bjorksten, Andrew R.; Libreri, F. C.; Leadbeater, Maria

doi:10.1093/bja/74.3.257

Cited by 32 publications

(15 citation statements)

References 14 publications

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“…The absence of a delaying effect on upper g.i. Postoperative analgesia with intramuscular morphine significantly slowed gastric emptying and delayed resolution of postoperative ileus by impairing colonic motility compared with ketorolac in two separate studies [34,351. This is in contrast to morphine, which has several antipropulsive effects in the upper and lower g.i.…”

Section: Discussionmentioning

confidence: 98%

The analgesic tramadol has minimal effect on gastrointestinal motor function

Wilder‐Smith

Bettiga

1997

Brit J Clinical Pharma

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Aims The analgesic tramadol, an opioid agonist and monoaminergic reuptake blocker, has been assumed to interfere less with gastrointestinal motor function than other opioid analgesics, but this has not been specifically investigated. In this study we examined the effect of tramadol on variables of gastrointestinal motor fimction. Methods Ten healthy volunteers participated in a two-arm, placebo-controlled, double-blind, randomized, cross-over study comparing tramadol 50 mg and placebo solutions given four times a day for 10 days. Oro-caecal (lactulose H,-breath test) and colonic (solid markers) transit times and anal sphincter pressures were measured after 10 days dosing. ResultsMehan oro-caecal transit time was 90 min (interquartile range: 75-105) with placebo and 90 min (60-105) with tramadol (not signlficant). The mehan total colonic transit time increased from 45.6 h (25.2-64.8) with placebo to 58.8 h (50.4-78.0) with tramadol (not significant), which is still withm the normal range ( < 60 h). Anal sphincter resting pressures were not significantly changed by tramadol compared with placebo.Concfrrsions Tramadol has a minor delaying effect on colonic transit, but no effect on upper gastrointestinal transit or gut smooth muscle tone. Tramadol may be a useful analgesic where interference with gut motor function is undesirable.

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Section: Discussionmentioning

confidence: 98%

The analgesic tramadol has minimal effect on gastrointestinal motor function

Wilder‐Smith

Bettiga

1997

Brit J Clinical Pharma

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“…While surgical intervention itself is well understood to cause decreased gastrointestinal motility and delayed gastric emptying, it has been shown that opioid analgesics, 32–34 the fasting state, 35 and supine positioning 36 all independently contribute to delayed gastric emptying. In a recent United Kingdom study 7 comparing preoperative IV or PO acetaminophen 1,000 mg given preoperatively to patients undergoing surgery produced significantly different postoperative PK results, where the PO group experienced inadequate plasma levels for producing an effective pain response as compared to the therapeutic levels seen in the IV group.…”

Section: Discussionmentioning

confidence: 99%

Plasma and Cerebrospinal Fluid Pharmacokinetic Parameters After Single‐Dose Administration of Intravenous, Oral, or Rectal Acetaminophen

et al. 2012

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Background: This is the first study to compare plasma and cerebrospinal fluid (CSF) pharmacokinetics of intravenous (IV), oral (PO), or rectal (PR) formulations of acetaminophen. Methods: Healthy male subjects (N = 6) were randomized to receive a single dose of IV (OFIRMEV Ò ; Cadence) 1,000 mg (15 minute infusion), PO (2 Tylenol Ò 500 mg caplets; McNeil Consumer Healthcare), or PR acetaminophen (2 Feverall Ò 650 mg suppositories; Actavis) with a 1-day washout period between doses. The 1,300 mg PR concentrations were standardized to 1,000 mg. Acetaminophen plasma and CSF levels were obtained at T0, 0.25, 0.5, 0.75, 1, 2, 3, 4, and 6 hours.Results: IV acetaminophen showed earlier and higher plasma and CSF levels compared with PO or PR administration. CSF bioavailability over 6 hours (AUC 0-6 ) for IV, PO, and PR 1 g was 24.9, 14.2, and 10.3 lgAEh/mL, respectively. No treatment-related adverse events were reported. One subject was replaced because of premature failure of his lumbar spinal catheter. The mean CSF level in the IV group was similar to plasma from 3 to 4 hours and higher from 4 hours on. Absorption phase, variability in plasma, and CSF were greater in PO and PR groups than variability with IV administration.Conclusions: These results demonstrate that earlier and greater CSF penetration occurs as a result of the earlier and higher plasma peak with IV administration compared with PO or PR. n

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“…It has been used in many contexts including healthy volunteers [8,9], cardiac patients [11], patients with severe burns [12], and head injury [13], and in other anaesthetic related studies [14][15][16][17]. The paracetamol absorption test is based upon pharmacokinetic evidence [8] that paracetamol is not absorbed in the stomach but is rapidly absorbed from the small intestine after passage through the pylorus.…”

Section: Discussionmentioning

confidence: 99%

A model of gastric emptying using paracetamol absorption in intensive care patients

Tarling

Toner

Withington

et al. 1997

Intensive Care Medicine

152

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The results suggest that there is a wide range in gastric emptying in critically ill patients. The results may be due to the case mix of the patients. The use of dopamine may adversely affect gastric emptying and requires further investigation in the ICU patient. Prediction of gastric emptying is difficult in these patients and further investigation is necessary in order to improve our understanding of this process.

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Normal postoperative gastric emptying after orthopaedic surgery with spinal anaesthesia and i.m. ketorolac as the first postoperative analgesic

Cited by 32 publications

References 14 publications

The analgesic tramadol has minimal effect on gastrointestinal motor function

The analgesic tramadol has minimal effect on gastrointestinal motor function

Plasma and Cerebrospinal Fluid Pharmacokinetic Parameters After Single‐Dose Administration of Intravenous, Oral, or Rectal Acetaminophen

A model of gastric emptying using paracetamol absorption in intensive care patients

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