The Effect of Transdermal Nitroglycerin on Spinal S(+)-Ketamine Antinociception Following Orthopedic Surgery

The combination of epidural clonidine and S(+)-ketamine did not enhance analgesic efficacy beyond that for each individual drug in adult orthopedic surgery

“…Nevertheless, the results from this study demonstrated that small doses of either epidural clonidine or S(+)-ketamine alone resulted in antinociception in adult surgery, in accordance with other studies [9,12]; the association of both drugs did not result in a greater analgesic effect in the model of acute postoperative pain studied. When we consider the time to reach Bromage 2 as the initial time for analgesia, whereas either 0.5 lg of epidural clonidine or 0.1 mg/kg of epidural S(+)-ketamine resulted in an extra 180 minutes of analgesia compared with 40 minutes in CG, the combination of both epidural drugs in the same doses resulted in 240-minute analgesic period, which was not statistically significant and was not clinically important in the adult population evaluated.…”

“…The number of subjects and the epidural doses used were based on preliminary data [12,13]. We hypothesized that either epidural 0.5 lg/kg clonidine or 0.1 mg/kg S(+)-ketamine would increase the time to first rescue analgesic by 50% compared with CG in the population studied.…”

“…In the present study, we decided to use small-dose epidural S(+)-ketamine based on previous data from the literature [2,12,20]. Because of the distinct sites of action of S(+)-ketamine and clonidine in central nociceptive pathways, any synergistic effect would be evident from the choice of doses in this study.…”

Transdermal nitroglycerine enhances the post-operative analgesic effect of intrathecal clonidine in abdominal hysterectomies

“…[10] tNTG also enhances the antinociceptive effect of epidural S (+) ketamine. [11] In the present study, tNTG along with IT bupivacaine delayed the time to rescue analgesia but it did not change the requirement of IM diclofenac injections significantly as compared with bupivacaine alone.…”

The analgesic effect of three different doses of nitroglycerine when added to lidocaine for intravenous regional anesthesia in trauma patients

“…[22,23] NTG was found to be beneficial in the treatment of shoulder pain, [24] chronic thoracotomy pain [25] and thrombophlebitis [26] and for augmenting the effect of spinal sufentanil or neostigmine, [27] or epidural S(+)-ketamine. [28] In these investigations, the analgesic effects of transdermal NTG were investigated, while in our study, the efficiency of IV NTG was documented with the mechanism similar to that of transdermal NTG.…”