Analgesic Preparations Research Articles

The Therapeutic Potential of Transdermal Gabapentin in the Symptomatic Management of Chronic Neuropathy

Standard pharmacotherapeutic options in the management of neuropathic pain are often poorly tolerated due to various contraindications, drug interactions, and troublesome adverse events. The investigation and pharmaceutical development of localized anti-neuropathic options is increasing among researchers and manufacturers, but results have not yet determined the role in therapy of transdermal/locally acting analgesics, anti-neuropathics, and anti-inflammatories. Compounding Pharmacies and FDA 503b Outsourcing Facilities aid in this critical endeavor through endogenous compounding and manufacturing (respectively) of transdermal analgesic formulations. This review summarizes the currently available clinical data supporting the implementation of transdermal gabapentin preparations in the management of chronic neuropathic symptoms. Transdermally applied analgesic, anti-inflammatory, and anti-neuropathic preparations are crucial in the development of pain management modalities which reduce the risk of numerous well-known complications, including drug-drug interactions, conflicting patient comorbidities, and CNS depressant effects. The adjunctive treatment of neuropathy with a transdermal analgesic/antispasmodic preparation remains under-investigated, and the role of these preparations in the management of chronic neuropathic pain remains unclear.

Effectiveness of Gel from Andaliman Fruit (Zanthoxylum acanthopodium DC.) Extract on Wound Inflammation.

&lt;b&gt;Background and Objective:&lt;/b&gt; Pain is caused by damaged tissue on the outside or inside of an organ and it is regulated by chemicals. Synthetic drugs are used to ease pain because they are analgesics in the field of medicine. Traditional medicine is known to help people all over the world, in both rich and developing nations. The Andaliman fruit, or &lt;i&gt;Zanthoxylum acanthopodium&lt;/i&gt; DC., comes from a spice plant that grows naturally in Toba Regency, North Sumatra, Indonesia. This study aims to determine the formulation of the nanoherbal analgesic spray gel preparation of Andaliman fruit (&lt;i&gt;Zanthoxylum acanthopodium&lt;/i&gt; DC.) in terms of its effectiveness as a pain reliever. &lt;b&gt;Materials and Methods:&lt;/b&gt; There were three amounts of spray gel made, namely 5, 10 and 15% and tests were done to see how well they worked. &lt;i&gt;Staphylococcus aureus&lt;/i&gt; bacteria were used in the bacterial blocking test. To test how well painkillers worked, five groups of mice were used. Using a hot iron, tests for anti-inflammatory activity and wound healing were done. The tissue was then watched for 14 days and analysed using Hematoxylin and Eosin (H&E) stains. &lt;b&gt;Results:&lt;/b&gt; The 15% concentration reduces pain and the time it takes for the body to respond to it. The clear zone size is the same as (K&lt;sup&gt;+&lt;/sup&gt;) and it can lower the number of inflammatory cells and help wounds heal by adding fibroblast and collagen cells. These findings are supported by significant data results (p<0.05, p = 0.018). &lt;b&gt;Conclusion:&lt;/b&gt; Finally, analgesic gel spray made from the Andaliman fruit at a 15% concentration can help with pain and also be antibacterial, reduce inflammation and help wounds heal.&lt;/p&gt.

Comparative Efficacy of Analdent (Herbal Analgesic Preparation) and Aceclofenac on Pain Intensity After Tooth Extraction: A Split-Mouth Randomized Clinical Trial.

Pain management following tooth extraction is crucial in minimizing patient suffering and risk of infection and hastening the recovery. Safety issues with routinely prescribed drugs such as NSAIDs for pain management call for search of an effective and safe alternative. Advances in the field of alternative medicine have led to the use of various natural products for pain management in the field of dentistry. The aim of the study was to compare the efficacy between the analdent and aceclofenac in terms of alleviation of post-operative pain and facial swelling after extraction of tooth. A split-mouth randomized clinical trial was conducted on 22 participants in the age range of 13-25years requiring extraction of first permanent premolars for orthodontic reason. The extraction sites were randomized to receive either analdent or aceclofenac post-orthodontic extraction. Post-extraction dental pain was assessed after 8h, 24h, 48h and 72h post-operatively using a visual analog scale, and incidence of swelling was recorded. Pain score showed a significant reduction (p = 0.001) post-operatively within analdent (herbal drug) group as well as Zerodol (aceclofenac) group. However, there was no significant difference in pain intensity between the two groups at each interval. Two participants in analdent group and one participant in aceclofenac group reported swelling after 8h of extraction which subsided after cold pack application. Analdent was found to be equally effective as aceclofenac in managing pain after the tooth extraction with relatively no side effects.CTRI Registration Number: CTRI/2020/ 03/024296 dated 27/03/2020.

Pre-emptive analgesia with methylprednisolone and gabapentin in total knee arthroplasty in the elderly

The aim of this study is to assess whether administration of gabapentin and methylprednisolone as “pre-emptive analgesia” in a group of patients above 65 years of age would be effective in complex pain management therapy following total knee arthroplasty (TKA). One hundred seventy patients above 65 years were qualified for the study, with exclusion of 10 patients due to clinical circumstances. One hundred sixty patients were randomly double-blinded into two groups: the study group (80 patients) and the control group (80 patients). The study group received as “pre-emptive” analgesia a single dose of 300 mg oral (PO) gabapentin and 125 mg intravenous (IV) methylprednisolone, while the control received a placebo. All patients received opioid and non-opioid analgesic agents perioperatively calculated for 1 kg of total body weight. We measured (1) pain intensity level at rest (numerical rating scale, NRS), (2) life parameters, (3) levels of inflammatory markers (leukocytosis, C reactive protein CRP), and (4) all complications. Following administration of gabapentin and methylprednisolone as “pre-emptive” analgesia, the NRS score at rest was calculated at 6, 12 (p < 0.000001), 18 (p < 0.00004) and 24 (p = 0.005569) h postoperatively. Methylprednisolone with gabapentin significantly decreased the dose of parenteral opioid preparations (p = 0.000006). The duration time of analgesia was significantly longer in study group (p < 0.000001), with CRP values lower on all postoperative days (1, 2 days—p < 0.00001, 3 days—p = 0.00538), and leukocytosis on day 2 (p < 0.0086) and 3 (p < 0.00042). No infectious complications were observed in the first postoperative days; in the control group, one patient manifested transient ischemic attack (TIA). The use of gabapentin and methylprednisolone as a single dose decreased the level of postoperative pain on the day of surgery, the dose of opioid analgesic preparations, and the level of inflammatory parameters without infectious processes.

Evaluation of the Usefulness of Postoperative Analgesic Solution Preparation by Pharmacists in the Surgical Department

Pharmacists began preparing drug solutions intraoperatively for postoperative analgesia in the Department of Surgery at Chiba University Hospital from May 2014. To verify the usefulness of pharmacists preparing these drug solutions, we conducted a questionnaire survey among 51 anesthesiologists and received 44 responses (recovery rate 86.3%). Burden on the anesthesiologists was significantly reduced both temporally and mentally when the pharmacists prepared the drug solutions compared with when the anesthesiologists did (p<0.01). The anesthesiologists' degree of anxiety about sometimes having to prepare drug solutions alone without any confirmation was also significantly reduced when pharmacists prepared them (p<0.01), which implies the need for a double-check system. In addition, 88.6% of anesthesiologists said that they were reassured with preparations done by the pharmacists under a sterile environment using a clean bench. Overall, 88.6% of anesthesiologists responded that they were satisfied with the preparation of drug solutions by pharmacists. Based on the results of this survey, pharmacists' preparation of drug solutions for postoperative analgesia is considered to be useful in ensuring the quality and safety of medical care because it reduced anesthesiologists' work to prepare the drug solutions, allowing them to concentrate on anesthesia and related work, it established a double-check system between the two staff teams, and it was done under a sterile environment.

Repeated idiopathic anaphylaxis caused by povidone

Povidone, also known as polyvinylpyrrolidone (PVP) and E1201, is a synthetic, hydrophilic polymer used as an excipient in cosmetics, pharmaceutical products, and food. 1 Bergendorff O. Hansson C. Urticaria and anaphylaxis to povidone in a paracetamol preparation. J Eur Acad Dermatol Venereol. 2007; 21: 573-574 PubMed Google Scholar It is used as a lubricant and antiseptic in eye drops and contact lenses and is found in the disinfectant povidone iodine (Betadine, Alcon Nordic, Copenhagen, Denmark). 2 Liccioli G. Mori F. Barni S. Pucci N. Novembre E. Anaphylaxis to polyvinylpyrrolidone in eye drops administered to an adolescent. J Investig Allergol Clin Immunol. 2018; 28: 263-265 Crossref PubMed Scopus (4) Google Scholar , 3 Rönnau A.C. Wulferink M. Gleichmann E. et al. Anaphylaxis to polyvinylpyrrolidone in an analgesic preparation. Br J Dermatol. 2000; 143: 1055-1058 Crossref PubMed Scopus (36) Google Scholar , 4 Bigliardi P.L. Alsagoff S.A.L. El-Kafrawi H.Y. Pyon J.K. Wa C.T.C. Villa M.A. Povidone iodine in wound healing: a review of current concepts and practices. Int J Surg. 2017; 44: 260-268 Crossref PubMed Scopus (111) Google Scholar Allergy to povidone is rare but has been reported with increasing frequency. We present a case of allergy to povidone diagnosed after repeated allergic reactions, over several years, to chemically unrelated drugs and idiopathic exposures.

EFFECTS OF THE REGIONAL NERVE BLOCKADE AT THE LIMB REPERFUSION IN PEDIATRIC ORTHOPEDICS

Introduction. Arterial tourniquets are widely used to improve visualization of the surgical field and to reduce blood loss . However, the resulting ischemia and subsequent reperfusion make doctors seek for better options to reduce these complications. Objective. To find out how the regional nerve blockade impacts the reperfusion of ischemized limb when arterial tourniquets are removed during orthopedic surgeries in children. Material and methods. In 16 patients, who were operated on at the department of trauma and orthopedics of the Novosibirsk Children ‘s Clinical Hospital of Emergency Medical Care (CCHEMC) , surgical intervention required the application of an arterial tourniquet. These patients became participants in an observational pilot study. Patients with tourniquets were divided into two groups: Group I - had the regional nerve blockade ( 9 patients) and Group II - had no regional nerve blockade (7 patients). Parameters of acid-base homeostasis, lactate and arterial blood glucose were assessed in all patients at all stages: before surgery (stage 1), main stage (stage 2), 5 minutes after the tourniquet removal (stage 3). The following parameters were compared in this work: mean arterial pressure (MAP), mm Hg; heart rate (min-1); concentration of lactate in the arterial blood (mmol/l), glycemia (mmol/l). The obtained findings are presented as median (Me) of lower and upper quartiles [Q25; Q75]. Results. The found dynamics of lactate concentration in participants’ blood was the most significant result of the study. In Group I, where regional anesthesia was used, lactate level decreased at the stage 2 and returned to its baseline at the stage 3. In Group II (without regional anesthesia, but with a powerful central analgesic preparation) , lactate level did not change at stage 2, but significantly increased at stage 3. Conclusion. Topical anesthetic (Ropivakaine), used in the regional nerve blockade during orthopedic surgeries in children when arterial tourniquets are put, has less harmful effects in surgical aggression.

IcyHot analgesic topical cream limits cardiac injury in rodents

Little is known whether topical analgesic creams, whose natural products enter the blood stream after application, affect myocardial infarct size. Here we tested whether topical analgesic creams can trigger remote cardioprotection and the mechanism involved. Male Sprague Dawley rats were used for an in vivo rodent model consisting of 30 minutes left anterior descending coronary artery ischemia and 2 hours of reperfusion followed by infarct size assessment. The topical analgesic IcyHot, applied to the abdomen prior to ischemia, reduced myocardial infarct size versus control (41 ± 3* vs 62 ± 1, n= 6/group, *P < 0.001). In contrast, the topical analgesic creams Preparation H, Aspercreme Heat, or Tiger Balm did not alter infarct size. IcyHot, unlike Preparation H, increased circulating methyl salicylate levels during reperfusion (3.0 ± 0.6 vs 0.4 ± 0.2 mg/dL, n = 6, *P < 0.001, measured at the internal jugular vein). Methyl salicylate (10 μM) applied to isolated adult cardiac myocytes during reoxygenation reduced cell death when compared to vehicle (21% ± 2%* vs 30% ± 2% of trypan blue positive cells, n = 9/group, *P < 0.01). Further, treatment with the TRP ankyrin 1 (TRPA1) inhibitors TCS-5861528 (1 μM) or AP-18 (1 μM) blocked the methyl salicylate-induced protective effect in isolated adult cardiomyocytes. In intact rodents, either of the TRPA1 inhibitors (1 mg/kg, intravenous) given prior to IcyHot topical application blocked IcyHot-induced infarct size reduction. IcyHot also reduced infarct size when applied 24 hours prior to myocardial ischemia or during myocardial ischemia versus control. Together, these findings support IcyHot analgesic cream can trigger remote cardioprotection through releasing methyl salicylate into the bloodstream with cardioprotection occurring by a TRPA1-dependent mechanism.

Ethanolic Extract Oitment of The Graptophylum Pictum L Griff Leaves as Analgesic agent to Male White Rat

&lt;p&gt;Graptophyllum pictum L Griff Leaves in the community are used as medicinal ingredients, one of which is for analgesics. Black pudding leaves contain secondary metabolite compounds that act as suspected analgesics, namely flavonoids. The ethanolic extract of black pudding leaves has been formulated into cream and ointment preparations. The purpose of this study was to determine the effectiveness of analgesic preparations of black pudding leaves (Graptophyllum pictum L. Griff) ethanol extract in white male mice. The effectiveness of analgesics was tested using the hotplate method. The test animals used were 25 white male mice which were divided into 5 groups: negative control (F0), positive control (Ichtiol® ointment), and black pudding leaf F1 (10%), F2 (15%) ethanol extract treatment group, and F3 (20%). Observation of stretching of mice was done after the feet of mice were induced and immediately given treatment. Observation of analgesic percentage in each mouse was carried out every 5 minutes for 60 minutes. The data obtained were processed and analyzed using one-way ANOVA and Duncan test with a 95% confidence level. One-way ANOVA test results showed that there were significant differences between treatment groups (0.003 &amp;lt;0.05). The results of the average percentage of analgesic effectiveness of formula 2 have a good effect that is equal to 77.969%. Duncan's test results showed that the group that gave the best analgesic effectiveness was formula 2 (15%) comparable to positive control.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Keywords: Graptophyllum pictum, Analgesics, ointment, Hotplate.&lt;/strong&gt;&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Combined Liquid Chromatography-mass Spectrometry and Next-generation DNA Sequencing Detection of Adulterants and Contaminants in Analgesic and Anti-inflammatory Herbal Medicines.

Methods for assessing the quality of herbal medicine preparations have advanced significantly in recent years in conjunction with increases in herbal medicine use and reports of adulteration and contamination. This study examined the quality of analgesic and anti-inflammatory herbal medicine preparations available on the Australian market by detecting the presence of listed ingredients, adulterants and contaminants. Forty-nine analgesic and anti-inflammatory herbal medicine preparations were randomly sourced from Australian capital cities. They were audited using a dual approach of liquid chromatography-mass spectrometry (LC-MS) combined with next-generation DNA sequencing. Once screened, a comparison of listed ingredients with verified ingredients was conducted to determine the accuracy of labelling, and the extent of adulteration and contamination. Twenty-six of 49 (53%) herbal medicines were adulterated or contaminated with undeclared ingredients. LC-MS revealed the presence of pharmaceutical adulterants including atropine and ephedrine. DNA sequencing uncovered concerning levels of herbal substitution, adulteration and contamination, including the use of fillers (alfalfa, wheat and soy), as well as pharmacologically relevant species (Centella asiatica, Panax ginseng, Bupleurum and Passiflora). Pig/boar and bird DNA was found in some preparations, inferring substandard manufacturing practices. Of the 26 contaminated samples, 19 (73%) were manufactured in Australia, and 7 (27%) were imported from other countries (6 from China, 1 from New Zealand). In 23 of 49 (47%) herbal medicine samples, no biological ingredients were detected at all. These were predominantly pain and anti-inflammatory preparations such as glucosamine and eicosapentaenoic and docosahexaenoic acids found in krill and fish oils, so DNA would not be expected to survive the manufacturing process. The high level of contamination and substitution of herbal medicine preparations sourced from Australian dispensaries supports the need for more stringent pharmacovigilance measures in Australia and abroad.

Research progress on alkaloid monomer analgesic preparations

Pain is one of the problems that seriously affect people's quality of life for thousands of years. The causes of pain are complex and varied,and long-term pain can also lead to depression. It has become a research hotspot to develop analgesic preparations with significant drug effects and small side effects. Recent studies have shown that certain alkaloid monomers have analgesic targets such as γ-aminobutyric acid,cannabinoids,and capsaicin. If their preparation is applied to the analgesic field,they can make up for the defects such as strong addiction and side effects of traditional opioid and non-steroidal analgesic drugs,but there is no relevant literature to summarize the research results in this field. This article first introduces the mechanism of pain production and the target of analgesia. Based on this,the application status of alkaloid monomer analgesic preparations approved by China Food and Drug Administration( CFDA)( number varieties,type of dosage form,drug description,analgesic mechanism and advantages) was analyzed,and the research dynamics of alkaloid monomer analgesic preparations( new formulation and new technology) were reviewed. Finally,some problems in this field were pointed out,such as imperfect medication information,inadequate transformation of research results,and too few kinds of analgesic components in developed alkaloids. The development direction was also pointed out for the above problems,with a view to provide reference for further development and in-depth research.

Which agent should be used to reduce ischemia-reperfusion injury after testicular torsion: a comparative animal experiment

Testicular torsion is an acute urological emergency that causes severe damage of testis. In order to prevent testicular damage, early diagnosis and surgical intervention is essential. Also pain management in both pre-operative and postoperative periods remains a challenging entity. In this study, we aimed to determine the possible positive effects of three different analgesics (ibuprofen, metamizole, and paracetamol), which are widely used in clinical practice on testicular tissue, in addition to pain control. Forty prepubertal rats (180-210g) were divided into five experimental groups. Group 1 was sham group in which the left testis was brought out through a scrotal incision and then replaced in the scrotum without torsion. Group 2 was control group (only 0.9% NaCl was applied). Also in group 3, paracetamol, in group 4, ibuprofen, and in group 5, metamizole sodium was applied 1h after the torsion. Torsion duration was planned as 4h for all groups. In the biochemical evaluation, malondialdehyde (MDA), myeloperoxidase (MPO), and total nitrate (NO) levels were measured in the testicular tissue. All groups were compared with group 2 (control group). In group 3, although the MDA level was lowerand the MPO level was found to be higher, these were not statistically significant. In group 4, the NO level was low but statistically significant. Histological findings were evaluated due to Cosentino's classification, and the scores of group 4 were better than all groups. In this study, severe damage was observed at the end of torsion period of 4h. This is in line with previous published data. The beneficial effects of all three drugs have been observed. Biochemical results did not clearly highlight any agents. According to pathology results, metamizole was better than paracetamol and the most ideal analgesic preparation was observed as ibuprofen.

Oblique-axis view should be the preferred view for ultrasound-guided internal jugular vein cannulation in intensive care unit.

Sir, In our view oblique-axis (OAX) plane should be the standard approach for ultrasound-guided internal jugular vein (IJV) puncture in critically ill patients. It combines the benefit of both short-axis plane (SAX) and long-axis plane (LAX). Short-axis plane (SAX) is more traditional approach and is used more commonly in teaching practice. The short-axis approach (SAX) allows simultaneous visualization of both artery and vein, but can make needle tip control difficult.[1] The course of the guidewire also cannot be followed by this approach. The long-axis approach (LAX) can optimize needle visualization, but it can be challenging to perform owing to certain anatomical limitations (such as neck length). In addition, LAX only displays the vein in the ultrasound image (unless the artery lies directly underneath) and if the operator strays medially, accidental arterial cannulation can occur.[1] In intensive care unit (ICU) we get multiple patients with history of long-term prior central line catheterization and multiple times central line catheterization. In these patients there is possibility of thrombus formation in the central vein.[23] We report here a case with easy puncture of IJV, but difficulty in the insertion of guidewire due to IJV thrombus. A 68-year-old male post-renal transplantation was admitted to our ICU with breathlessness. He was diagnosed with end-stage renal disease 10 years back and had undergone renal transplantation. Currently, he was showing features of graft-rejection and respiratory infection. His deranged investigations were serum urea –104 mg/dl, serum creatinine –3.5 mg/dl, and total leucocyte count –18,000. Patients respiratory rate was 23/min and arterial blood gas pH 7.55, paO2 – 58, pCO2 – 22, HCO3 – 21. He was put on noninvasive bilevel positive airway pressure ventilation (inspiratory positive airway pressure: 15, expiratory positive airway pressure: 7). His urine output was also on lower side, so it was planned to give fluids and antibiotics from central venous line. Nephrologist suggested that dialysis may be required in the patient, so we planned to insert a hemodialysis catheter in right IJV. We routinely use ultrasound for the procedure in our ICU. After adequate aseptic and analgesic preparation, we localized right IJV by ultrasound in SAX view and immediately punctured the vein, but guidewire could not be negotiated beyond 7 cm. We rotated the probe for long-axis view but due to short neck and less space it was difficult to visualize and do the procedure. So we kept midway, i.e., oblique-view and tried to insert the guidewire and were able to localize the point beyond which guidewire was not moving. There was a partial thrombus in IJV. We abandoned the procedure for right IJV. In OAX view if we face resistance in guidewire insertion, after successful puncture of the vein, we can successfully negotiate the guidewire under ultrasonic view without creating a new puncture.[4] We consider that OAX plane approach of IJV cannulation is safe and effective and that it should be encouraged in clinical teaching. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Banned Drugs-Indian Scenerio

India is a major Hub of Banned drugs. A large number of banned drugs are available which are not used in foreign countries. The production of banned drug is increasing day by day. Only a few drugs are lifesaving and essential, rest of the drugs are substitutes of each other. Every drug has some side effects but Banned drugs have more side effects. Doctors should immediately stop prescribing banned drugs. Banned drugs are still available in developing countries like India due to lack of physician awareness, law enforcement and the laxity of drug control authorities. The most common drugs which are banned in foreign countries like nimesulide, furazolidone, phenyl-propanolamine and other over the counter preparation due to their side effect on kidney, liver and nerve are freely available in Indian market. Most of analgesic, anti-diarrheal and cough preparations which are banned in other countries are blindly used in India as over the counter drugs. This Review will throw light on the current scenario and process of banned drugs in India.

Feedback on the Centralization of Intrathecal Analgesic Preparations in Hospital Pharmacy

AbstractIntrathecal analgesia has increased over the last 30 years. In oncology, it is a real alternative for the treatment of refractory pain. The diversity of the molecules alone or in combination that can be used, the risk related to the route of administration, and the cost of certain molecules are all arguments in favor of centralized preparation within the pharmacy. The purposes of this work are first of all to explain the reasons for centralization of these preparations, and in a second time to describe the circuit developed within our establishment.

Validating the Role of Steroid in Analgesic Cocktail Preparation for Local Infiltration in Total Knee Arthroplasty: A Comparative Study.

Background:Pain control after total knee arthroplasty (TKA) through local analgesic cocktail preparation has gained widespread popularity in recent times. Local steroids have potent anti-inflammatory effect leading to reduced postoperative swelling and pain which might increase the efficacy and duration of local infiltration analgesia.Aim:The aim is to evaluate whether the addition of local steroid to an injectable analgesic cocktail for periarticular infiltration leads to better pain control and knee range of motion (ROM) in the immediate postoperative period compared to patients who do not receive steroid in their cocktail.Settings and Designs:A prospective study was conducted in a group of 140 patients undergoing unilateral TKA between June 2017 and December 2017.Materials and Methods:All the patients in the study group received either periarticular infiltration with an analgesic cocktail (Group I, n = 70) or analgesic cocktail with 100 mg methylprednisolone (Group II, n = 70) for postoperative pain with ultrasound-guided adductor canal block (ACB). Patients were evaluated with visual analog scale (VAS) for pain at 8, 24, and 48 h postoperatively and ROM at 48 h after surgery.Statistical Analysis:The SPSS 19.0 software (SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Student t-test has been used to find the pairwise significance.Results:Group II had a statistically significant decrease in VAS scores at 8 h (P = 0.096), first postoperative day (P = 0.0001) and second postoperative day (P = 0.0001) as compared to Group I. However, there was no statistically significant difference seen with early ROM in both the groups at 48 h (P < 0.361).Conclusion:Patients who received steroid cocktail infiltration plus ACB had an improved and better postoperative analgesia in an early postoperative period of 24–48 h; however, there was no significant difference in clinical ROM and functional outcome when compared to the study group.

To what extent do data from pharmaceutical claims under-estimate opioid analgesic utilisation in Australia?

Although pharmaceutical claims are an essential data source for pharmacoepidemiological studies, these data potentially under-estimate opioid utilisation. Therefore, this study aimed to quantify the extent to which pharmaceutical claims from Australia's national medicines subsidy programs (Pharmaceutical Benefits Scheme [PBS] and Repatriation Schedule of Pharmaceutical Benefits [RPBS]) under-estimate prescription-only and total national opioid utilisation across time and for different opioids. A secondary aim was to examine the impact of the 2012 policy change to record all PBS/RPBS dispensed medicines, irrespective of government subsidy, on the degree of under-estimation. Aggregated data on Australian opioid utilisation were obtained for the 2010 to 2014 calendar years, including all single ingredient and combination opioid analgesic preparations available on prescription or over-the-counter (OTC). Total opioid utilisation (oral morphine equivalent kilogrammes) was quantified using sales data from IMS Health and compared with pharmaceutical claims data from the PBS/RPBS. PBS/RPBS claims data did not account for 12.4% of prescription-only opioid utilisation in 2014 and 19.1% in 2010, and 18.4% to 25.4% of total opioid use when accounting for OTC preparations. Between 2010 and 2014, 5.6% to 5.3% of buprenorphine, 8.1% to 6.3% fentanyl, 17.7% to 10.7% oxycodone, 18.4% to 11.0% tramadol, 38.4% to 21.0% hydromorphone, and 28.6% to 21.0% of prescription-only codeine utilisation were not accounted for in PBS/RPBS claims. Despite increased capture of less expensive (under co-payment) opioid items since 2012, PBS/RPBS claims still under-estimate opioid use in Australia, with varying degrees across opioids. The estimates generated in this study allow us to better understand the degree of under-estimation and account for these in research using Australia's national pharmaceutical claims data.

Ototoxicity associated with topical administration of diclofenac sodium as an otic drop: An experimental animal study

ObjectivesThe aim of the study is to evaluate the ototoxicity of topical diclofenac sodium in comparison to positive and negative controls prior to the investigation of analgesic and anti-inflammatory efficacy of the agent in otic administration. MethodsTwenty four ears of 12 guinea pigs were included in the study. Wide myringotomy was performed on all tympanic membranes under general anesthesia and auditory brainstem responses (ABR) were evaluated. The subjects were separated into four groups, two groups received diclofenac sodium at low and high doses, positive controls received gentamicin and negative controls received isotonic sodium chloride topically for 14 days and ABRs were reevaluated. ResultsNo significant difference were observed between the pre and post-treatment click response, 1 kHz and 8 kHz response threshold levels after isotonic sodium chloride administration. All threshold levels were elevated in the positive control group. In the low and high dose diclofenac sodium groups, click response, 1 kHz and 8 kHz response threshold levels were significantly higher compared to the baseline values. Pre and post-treatment mean threshold level changes were not significantly different between the low and high dose diclofenac sodium groups. Pre and post-treatment mean threshold level changes in the gentamicin group were not significantly different from low or high dose diclofenac sodium groups. ConclusionDiclofenac sodium, considered as an analgesic and anti-inflammatory otic preparation, is shown to be as ototoxic as gentamicin in chronic use which may lead to loss of hearing especially when used topically in chronic otitis cases with tympanic membrane damage.

Anti-nociceptive and desensitizing effects of olvanil on capsaicin-induced thermal hyperalgesia in the rat.

BackgroundOlvanil (NE 19550) is a non-pungent synthetic analogue of capsaicin, the natural pungent ingredient of capsicum which activates the transient receptor potential vanilloid type-1 (TRPV1) channel and was developed as a potential analgesic compound. Olvanil has potent anti-hyperalgesic effects in several experimental models of chronic pain. Here we report the inhibitory effects of olvanil on nociceptive processing using cultured dorsal root ganglion (DRG) neurons and compare the effects of capsaicin and olvanil on thermal nociceptive processing in vivo; potential contributions of the cannabinoid CB1 receptor to olvanil’s anti-hyperalgesic effects were also investigated.MethodsA hot plate analgesia meter was used to evaluate the anti-nociceptive effects of olvanil on capsaicin-induced thermal hyperalgesia and the role played by CB1 receptors in mediating these effects. Single cell calcium imaging studies of DRG neurons were employed to determine the desensitizing effects of olvanil on capsaicin-evoked calcium responses. Statistical analysis used Student’s t test or one way ANOVA followed by Dunnett’s post-hoc test as appropriate.ResultsBoth olvanil (100 nM) and capsaicin (100 nM) produced significant increases in intracellular calcium concentrations [Ca2+]i in cultured DRG neurons. Olvanil was able to desensitise TRPV1 responses to further capsaicin exposure more effectively than capsaicin. Intraplantar injection of capsaicin (0.1, 0.3 and 1 μg) produced a robust TRPV1-dependant thermal hyperalgesia in rats, whilst olvanil (0.1, 0.3 and 1 μg) produced no hyperalgesia, emphasizing its lack of pungency. The highest dose of olvanil significantly reduced the hyperalgesic effects of capsaicin in vivo. Intraplantar injection of the selective cannabinoid CB1 receptor antagonist rimonabant (1 μg) altered neither capsaicin-induced thermal hyperalgesia nor the desensitizing properties of olvanil, indicating a lack of involvement of CB1 receptors.ConclusionsOlvanil is effective in reducing capsaicin-induced thermal hyperalgesia, probably via directly desensitizing TRPV1 channels in a CB1 receptor-independent fashion. The results presented clearly support the potential for olvanil in the development of new topical analgesic preparations for treating chronic pain conditions while avoiding the unwanted side effects of capsaicin treatments.

Application of Laser Phoresis in Complicated Postmenopausal Osteoporosis

This study presents postmenopausal osteoporosis as a feature of metabolic systemic diseases of the skeleton, with abnormalities of the bone microarchitecture and reduction in bone mineral density, leading to an increased risk of fractures with a low level of trauma. The neurological manifestations of such fractures are uncharacteristic, representing a differential diagnostic indication. There is a change of posture in the form of hyperkyphosis of the thoracic spine and loss of height due to the increase in the number of modified vertebrae. The age of these patients is between 66 and 68 years, which limits the use of traditional analgesic preparations. The ionized gel ‘Giasulf' was applied in 29 cases according to the developed technology. The description of the composition of the gel that provides maximum analgesic effect, reinforced by the influence of laser radiation on the cell membranes, is presented. A significant antinociceptive effect was obtained.