Nitroglycerin Patches Research Articles

Making Sense of Topical Pain Relief Options: Comparing Topical Analgesics in Efficacy and Safety.

In patients with musculoskeletal (MSK) conditions, pain is the leading contributor to disability and significantly limits mobility and dexterity. This narrative review describes the efficacy and safety of topical analgesics in common use today. Secondary literature gained via a literature search using PubMed.gov and the Cochrane library were used. Recent literature (2000-2023) on several major classes of topical analgesics and topical delivery systems were reviewed to provide strength of recommendation taxonomy (SORT) levels. A total of 86 articles were reviewed. Level 2. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and cabbage leaf wraps (CLW) appear to be best suited for multiple types of acute MSK pain, and topical nitroglycerin is helpful when used specifically for rotator cuff pain in patients seeking relief while performing activities of daily living and willing to treat for long periods of time. For compounded topical formulations, it may be better to offer single agent creams based on patient preferences. Little data support the use of cryotherapy. Traumeel could be a promising natural analgesic that compares with diclofenac. Topical lidocaine appears best suited for postherpetic neuropathic pain. O24 is a reasonable alternative with a low risk profile to treat pain in patients with fibromyalgia syndrome. Choice of topical agents should be guided by current evidence accounting for type of pain, medication side effects, patient comorbidities, as well as patient preference, convenience, and cost. Of the topical analgesics and modalities reviewed, SORT level A evidence was found for topical NSAID use in decreasing MSK pain, topical lidocaine for postherpetic neuralgia, and nitroglycerin patches for treating rotator cuff pain if used for prolonged periods of time. Alternative treatments such as CLW and Traumeel show promising results (SORT level B).

Effectiveness of a Glyceryl Trinitrate (GTN) Patch in Preventing Amputation, Improving Pain Control and Reducing the Size of Tissue Loss for a Patient With Critical Limb-Threatening Ischaemia (CLTI).

Background Foot ulcer is a common complication of poorly controlled diabetes and peripheral vascular disease (PVD). The current standard of treatment for diabetic foot ulcers includes the management of underlying risk factors, wound debridement, use of antibiotics for infection, off-loading with cast, and revascularisation surgery. The glyceryl trinitrate (GTN) patch is currently off-licence in treating PVD or diabetic foot ulcers. This study aims to evaluate the effectiveness of the GTN patch in preventing amputation, improving pain control, and reducing the size of tissue loss (ulcer/gangrene) or localised ischaemic area. Method This is a pilot study of 30 patients who were started on the GTN patchfrom February 2020 to October 2021. Inclusion criteria were patients who have critical limb-threatening ischaemia (CLTI) and with no viable options or are at high risk for revascularisation, both endovascular and open surgery. Patients who were on a GTN patch for less than six weeks at the time of data collection or had unclear outcomes were excluded. The outcomes were retrospectively collected on prevention of amputation, improvement in pain control, and reduction in tissue loss (the size of ulcer/gangrene) or localised ischaemic area with the use of a GTN patch. The binomial test was used to compare the observed outcome of the GTN patch and the expected outcome, which was assumed to be 50% in this study. Results Ninety-three per cent (93%) of the patients who had GTN patches successfully avoided amputation (p<0.0001). Eighty-four per cent (84%) of patients reported better pain control (p=0.0022) and improvement in the size of ulcer/gangrene/localised ischaemic areas (p=0.0005). Conclusion The GTN patch is effective in preventing amputation, improving pain control, and reducing the size of ulcer/gangrene/localised ischaemic areas in patients who have end-stage CLTI and no viable options or who are at high risk for revascularisation surgery.

Efficacy of Transdermal Nitroglycerin Patch for the Arrest of Preterm Labor: A Retrospective Study

Efficacy of Transdermal Nitroglycerin Patch for the Arrest of Preterm Labor: A Retrospective Study

Challenges and Experiences in Multicenter Prehospital Stroke Research: Narrative Data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial-2 (RIGHT-2)

Background Ambulance services are increasingly research active and the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2) is the largest United Kingdom (UK) ambulance-based randomized controlled trial in stroke. We explore the complexities and challenges encountered during RIGHT-2. Methods Five hundred and sixteen of 1487 paramedics from eight UK ambulance services serving 54 comprehensive or primary stroke care centers screened and consented 1149 patients presenting within 4 h of FAST-positive stroke and with systolic blood pressure >120 mmHg; participants were randomized to treatment with transdermal glyceryl trinitrate versus sham patch in the ambulance. Key findings Working with multiple ambulance services demanded flexibility in the trial protocol to overcome variation in operating procedures to ensure deliverability. Many paramedics are novice researchers, and research concepts and practices are emerging including consent strategies in emergency stroke care. Regional variation in hospital participation and hours/days of operation presented paramedics with additional considerations prior to patient recruitment. The working hours of hospital research staff often do not reflect the 24/7 nature of ambulance work, which challenged deliverability until trial processes became fully embedded. Management of investigational medicinal product between ambulance stations, in-transit when on ambulance vehicles and on handover at hospital, necessitated an in-depth review to maintain accountability. Conclusion RIGHT-2 demonstrated that although there are significant practical challenges to conducting multicenter ambulance-based research in a time-dependent environment, careful planning and management facilitated delivery. Lessons learned here will help inform the design and conduct of future ambulance-based trials.

Distal radial approach using a transdermal nitroglycerin patch : double-blinded randomized trial

Abstract Background The distal radial approach (DRA) provides a lower risk of radial artery occlusion than the conventional transradial approach (TRA) and has recently been used worldwide as an alternative access route for coronary catheterization. However, the small diameter of the distal radial artery causes difficulty in puncture and leads to DRA failure. Purpose The aim of this study is to elucidate whether a transdermal nitroglycerin patch improves the rate of successful DRA cannulation. Methods A total of 92 patients with angina pectoris scheduled for elective coronary angiography via DRA randomly received (1:1) a transdermal nitroglycerin patch pre-integrated with the covering material or only the covering material on their upper arm on the side of the puncture. The diameter of the distal radial artery was evaluated with ultrasound at baseline and after application. DRA procedures were performed in a double-blinded fashion. The primary outcome was the rate of successful palpation-guided distal radial artery cannulation with the first puncture. Results The nitroglycerin group had larger distal radial artery diameter after patch application than the no-treatment group (3.21 ± 0.68 mm vs. 2.71 ± 0.52 mm, P&amp;lt;0.001), but not at baseline (2.64 ± 0.48 mm vs. 2.64 ± 0.45 mm, P = 0.965, Figure 1).The nitroglycerin group had a significantly higher success rate of palpation-guided DRA cannulation with the first puncture than the no-treatment group (58.7% vs. 23.9%; P = 0.001; odds ratio, 4.5; 95% confidence interval, 1.9–11.0, Figure 2). Fewer punctures were required for successful sheath insertion in the nitroglycerin group compared with the no-treatment group (1 [1–5] vs. 3 [2–6]; P=0.019). Procedure time from puncture to sheath insertion was shorter in the nitroglycerin group, but the difference was not significant (142 [112–287] seconds vs. 202 [142–411] seconds; P=0.058). The incidence of vasospasm, hypotension (systolic blood pressure &amp;lt; 90 mmHg) before and during CAG, and puncture site hematoma was similar in the two groups. No patients experienced distal radial arterial occlusion. Conclusions The use of a transdermal nitroglycerin patch was associated with an increase in the diameter of the distal radial artery, higher success rate of DRA cannulation with the palpation-guided first puncture. The transdermal nitroglycerin patch has a potential to be an effective pretreatment for DRA.Changes in distal radial artery diameterResults of primary outcome

Effect of Nitric Oxide Donors on Uterine and Subendometrial Blood Flow in Patients with Unexplained Infertility: A Randomized Controlled Trial

Unexplained infertility has been defined, by the Practice Committee of the American Society of Reproductive Medicine (ASRM), as inability of a couple to conceive for at least 12 months, with unremarkable standard infertility evaluation ((ASRM), 2006). Although estimates vary, the prevalence of unexplained infertility is approximately 15–30% Aim of the Work to evaluate the effect of nitroglycerine transdermal patches on uterine and subendometrial blood flow in women with unexplained infertility. Patients and Methods Transdermal nitroglycerine patch was administered to the allocated group from the 2nd day of cycle till maturation of the follicles ≥ 18 mm just for one cycle. Results The relatively underdeveloped endometrial thickness did not change significantly after treatment of women with unexplained infertility with nitroglycerin and remained significantly lower than women of the fertile group. Also, nitroglycerin treatment did not result in significant change in uterine artery Doppler indices. However, uterine artery indices of nitroglycerin-treated women did not also show a significant difference (P &amp;gt; 0.05) from fertile women. On the contrary, nitroglycerin treatment in women with unexplained infertility significantly increased subendometrial 3D power Doppler indices to mean values that did not differ significantly from the fertile women. According to the results of the current study, biochemical pregnancy was more commonly achieved in the nitroglycerin group compared to the control group (6.67% vs 3.33%), Yet this difference failed to prove statistical significance. Although adverse effects of nitroglycerin treatment in the current study, namely headache, blurring of vision and hypotension, were more common on the nitroglycerin group compared to the control and fertile groups; this difference couldn’t reach statistical significance (P &amp;gt; 0.05). Conclusion Doppler study of uterine hemodynamics can be considered in infertility work-up. Although still lacking evidence, women with suboptimal uterine perfusion may be offered therapies improving uterine blood flow, such as nitroglycerin.

Distal Radial Approach in Coronary Angiography Using a Transdermal Nitroglycerin Patch: Double-Blinded Randomized Trial

Nitroglycerin dilates the radial artery and prevents spasm, which increases the success rate of sheath cannulation through the conventional transradial approach. However, the effects of nitroglycerin on distal radial approach (DRA) procedures are not known. The aim of this study is to elucidate whether a transdermal nitroglycerin patch improves the rate of successful DRA cannulation. A total of 92 patients scheduled for coronary angiography by means of DRA randomly received (1:1) a transdermal nitroglycerin patch preintegrated with the covering material or only the covering material on their upper arm on the side of the puncture. The diameter of the distal radial artery was evaluated with ultrasound at baseline and after application. DRA procedures were performed in a double-blind fashion. The primary outcome was the rate of successful palpation-guided distal radial artery cannulation with the first puncture. The nitroglycerin group had larger distal radial artery diameter after patch application than that of the no-treatment group (mean, 3.21 mm vs 2.71mm, p <0.001), but not at baseline (mean, 2.64 mm vs 2.64mm, p=0.965).The nitroglycerin group had a significantly higher success rate of DRA cannulation with the first puncture than that of the no-treatment group (59% vs 24%, p=0.001; odds ratio 4.5, 95% confidence interval 1.9 to 11.0). The nitroglycerin group required fewer punctures than did the no-treatment group (median, 1 vs 3, p=0.019). There were no significant differences in the occurrence of hypotension between the 2 groups. No patients experienced radial artery occlusion. In conclusion, transdermal nitroglycerin patch application safely facilitates DRA cannulation. Trial Registration: Japan Registry of Clinical Trials, https://jrct.niph.go.jp/ (identifier: jRCTs051210128).

WHICH ONE IS BETTER FOR TOCOLYSIS IN PRE-TERM LABOR?: ORAL NIFEDIPINE VS TRANSDER-MAL NITROGLYCERIN PATCH

Introduction: Preterm labour follows a spontaneous commencement of labour in two-thirds of preterm birth instances. Obstetricians must consider both treatment options for the management of preterm. The study was conducted to compare the tocolytic effects of oral nifedipine tablets and transdermal nitroglycerine patches in preterm labor.&#x0D; Methodology: Cases with Singleton pregnancy, Pregnancy between 28 weeks to 36 completed weeks, and without contraindication for tocolysis were included in the study. Randomly assigned Nifedipine group received oral nifedipine (Tab Depin 10mg) and NTG group received transdermal nitroglycerine patch (Nitroderm 10). Progress was assessed for effect of drug for tocolysis.&#x0D; Results: Both groups were comparable in terms of demographic variable, vital measures, bishop score and cervical dilatation at the time of reporting. Comparison of mean prolongation duration according to gestational age in both the study groups indicate that overall duration of prolongation was better in oral nifedipine. However, the differences were not statistically significant. Headache and hypotension were significantly higher in Nitroglycerine patch compared to oral nifedipine group. The treatment discontinuation was significantly higher in Nitroglycerine patch compared to oral Nifedipine.&#x0D; Conclusion: Tocolytic effect of both, oral nifedipine and Nitroglycerine patch was statistically almost similar. However, considering the feasibility of application, availability, and cost of the drug, we recommend to use oral nifedipine for tocolysis over Nitroglycerine patch.

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): effects on outcomes at day 365 in a randomised, sham-controlled, blinded, phase III, superiority ambulance-based trial

BackgroundThe Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial-2 (RIGHT-2) reported no overall treatment difference between glyceryl trinitrate (GTN) and sham at day 90. Here we assess participants’ outcomes...

A Comparative Study of the Effectiveness of Transdermal Nitroglycerine Patches and Oral Nifedipine in Prolongation of Pregnancy in Women With Preterm Labour.

Backgrounds A significant contributor to newborn morbidity and mortality is preterm birth. Several techniques have been employed to identify patients at risk of premature labour. However, these predictors are not always effective because of their multifactorial aetiology. Preterm labour can be suppressed largely through tocolysis. This study compared the effectiveness and safety of transdermal nitroglycerine and oral nifedipine in preventing premature labour. Methods This study was done at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, from December 2020 to November 2022, on 130 women presenting with preterm labour pains between 28 and 37 weeks of gestational age. All the women selected were randomized into two equal groups by using the envelope method. Sixty-five women were given a nitroglycerine patch (Group A), and the rest (65 women) were given an oral nifedipine tablet (group B). The variables studied were mean days of prolongation of pregnancy, treatment outcome, steroid coverage, along with feto-maternal outcomes among both groups. Results The percentage of women whose pregnancy was prolonged for at least 48 hours in the nitroglycerine group was 75.3%, and in the nifedipine group it was 93.8%. Failure to achieve tocolysis, defined as delivery within 48 hours, was seen significantly more in the nitroglycerine group (24.6%) than in the nifedipine group (6.1%). The overall foetal outcomes were comparable in both groups. Conclusion Oral nifedipine was found to be superior to transdermal nifedipine patches in terms of efficacy and safety in the management of preterm labour, with a better side effect profile.

MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY

You have accessJournal of UrologyCME1 Apr 2023MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY Piotr Sluzar, Alex Murray, Anna Daunt, Aatish Patel, Achyuta Nori, Geraldine O'Hara, and Tet Yap Piotr SluzarPiotr Sluzar More articles by this author , Alex MurrayAlex Murray More articles by this author , Anna DauntAnna Daunt More articles by this author , Aatish PatelAatish Patel More articles by this author , Achyuta NoriAchyuta Nori More articles by this author , Geraldine O'HaraGeraldine O'Hara More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monkeypox is a viral illness affecting predominantly gay, bisexual and other men having sex with men. The rapid progression of the recent outbreak meant genital manifestations preceded any guidelines for cases with urological symptoms. This study aims to develop an empirical care pathway for patients presenting with penile and scrotal symptoms secondary to monkeypox. METHODS: From May to September 2022, 198 patients with monkeypox who presented to a tertiary referral hospital were assessed for genital involvement by the infectious disease team, with the involvement of a urologist. Of these, 19 patients (10%) were admitted with genital lesions and were treated in an isolation ward with full personal protection equipment (PPE) in use. Symptoms requiring urological input were present in 8 individuals (4%). The mean time from the onset of symptoms to resolution was 25.3 (range 9-63) days. Based on the management of these patients, an empirical care pathway for genital monkeypox was developed. RESULTS: Four stages of genital monkeypox were observed (Figure 1). Limited penile oedema and discrete lesions should be managed conservatively with analgesia, cold compresses and elevation for swelling control. Patients with moderate oedema, paraphimosis and large coalescing ulcers should be considered for a topical 1% hydrocortisone cream to reduce the inflammation. In severe oedema with necrotic ulcers glyceryl trinitrate (GTN) patches are crucial to improve the vascularization of the necrotic ulcers on the penis. Cases of widespread necrosis and oedema may require imaging to assess the need for surgical debridement. GTN patches require daily changes for tissue salvage. Catheterization should be guided by the extent of oedema, the presence of paraphimosis and lesions close to the external urethral orifice. CONCLUSIONS: Monkeypox cases presenting through lesions on the penis and scrotum often require urological management to reduce penile oedema and prevent catheterisation. All admitted patients require isolation with full PPE. The initial stages of the infection should be managed conservatively with cold compresses, elevation and analgesia. Patients with advanced genital symptoms can benefit from the early use of topical steroid creams and GTN patches applied over the necrotic areas to reduce swelling and aid perfusion. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e192 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Piotr Sluzar More articles by this author Alex Murray More articles by this author Anna Daunt More articles by this author Aatish Patel More articles by this author Achyuta Nori More articles by this author Geraldine O'Hara More articles by this author Tet Yap More articles by this author Expand All Advertisement PDF downloadLoading ...

Use of Nitroglycerine Patch in the Management of Preterm Labor

Background: Preterm birth is the delivery of the baby before 37 completed weeks of pregnancy. The goal of tocolytic therapy is to reduce neonatal mortality and morbidity by delaying birth, allowing for corticosteroid administration and maternal transfer to the tertiary care center. This study was conducted to observe the tocolytic efficacy of GTN transdermal patches in preterm labor between 28 – 36 weeks of pregnancy. Methods: This cross-sectional study was done in Obstetrics &amp; Gynecology Department at Mufti Mehmood Memorial Hospital, Dera Ismail Khan, from July 2017 to December 2017. Non-probability consecutive samplings of 186 pregnant women with preterm labor were included in the study. Detailed history and examination, routine investigations and ultrasound were performed to confirm viability, gestational age and exclusion of multiple pregnancies, lethal fetal malformation and intrauterine death. Effectiveness of the GTN patch was considered successful if the cessation of uterine contraction occurred within 24 hours of the application of the GTN patch and persisted for 48 hours to achieve the effect of steroids. Results: Tocolytic efficacy of GTN transdermal patch in preterm labor between 28 to 36 weeks of pregnancy was 88.71%. Regarding the parity of the women, 75.8% of women had multipara (parity 2 to 5) and 24.2% had primipara. The average gestational age was 33.15±2.28 weeks. . Two to three uterine contractions per 10 minutes were observed in 75.8% of women while four uterine contractions per 10 minutes were observed in 24.19% of cases. 2cm cervical dilatation was observed in 82 women (44.09%) and 3cm was 75 women (40.32%). Practical implication: The incidence of preterm delivery can be minimized using GTN patch to reduce the uterine contractions and increase the fetal viability inside the womb. Conclusion: There is no better incubator than a mother's womb. The GTN patch appears to be a safe, non-invasive method of suppressing uterine contractions in pre-term labor and also a simple, quicker and cost-effective tocolytic agent. Keywords: Pre-term labor; Tocolytic; Transdermal patch; Uterine contractions.

Preterm Labour Management with Glyceryl Trinitrate Patch and Isoxsuprine: A Longitudinal Study

Introduction: Nitric oxide donors in the form of nitroglycerine and β-mimetic drugs (Isoxsuprine hydrochloride) are commonly used in managing preterm labour. It is one of the most challenging obstetric complications encountered by obstetricians, as well as preterm neonates for paediatricians. Preterm labour refers to the onset of uterine contractions of sufficient strength and frequency to effect progressive dilatation and effacement of the cervix between 20 and 37 weeks of gestation. Aim: To compare the effects of transdermal Glyceryl Trinitrate (GTN) with Isoxsuprine in terms of maternal complications, perinatal outcomes, and their tocolytic effectiveness. Materials and Methods: A hospital-based longitudinal study was conducted in the Department of Obstetrics and Gynaecology at JNU Medical College and Research Centre, Jaipur, Rajasthan, India. The study duration of the study was one year, from March 2022 to February 2023. A total number of 100 cases of preterm labour were enrolled and equally divided into two groups: Groups A (GTN patch) and group B (Isoxsuprine) with a defined dosing schedule. Singleton pregnancies with intact membranes and gestational age of 26-36 weeks were included in the study, metting the diagnostic criteria for preterm labour. Both the groups received pharmacological intervention, and outcome measures such as success rate of treatment (i.e., prolongation of labour),. maternal side effects, and foetal outcomes {Neonatal Intensive Care Unit (NICU) admission and Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score) were measured and evaluated. Predefined parameters and other data were tabulated in Microsoft Excel and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. The Chi-square test was applied to identify significant differences. Results: The incidence of preterm labour was highest in the age group of 21-30 years (76% in Group A and 70% in Group B) among patients treated with nitroglycerine and isoxsuprine, respectively. The mean prolongation of pregnancy in the nitroglycerine group was 21.42 days, and in the isoxsuprine group, it was 16.22 days (p=0.042). The most common side effect in the nitroglycerine group was headache (60%), while in the isoxsuprine group, it was maternal hypotension (24%). The mean APGAR score in Group A and Group B was 8.18 and 8.06, respectively. It was observed that 24% of newborns in the nitroglycerine group and 36% in the isoxsuprine group required NICU admission. The success rate was 90% in the nitroglycerine group and 80% in the isoxsuprine group. Conclusion: Both drugs were effective in prolonging pregnancy for the first 48 hours, but nitroglycerine was found to be slightly better in terms of success rate. Nitroglycerin was more acceptable to patients with preterm labour, as it did not have to be administered through painful injections.

The effect of using nitroderm TTS in ERCP on precut, selective cannulation, and bleeding.

The aim of the study was to investigate the use of prophylactic nitroglycerin patch in patients who applied to our clinic with occlusion icter and underwent endoscopic retrograde cholangiopancreatography (ERCP) for complications such as pancreatitis, bleeding, perforation that may occur during and after the procedure, duration of the procedure, length of hospitalization, precut and selective cannulation rates, and mortality. Patients were searched retrospectively using the hospital database. Patients under the age of 18, patients with poor general condition and patients treated under emergency conditions were excluded from the study. The effects of the drug on morbidity, mortality, duration of procedure, length of hospital stay, and cannulation techniques were investigated in patient groups with and without nitroglycerin patch. It was observed that using nitroglycerin decreased the precut probability by 2.28 times (p<0.001), and decreased periop-erative bleeding by 3.4 times (p<0.001). 75.1% selective cannulation was observed in the group not administered nitroglycerin, this rate was determined as 87.3% in the group administered nitroderm(p<0.001). In the regression model, it was observed that the presence of nitroderm increased the probability of selective cannulation 2.21 times (p<0.001). The effects of nitroglycerin use on mortality, patient's history of malignancy, presence of stones and mud, gender, age, post-operative pancreatitis, and perioperative bleeding variables were evaluated by regression analysis, and age increased mortality by 1.09 (p=0.023). It has been shown that the use of prophylactic nitroglycerin patch in ERCP procedure increases the prophylactic selective cannulation rate, shortens the precut rate, pre-operative bleeding, hospital stay, and procedure time.

Management of Lateral Epicondylitis Using Transdermal Nitroglycerin: A Systematic Review.

Lateral epicondylitis (LE), also known as tennis elbow, is an overuse tendinopathy originating from the forearm extensor tendons of the elbow. An emerging therapy for the treatment of LE is the use of transdermal nitroglycerin (NTG) patches for pain relief and improved function. The aim of this systematic review was to assess the current literature on the effect of a transdermal NTG patch for the treatment of LE. A literature search using MEDLINE, EMBASE, SportDiscus, and the Cochrane Database of Systematic Reviews was conducted. Studies selected for inclusion were those in which patients were clinically diagnosed with LE, RCTs, observational studies, and only articles published in English. Studies were excluded if they involved patients <18 years of age or involved patients with a potential alternative source of elbow pain such as previous surgery to the elbow, a previous history of dislocation, fracture of the elbow or tendon rupture, or a referred pain source such as cervical radiculopathy or peripheral nerve involvement. Studies were also excluded if they involved patients who were already prescribed topical NTG for any other indication (i.e., angina), and if the studies had no measurement of symptom relief or measurement or functional scoring. The initial search strategy yielded 69 articles, out of which four met the eligibility criteria and were included in this systematic review. The studies showed improvement in elbow pain in the short-term and mid-term (up to six months), while one study that followed participants for a five-year duration post-treatment, showed no benefit. Three studies used an effective NTG dose of 1.25mg/24h and one study used an effective dose of 1.44mg/24h. Topical NTG was more effective when combined with a tendon rehabilitation program. The most commonly reported side effects of topical NTG were headaches and dermatitis. Overall, the current literature demonstrates that the use of NTG patches for LE improves short- and mid-term pain as well as elbow function. However, more studies are required to fully understand the effect of topical NTG on LE, particularly the effective dose range and the long-term benefits.

Prevention of radial artery spasm during coronary angiography with transdermal glyceryl trinitrate patches: the NURSE-TTS trial

Abstract Background/Introduction One of the most common complications encountered during transradial procedures is radial artery (RA) spasm, whereas its management remains a challenge. Purpose We hypothesized that in patients undergoing cardiac catheterization via the RA, the use of transdermal nitroglycerin (NTG) patches applied to skin over the RA puncture site may prevent the occurrence of radial artery spasm. Methods NURSE-TTS (Nitrate Use to Obtain Radial Spasm Embarrassment) is a parallel-group, randomized, double-blind, placebo-controlled trial evaluating the impact of transdermal NTG application to RA spasm prevention. 146 patients were consecutively enrolled from February 2021 to December 2021 from an experienced center in Greece and underwent diagnostic coronary angiography. The primary endpoint was the exerting force of the RA measured by the dynamometer in Newton. Results The primary endpoint of the dynamometer measurements was found to be significantly different between the two groups. The treatment group's mean force was 5.95±2.60 and 7.21±2.82 for the placebo group respectively (p=0.007). The multivariate analysis confirmed that NTG patches affected radial spasm (treatment group p=0,010, 95% CI: −2,038, −0,282; age p=0,010, 95% CI: −0,099, −0,014; male gender p=0,011, 95% CI: −2,612, −0,349; CKD p=0,044, 95% CI: 0,064,0,951). Conclusions This is the first prospective randomized study demonstrating that the application of transdermal NTG 10mg on skin for 30 minutes before coronary angiography resulted in lower exerting force of the cannulated radial artery thus lower arterial spasm. Funding Acknowledgement Type of funding sources: None.

CASE REPORT OF SPONTANEOUS CORONARY ARTERY DISSECTION IN A PATIENT POSITIVE FOR COVID-19

CASE REPORT OF SPONTANEOUS CORONARY ARTERY DISSECTION IN A PATIENT POSITIVE FOR COVID-19

TRANSDERMAL NITROGLYCERIN PATCH AND ITS EFFECT ON DIEP FREE FLAP : A CASE REPORT

There may occasionally be venous congestion in a free flap lacking venous anastomosis blockage or other biological causes of decreased venous drainage (hematoma, seroma compressing the pedicle). The researchers advise applying a nitroglycerine patch in this situation very few hours before to the surgical investigation of the anastomosis in the crowded area of the flap. The surgical exploration could be avoided if the clinical characteristic of the flap improves quickly. The researchers emphasize that using a nitroglycerin patch should not be viewed as a treatment for free flap venous thrombosis but rather as a helpful tool that should only be employed when a surgeon is unsure of whether or not to review the anastomosis.

Achilles Pain - Track And Field

HISTORY: An 18-year-old, female, Division 1 collegiate track and cross-country athlete presented mid-season with acute on chronic, right posterior ankle pain after running. She was treated the season prior for insertional Achilles tendinopathy with protected weight bearing, manual therapy, eccentric strengthening, night splints, oral and topical NSAIDs, nitroglycerin patches and intra-tendinous prolotherapy. Her pain returned this season with running or direct contact of the Achilles tendon. PHYSICAL EXAMINATION: On inspection there was bilateral pes planus and slight swelling of the Achilles tendon 1-2 cm proximal to the insertion with tenderness to palpation. She had full ankle range of motion with mild pain only on end range of passive dorsiflexion. There was a non-antalgic gait pattern and no pain with toe and heel walking or with heel pumps. Ankle strength was normal and sensation to light touch was intact throughout. DIFFERENTIAL DIAGNOSIS:1. Achilles tendinopathy, recalcitrant2. Achilles paratenonitis3. Retrocalcaneal bursopathy4. Posterior ankle impingement TEST AND RESULTS: Diagnostic musculoskeletal ultrasound showed a normal appearing Achilles tendon without fusiform swelling, hypoechogenicity, fiber disruption, neovascularization or cortical irregularities FINAL/WORKING DIAGNOSIS: Achilles paratenonitis TREATMENT AND OUTCOMES:1. Referral to sports physical therapy for a progressive tendon loading program and return to run program using a weight assisted treadmill2. Despite strength and flexibility gains, the patient was unable to return to run without pain3. We performed an ultrasound guided, percutaneous Achilles paratenon brisement with saline to dissect the tight, adhesive paratenon from the tendon itself4. Additionally, during the same procedure, we performed an ultrasound guided, percutaneous, Achilles tendon scraping to disrupt peritendinous neovessels and neonerves5. After 1 week of protected rest, patient returned to physical therapy and was able to complete a return to run program and return to sport without pain within 1 month.

TCT-581 Prevention of Radial Artery Spasm With Transdermal Glyceryl Trinitrate Patches: The NURSE-TTS Randomized, Double-Blind, Placebo-Controlled Trial

TCT-581 Prevention of Radial Artery Spasm With Transdermal Glyceryl Trinitrate Patches: The NURSE-TTS Randomized, Double-Blind, Placebo-Controlled Trial