Indomethacin Suppositories Research Articles

Price and Variability in Hospital Charges for Generic Indomethacin Suppositories

Price and Variability in Hospital Charges for Generic Indomethacin Suppositories

Value of indomethacin suppository for preoperative analgesia and anti-inflammation in laparoscopic appendectomy: a protocol of prospective, double-blinded, single-centre, randomised controlled trial in China

IntroductionPostoperative pain has always been a problem for patients and surgeons. Local inflammation, surgical trauma and pain in the body can cause a systemic stress response and immune imbalance, which...

MRI Evaluation of Indomethacin Suppositories in the Prevention of Complications of Pancreatitis and Hyperamylasemia after Choledocholithiasis ERCP Based on Image Denoising Algorithm.

Objective To explore the value of MRI evaluation of indomethacin suppositories in the prevention of pancreatitis and hyperamylasemia in patients with common bile duct calculi after endoscopic retrograde cholangiopancreatography (ERCP) based on image denoising algorithm. Methods A retrospective analysis in August 2020 to December 2021. Because of the common bile duct calculi hospitalized parallel ERCP operation, 89 cases of patients, according to the different postoperative treatments, were divided into group A (n = 44) and group B (n = 45), in which A set of separate application inhibits the pancreatic enzyme secretion after surgery drug treatment, and B group on the basis of group A linked with indole beauty Xinshuan treatment. The incidence of postoperative pancreatitis and hyperamylasemia was compared between the two groups. The levels of serum amylase were compared between the two groups. Patients in group B were diagnosed with pancreatitis by conventional MRI and MRI with denoising algorithm, respectively, and the imaging characteristics and diagnosis rate differences of the two methods were observed. ROC curve was drawn to evaluate the diagnostic efficacy of MRI denoising algorithm for postoperative pancreatitis and serum amylase level detection for hyperamylasemia. Results The incidence of postoperative pancreatitis and hyperamylasemia in group B was significantly lower than that in group A (P < 0.05). There were 6 cases of postoperative pancreatitis in group B, 2 cases (33.33%) were diagnosed by conventional MRI, and 5 cases (83.33%) were diagnosed by MRI based on denoising algorithm. Although there was no significant difference in diagnosis rate between the two methods, the number of cases of pancreatitis diagnosed by MRI based on denoising algorithm was slightly higher than that by conventional MRI. Compared with conventional MRI images, MRI images with denoising algorithm showed that the number of cases with pancreatic swelling, the number of cases with pancreatic duct/bile duct dilation, and the number of cases with abdominal effusion were all high (all P < 0.05). ROC results showed that the area under the curve of MRI with denoising algorithm for the diagnosis of postoperative pancreatitis was 0.855, and the sensitivity was 89.40%. The specificity was 83.20%, and the area under the curve of serum amylase for postoperative hyperamylasemia was 0.893, the sensitivity was 89.80%, and the specificity was 85.20%, all of which had high diagnostic efficacy. Conclusion MRI results of denoising algorithm suggest that indomethacin suppositories can effectively reduce the incidence of postoperative pancreatitis and hyperamylasemia after ERCP, which is worthy of clinical application.

Rectal indomethacin versus intraperitoneal lidocaine for analgesia after laparoscopic cholecystectomy

Background: Visceral and shoulder painare among the most frequent reported pain after laparoscopic cholecystectomy (LC). Objectives: To investigate the effectiveness and clinical value of rectal indomecthacin and intraperitoneal lidocaine for treating pain after laparoscopic cholecystectomy. Patients and methods: In Qena university hospital, this prospective randomized comparative study was conducted, 80 patients were scheduled to elective laparoscopic cholecystectomy. Group intraperitonealIP lidocaine (40 patients) received 200 ml saline containing 200 mg 2%lidocaine immediately after pneumoperitoneum, the total solution was sprayed on the upper surface of the liver, right subdiaphragmatic space and around the cholecystectomy site. Group indomethacin (40 patients) received two 100 mg indomethacin rectal suppositories 2 hours prior to surgery. Results: VAS score was significantly lower in indomethacine group ( p value =0.03)over the 24 hours postoperative . The postoperative pethidine requirements were significant lower in group indomethacin mean (34±11.4 mg). Postoperative nausea and vomiting were less in group indomethacin with no statistically significant difference. Conclusion: preoperative rectal indomethacin suppositories decrease postoperative pain scores and analgesics requirements without producing side effects comparing to IP lidocaine in LC. Clinical trail .gov . ID:NCT04964180

Change of Urinary Nitrite Excretion in Primary Enuresis after Indomethacin Treatment

Various treatment modalities have been used in primary Nocturnal Enuresis (PNE). Inhibition of prostaglandin synthesis may have value in the management of PNE. The effect of PGs on the urinary system are similar to those of Nitrous oxide (No), so there might be a link between No production and PNE. We can use nitrite as a good indicator of both PG and No because it is a stable metabolite of No. Our objective in this study was to assess urinary nitrite excretion in patients with enuresis and to evaluate the effect of indomethacin (a potent prostaglandin synthesis inhibitor) on urinary nitrite excretion. Sixty children participated in this study with age range 5-14 years and were divided into three groups: Group A comprised 20 children with PNE and were given 50 mg indomethacin suppositories each night for 1 month, group B comprised also 20 children with PNE not receiving treatment. Both groups were assessed by frequency of bed wetting episodes as well as by measuring urinary nitrites. In addition, 20 normal comparable controls were assessed as regards their urinary nitrites to show the difference in its values between enuretics and normal individuals. The results showed increase in nitric acid level in enuretic children than controls with marked decrease in its levels after receiving Indomethacin and marked improvement in the frequency of bed-wetting.

Ketorolac Is Safe and Associated With Lower Rate of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Children With Pancreatic Duct Manipulation.

Use of non-steroidal anti-inflammatory drugs (NSAIDs) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prevention in pediatrics is not well studied. Because of difficulty in accurately dosing indomethacin suppositories in pediatric patients, our center has used intravenous ketorolac for PEP prevention and present data on its safety and associated PEP rates. Prospective monitoring of PEP for all patients who underwent ERCP at a pediatric tertiary care center from July 2010 to June 2018. Retrospective review of patient and procedural factors and severity of PEP. Routine use of ketorolac for PEP prevention began in 2014. Two hundred and ninety-eight ERCPs were analyzed. One hundred and sixty-six patients received intraprocedural ketorolac and 132 did not. One patient had post-ERCP bleeding and bleeding rates were not significantly different between ketorolac and non-ketorolac groups (0.6% vs 0%, P = 1). Overall rates of PEP were not significantly different between the ketorolac and no ketorolac group (9% vs 13%, P = 0.29); however, for high-risk pediatric patients with injection of contrast into and/or cannulation of the pancreatic duct, the rates of PEP were significantly lower for patients who received ketorolac (11% vs 25%, P = 0.035). Pediatric patients undergoing ERCP with manipulation of the pancreatic duct are high risk for PEP, and ketorolac was associated with a lower rate of PEP in these patients. Ketorolac was well tolerated without a higher rate of bleeding after ERCP. These results are the first to provide evidence showing an association with intraprocedural NSAID use and lower rates of PEP in select pediatric patients.

Prospective study on the effect of parecoxib sodium analgesia on pain and stress response after surgery in elderly patients with hip fracture

To investigate the effect of parecoxib sodium preemptive analgesia on pain and stress response after surgery in elderly hip fracture patients. The clinical data of 70 elderly patients with hip fracture treated in our hospital from October 2017 to October 2019 were prospectively analyzed. According to different analgesic patterns, 35 cases were randomly divided into experimental group, aged 65 to 86(78.5±9.1) years, 21 males and 14 females, including 18 femoral neck fractures and 17 femoral intertrochanteric fractures. There were 35 cases in control group, aged 66 to 88 (80.6±8.1) years, 18 males, and 17 females, including 20 cases of femoral neck fractures and 15 cases of intertrochantericfractures. The visual analogue scale (VAS) at 4 h, 12 h, 24 h, 48 h, and 72 h after surgery, the incidence of delirium and stress indicators of malondialdehyde (MDA), superoxide dismutase (SOD), cortisol (COR), and epinephrise (E) postoperatively in the two groups were observed. At 4 h, 12 h, 24 h, 48 h after surgery, the VAS score of experimental group was lower than that of the control group, and the difference was statistically significant (P<0.05). There was no statistical difference between the two groups at 72 h postoperatively (P>0.05). Within 72 h after surgery, the dosage of indomethacin suppository (0.1 g/suppository) in experimental group was 0.3 g, and that in control group was 1.2 g, the dosage of experimental group was less than that of control group. Within 7 days after operation, delirium occurred in 2 cases(5.7%) in experimental group and 8 cases (22.8%) in control group, the incidence of delirium in experimental group was significantly lower than that in the control group (χ2=4.2, P= 0.040). Two days after surgery, the serum SOD content of the two groups of patients increased, and the levels of MDA, E, and COR decreased; and the serum MDA, E, and COR levels of experimental group were lower than control group, and the SOD content was higher than control group;the differences were statistically significant (χ2<0.05). The advanced analgesic application of parecoxib sodium can significantly reduce the postoperative stress response of elderly hip fracture patients, enhance the postoperative analgesic effect, reduce the incidence of postoperative delirium, and improve the quality of rehabilitation of patients.

Clinical Effect analysis on indomethacin suppositories prevention of POST-ERCP acute pancreatitis

&lt;p&gt;ObjectiveToinvestigate the clinical effect of indomethacin suppositories prevention of POST-ERCP acute. Pancreatitis20&amp;gt;Methods180 cases of ERCP were selected from March to September 2015 in ourHospital, all the patients according to the random number table were divided into two groups, there were-cases in the OBsenTation Group and the control group.Hie control group received conventional treatment, the observation group treated with indomethacin on the preventionof the conventional treatment.The serum amylase levels at different time points before and after surgery, acute pancreatitis and hyperamylasemia&amp;lt;/b13&amp;gt;&lt;/p&gt;&lt;p&gt;author Units:4732b4Nanyang,Henan Zhongnan Industrial Co., Ltd. Staff Hospital surgery&lt;/p&gt;&lt;p&gt;oftwo groups were compared.ResultsTheserum amylase levels of the observation group and the control group after 2 H, after H, H PostoperativE were higlier than the preoperative, the degree of elevation of the Obsen&lt;sup&gt;T&lt;/sup&gt;ation Group was smaller than the conTrol Group, the difference was statistically significance (P 0.05).The incidence of acute pancreatitisand hyperamylasemia of the Obsen&lt;sup&gt;7&lt;/sup&gt;ation Group were lower than the control groUp, the difference was statistically significant (^ 0.05).conclusionindomethacin can be effective in preventing POST-ERCP acutePancreatitis and reduce the incidence of hyperamylasemia, can significantly lower blood.&lt;/p&gt;

Prophylactic effect of rectal indomethacin plus nitroglycerin administration for preventing pancreatitis after endoscopic retrograde cholangiopancreatography in female patients.

Prophylactic pancreatic stent placement (PSP) and rectal indomethacin suppository are recommended to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk cases. Clinical trials on the use of nitroglycerin to reduce PEP have reached no definitive conclusion. Our study aimed to determine whether treatment with rectal indomethacin plus nitroglycerin could eliminate the need for PSP in patients. In this randomized clinical trial, patients were allocated into groups using a random number table, with each patient receiving a pre-made envelope containing their intervention prior to ERCP. The three treatment groups were: the placebo group, the indomethacin + nitroglycerin group, and the PSP group. The subjects were assessed for PEP and its severity by a panel of independent and blinded adjudicators. A total of 526 patients were eligible for inclusion. The placebo group included 176 patients, the indomethacin + nitroglycerin group included 176 patients and the PSP group included 174.A diagnosis of PEP was made in 64 (12.2%) cases. The rate of PEP in the three study groups placebo group, indomethacin + nitroglycerin group and the PSP group was 19.3%, 5.1%, and 12.1%, respectively. The risk of post-ERCP pancreatitis in the indomethacin + nitroglycerin group was 7% lower than that in the PSP. Indomethacin + nitroglycerin is superior to PSP in preventing and relieving the severity of post-ERCP pancreatitis in patients with difficult intubation. Indomethacin plus nitroglycerin can avoid the need for PSP in the prevention of post-ERCP pancreatitis. Current Controlled Trials ChiCTR2000033944.

Comparative Study of the Tocolytic Effects of Magnesium Sulfate and Indomethacin on Pregnancy Duration and Neonatal Outcomes in Preterm Labor: A Clinical Trial

Introduction: Preterm labor is still one of the most serious complications of pregnancy. Many drugs have been used to control preterm labor, but their definitive effect is not known. Hence, this study was conducted to compare the tocolytic effects of magnesium sulfate and indomethacin on pregnancy duration and neonatal outcomes in preterm labor. Methodology: The present study was a randomized clinical trial study conducted at Kamali Hospital of Alborz Province. Research samples included 211 mothers with singleton pregnancy, healthy amniotic membrane, gestational age over 25 and less than 32 weeks, regular uterine activity as contraction in 20 minutes or cervical changes of 1 cm/h or effacement equal or more than 80. Sampling was performed using convenience and randomized method through a random number table. Accordingly, both groups received the initial neuroprotection of magnesium sulfate at doses of 6 mg. Then, subjects of one group received 50 mg of indomethacin suppository at 8-hour intervals so that they could finally receive 4 doses. The subjects of another group received magnesium sulfate 2 g/h as intravenous infusion for at least 12 hours after discontinuation of contraction. Then, two groups were compared in terms of difference of gestational age at hospitalization and discharge times, neonatal Apgar score, and rate of neonatal hospitalization in ICU though SPSS software. Results: The results of independent t-test showed that there was no significant differences between two groups in terms of gestational age at discharge and hospitalization times (p <0.8). Also, the rate of neonatal hospitalization in sulfate group was lower than that of the indomethacin group and this difference was statistically significant (p <0.03). The most common cause of hospitalization in ICU was respiratory distress that was higher in the indomethacin group. Conclusion: Magnesium sulfate reduced neonatal hospitalization in ICU compared to indomethacin. The use of tocolytic magnesium sulfate and indomethacin increased the duration of pregnancy, but no difference was seen between these tocolytics. © 2020, Advanced Scientific Research. All rights reserved.

Real-World Practice Patterns in the Era of Rectal Indomethacin for Prophylaxis Against Post-ERCP Pancreatitis in a High-Risk Cohort.

The benefit of indomethacin suppositories for prophylaxis against post-ERCP pancreatitis (PEP) in high-risk patients was established in a landmark trial published in 2012. The aims of this study were to measure the adoption of indomethacin prophylaxis in widespread clinical practice, evaluate concurrent trends in pancreatic duct (PD) stent utilization, and estimate the impact of these changes on PEP in a high-risk population. Data were extracted from a commercial database (Explorys, IBM Watson Health, Somers, NY) that aggregates electronic health records from 26 US healthcare systems from 2009 to 2018. Using Systematized Nomenclature of Medicine Clinical Terms, we identified a cohort of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) and were at high risk for PEP based on narrow criteria. PEP was defined as an emergency department or hospital admission 1-5 days after ERCP with an associated diagnosis of pancreatitis. Twenty six thousand eight hundred twenty ERCPs were performed on this high-risk cohort from 2009 to 2018. The overall PEP rate during the study period was 8.6%. There was no decrease in PEP rates from 2012 to 2018. Beginning in 2012, indomethacin usage increased linearly (P < 0.001), but remained below 50% in 2018. As indomethacin increased, utilization of PD stents declined abruptly from 2013 to 2014 (40.7%-8.5%) and trended to a nadir of 3.0%. Despite its low cost, widespread availability, and level I evidence of benefit in reducing the risk of PEP in high-risk patients, the adoption of rectal indomethacin during ERCP has been slow and the medication continues to be under-utilized. In parallel, the PD stent usage has declined dramatically. The lack of change in PEP rates during the study period could be attributable to the persistent low usage of rectal indomethacin or the decline in PD stent use. Further educational efforts and quality assurance measures are warranted to ensure that rectal indomethacin and PD stent placement are more appropriately used in clinical practice.

Combination of intravenous hydration and indomethacin suppository is the most effective therapy for the prevention of post-ERCP pancreatitis – A network meta-analysis

It has previously been reported in a European case-control study with patients from Germany and France that CEL-HYB1, a hybrid allele of the carboxyl ester lipase (CEL) gene and its pseudogene CELP, increases susceptibility to chronic pancreatitis (CP). Here, we aimed to replicate this finding in Polish pediatric patients with CP.The distribution of the CEL-HYB1 allele in a CP pediatric cohort (n = 147, median age at CP onset 7.6 years) with no history of alcohol/smoking abuse was compared with ethnically matched healthy controls (n = 500, median age 46 years). Screening was performed using long-range PCR followed by agarose gel-electrophoresis.We observed no significant difference in the carrier frequency of the CEL-HYB1 allele between CP patients (7/147, 4.8%) and controls (12/500, 2.4%; P = 0.16).This study found no statistically significant association between CEL-HYB1 and chronic pancreatitis in a cohort of Polish pediatric CP patients.

Sa1327 REAL-WORLD PRACTICE PATTERNS IN THE ERA OF RECTAL INDOMETHACIN FOR PROPHYLAXIS AGAINST POST-ERCP PANCREATITIS: A LARGE POPULATION-BASED STUDY

The benefit of indomethacin suppositories for prophylaxis against post-ERCP pancreatitis (PEP) in high risk patients was established in a landmark randomized trial published in 2012. The aim of this study was to measure the adoption of indomethacin prophylaxis in widespread clinical practice since 2012 and to estimate its effectiveness in a high-risk population.

Timing of indomethacin suppositories for the prevention of post-ERCP pancreatitis – from the pathomechanism to the optimal therapy. Protocol of a randomized, double-blind, two-armed, non-inferiority study (PEPPER)

Our previous study suggested that a combination of ulinastatin and risperidone reduced post-ERCP pancreatitis (PEP) compared with ulinastatin alone.The aim of this study was to evaluate the efficacy of risperidone alone for prevention of PEP.A multicenter, randomized, placebo-controlled, double-blind clinical trial.Two academic hospitals and 5 referral hospitals in Tokyo and Saitama, Japan.Patients undergoing therapeutic or interventional-diagnostic ERCP.The patients were randomized to receive 2 mg of oral risperidone or oral placebo at 0.5 to 2 hours before ERCP.The primary endpoint was the incidence of PEP. Secondary endpoints were the incidence of hyperenzymemia and enzyme levels (amylase, pancreatic amylase, lipase). Risk factors for PEP were evaluated.We initially enrolled 500 patients in the study (250 in the risperidone group and 250 in the placebo group), but 17 (11 in the risperidone and 6 in the placebo group) were excluded after randomization. PEP developed in 24 patients (10.0%) in the risperidone group and 21 patients (8.6%) in the placebo group (P = .587). Serum amylase levels at 3 hours after ERCP were lower in the risperidone group (P = .007 in a single test of hypothesis, significance removed by Bonferroni correction for multiple testing). In multivariate analysis, a small papilla of Vater, total procedure time ≥40 minutes, and stenosis of the intrahepatic duct were significantly associated with PEP.Multiplicity of study centers and a relatively wide time range of drug administration time.Risperidone did not show a benefit in prevention of PEP in this trial. (Clinical trial registration number: NCT000004592.)

Desmopressin/indomethacin combination efficacy and safety in renal colic pain management: A randomized placebo controlled trial

IntroductionRenal colic is a prevalent cause of abdominal pain in the emergency department. Although non-steroidal anti-inflammatory drugs and opioids are used for the treatment of renal colic, some adverse effects have been reported. Therefore, desmopressin -a synthetic analogue of vasopressin- has been proposed as another treatment choice. In the present study, indomethacin in combination with nasal desmopressin was compared with indomethacin alone in the management of renal colic. MethodsIncluded in the study were 124 patients with initial diagnosis of renal colic and randomized to receive indomethacin suppository (100 mg) with either desmopressin intranasal spray (4 puffs, total dose of 40 micrograms) and or placebo intranasal spray. ResultsAll the included patients were finally diagnosed with renal colic. There was no difference between the two groups in pain at the baseline (p = 0.4) and both treatments reduced pain successfully (p < 0.001). There was no significant difference between the two groups in pain reduction (p = 0.35). ConclusionsWhile there was significant pain reduction in both patients groups, pain reduction of NSAIDs (e.g. indomethacin) in renal colic, does not significantly improve when given in combination with desmopressin.

Pain Relieving Effect of Sublingual Glycerol Trinitrate in Renal Colic: a Randomized Placebo-Controlled Trial.

Introduction:Renal colic is caused by colicky spasms of ureters. As has been shown in previous experiments, glycerol trinitrate (TNG) can inhibit these muscular spasms. Objective:This study was performed to assess the pain relieving effect of TNG among patients referred due to renal colic pain to the emergency department (ED). Methods:This study is a randomized, placebo-controlled study on 60 patients with renal colic who were referred to the ED, who were diagnosed clinically to have renal colic, and their pain was more than 5 based on a visual analogue scale (VAS). The patient's pain was recorded at the moment of clinical diagnosis, and each one received one capsule, either 0.4 mg TNG or placebo, plus a 100 mg indomethacin suppository. The pain score was re-assessed after 5 and 30 min. The values were recorded and compared using SPSS-16 software. Results:Sixty patients with a mean age of 35.75 ± 11.99 years were enrolled (73.3% male). Patients in the two groups were matched for age (p = 0.290), sex (p = 0.559), and the presence of microscopic hematuria (p = 0.292). Pain relief from the start point until the end of the intervention was statistical different in all studied patients (p < 0.05); but the comparison between the two groups showed no significant difference in this regard (p = 0.440). Conclusion:It is likely that adding TNG to an indomethacin suppository had no significant effects on better pain management of patients referred with renal colic to the ED.

A Comparative Study on Indomethacin Suppositories with Physical Therapy and Conventional Treatment Modalities for Lumbago Sciatica

Introduction: Most of the patients with Lumbago sciatica can be managed conservatively in a primary care setting with the expectation of a good outcome. It is one of the most common causes of pain and disability pertinent to lumbar spine. There are many alternative forms of treatment for this condition but the evidence of the efficacy of Indomethacin suppositories is yet to be established from clinical trials. Though several interventions are used in combination with physical therapy but indomethacin suppositories is commonly employed as a first line agent in the management of lumbago sciatica.&#x0D; Objective: To ascertain whether a comparative effect of Indomethacin suppositories with other conventional treatment modalities produce a significant difference in the outcome.&#x0D; Materials and Methods: This experimental clinical study was carried out at the Department of Physical Medicine, Combined Military Hospital (CMH), Dhaka and Department of Physical Medicine and Rehabilitation BSMMU, from 01 September 2015 to 28 February 2016. A total of 153 patients were randomly selected for trial and they were divided by lottery into 3 Groups. Group-“A” received Indomethacin suppositories with physical exercise and patients were 54 in number. 'Group-B' received NSAIDs (except indomethacin suppositories), SWD /MWD/IFT/TENS and patients were 47. In 'Group-C' there were 52 patients who received counseling with only physical exercises. Each Group received above-mentioned treatment modalities 5 days in a week for 6 weeks.&#x0D; Results: The results were observed and noted with the help of visual analogue scale (VAS). The highest significant improvement was observed in 'Group-A' throughout the whole treatment period. The significant difference of improvement was found between groups finally in week 4 (W4) to week 6 (W6). The group received Indomethacin suppositories with physical exercise shows improvement of patients with lumbago sciatica.&#x0D; Conclusion: The use of Indomethacin suppositories with physical therapy and the conventional modalities of treatment comparison help the physician to provide treatment facilities. The result was found better in groups those who received Indomethacin suppositories (Group-A) rather than those Groups who received other conventional treatment modalities.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 28-32

Use of double wire-guided technique and transpancreatic papillary septotomy in difficult ERCP: 4-year experience.

Background and aims: Post-ERCP complications increase with repeated attempts at cannulation. We evaluated several advanced biliary cannulation techniques applied when the standard approach fails. Methods: In total, 1873 consecutive patients underwent ERCP at our institution during the period 2010 – 2014. Guidewire-assisted (GA) cannulation with no contrast injection until deep biliary cannulation was considered the standard technique. Advanced techniques used were double wire-guided (DWG) cannulation, transpancreatic papillary septotomy (TPS), and needle-knife sphincterotomy (NKS). When GA cannulation failed, DWG cannulation was usually attempted first if the pancreatic duct (PD) wire was in place; if that failed, TPS or NKS was performed. Alternatively, TPS or NKS were performed alone. A prophylactic pancreatic stent was placed with repeated PD cannulation or PD contrast injection. During the last 2 years of review, indomethacin suppositories were given post-procedure to all patients who underwent advanced techniques. Results: The overall biliary cannulation success rate was 97 % (1823/1873). Advanced techniques were used in 12 % of ERCPs (230/1873), with 87 % (200/230) success rate. DWG was used alone or in combination with other techniques in 58 % (134/230) of advanced cases, with 68 % (91/134) success rate. Biliary cannulation was achieved in 96 % (91/95) of procedures when DWG was used alone, 76 % (26/34) with TPS alone, 80 % (37/46) for NKS alone, and 84 % (46/55) with multiple techniques. The overall rate of post-ERCP pancreatitis was 0.4 %, with all patients treated conservatively. Conclusion: In our experience at an urban tertiary care center, use of advanced techniques in difficult ERCP improved the overall success rate of biliary cannulation after standard technique failure without a significant increase in complication rate.

Morphine Suppository versus Indomethacin Suppository in the Management of Renal Colic: Randomized Clinical Trial.

Background. Renal colic is a medical emergency due to the rapid onset and devastating nature of its pain. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are both used as first-line choices in its management. Aim. This study aimed to compare the efficacy and safety of opioids and NSAIDs in the management of acute renal colic. Methods. One hundred and fifty-eight patients were divided into two groups (n = 79) and received either 10 mg morphine or 100 mg indomethacin suppositories. The severity of pain was measured using verbal numeric rating scale at baseline and 20, 40, 60, and 90 minutes after the administration of analgesics. Drug side effects as well as patients' vital signs were also recorded. Results. The mean decrease in the pain score during the first 20 minutes was significantly higher among those who received morphine suppository. However, no significant difference was observed between the two groups regarding the mean decrease in pain score during the first 40, 60, and 90 minutes after the admission. Prevalence of drug side effects or changes in the vital signs was not significantly different between the two groups. Conclusions. Morphine suppositories seem to be more efficient in achieving rapid pain relief comparing to indomethacin.

Formulation, evaluation and release studies of Indomethacin Suppositories

Indomethacin suppositories were prepared by using water soluble bases. All the prepared suppositories were evaluated for various physical parameters like weight variation, hardness, Liquefaction time. In-vitro release study was performed USP type I apparatus (Basket type) using phosphate buffer pH 7.4 as dissolution media. The suppositories prepared were within permissible range of all physical parameters.