Ketorolac Research Articles

Comparative Study of Dezocine and Ketorolac Tromethamine in Patient-Controlled Intravenous Analgesia of Laparoscopic Cholecystectomy.

PurposeThis study aimed to observe the application value of dezocine and ketorolac tromethamine in patient-controlled intravenous analgesia (PCIA) of patients undergoing laparoscopic cholecystectomy (LC).MethodsA total of 154 patients who underwent LC surgery in our hospital and received PCIA after surgery from September 2020 to September 2021 were selected, they were divided into group A (n = 77) and group B (n = 77). Group A was given dezocine and group B was given ketorolac tromethamine. The analgesia, sedation, comfort, and adverse reactions of the two groups were closely observed at 4, 8, 12, and 24 h after surgery.ResultsAt 4, 8, 12, and 24 h after surgery, the visual analog scale scores in group B were lower than those in group A (P < 0.05). At 4, 8, 12, and 24 h after surgery, the Ramsay scores in group B were higher than those in group A (P < 0.05). At 4, 8, 12, and 24 h after surgery, there was no significant difference in Bruggrmann comfort scale scores between the two groups (P > 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05).ConclusionBoth dezocine and ketorolac tromethamine have high clinical application value in patients who underwent LC surgery and received PCIA, with higher patient comfort and fewer adverse reactions. But compared with dezocine, ketorolac tromethamine can achieve better sedative and analgesic effects, which is worthy of clinical promotion.

Ketorolac tromethamine represses senescence in aging articular chondrocytes

The present study aims to explore the potential function of ketorolac tromethamine in treating osteoarthritis by examining its effects on interleukin-1β (IL-1β)-triggered cellular senescence in chondrocytes. More β-galactosidase (SA-β-Gal) positively stained cells, promoted cell fraction in the G0/G1 phase, increased release of matrix metalloproteinase (MMP)-3 and MMP-13, and upregulated cellular senescence-related genes (p21 and p53) were observed in IL-1β-challenged HC-A cells, all of which were significantly reversed by 25 and 50 mg/mL ketorolac tromethamine. Furthermore, the upregulated cyclooxygenase-2 (COX-2) and elevated release of prostaglandin E2 in IL-1β- challenged HC-A cells were dramatically repressed by ketorolac tromethamine. Lastly, the inhibitory effects of ketorolac tromethamine on the activation of SA-β-Gal and the upregulation of p21 and p53 were greatly abolished by the overexpression of COX-2. Collectively, ketorolac tromethamine repressed cellular senescence in aging articular chondrocytes by inhibiting COX-2.

In situ gelling system for sustained intraarticular delivery of bupivacaine and ketorolac in sheep

Suboptimal control of postoperative pain following knee arthroplasty can slow recovery and reduce patient satisfaction. Intraarticular (IA) administration of bupivacaine and ketorolac offers efficient pain control and minimizes opioid consumption. However, the clinical benefits of this approach are short lived due to rapid clearance of drugs from the joint cavity. Here, we describe a poloxamer based thermoresponsive in situ gelling system for the sustained IA delivery of bupivacaine hydrochloride (BH) and ketorolac tromethamine (KT) following knee surgery in an ovine model. Drug loaded formulations were prepared using poloxamer 407, poloxamer 188 and sodium chloride. In vitro characterization was conducted, followed by in vivo evaluation of sustained drug release and safety in an ovine model of knee joint surgery. Rheological studies revealed a Newtonian-like flow of the developed formulation at room temperature, confirming its injectability, followed by a transition to a viscous gel as temperature approached body temperature. The developed formulation successfully sustained the in vivo release of BH for 72 h and KT for 48 h, as determined by circulating drug levels, compared to 24 and 8 h for marketed drug solutions. The concentrations of BH and KT in the synovial fluids at 72 h were 11.5 and 1.8 times that of marketed products, suggesting a significant increase in the IA residence time. The developed formulation induced a comparable inflammatory response compared to the marketed drug solutions, however a significantly higher chondrotoxicity was observed following administration of the gel formulations. Poloxamers based in situ gelling systems are promising delivery platforms for the sustained and localised IA delivery of BH and KT, with potential clinical benefits in managing the postoperative pain following knee arthroplasty.

Design and invitro evaluation of gastro retentive oral matrix tablet formulations of ketorolac tromethamine

Ketorolac Tromethamine floating tablets were prepared by using combination of hydrophilic polymers such as Hydroxy Propyl Methyl Cellulose 4000 cps grade and 100000 cps grade. Eight set of formulations were prepared by gradual increasing and decreasing concentrations of above two polymers. The floating pattern was found to be instant for all the formulations and best controlled release profile was achieved for few set of formulations. The drug content, tablet weight, friability and weight variation were found to be within the limits. Validated UV spectrophotometric method was developed and standard linear regression was used to determine the concentration of released drug during the course of dissolution. The release studies were subjected to zero order, first order, higuchi and ritger-peppas kinetics and the parameters for controlled release were calculated.

Ketorolac tromethamine alleviates IL-1β-induced chondrocyte injury by inhibiting COX-2 expression.

Osteoarthritis (OA) is one of the most frequently diagnosed chronic diseases, and its prevalence is rising as life expectancy increases. The present study was designed to investigate the role of ketorolac tromethamine (KT) in OA by establishing an in vitro model in ATDC5 cells. The OA model was established through induction using 10 ng/ml IL-1β. KT was then used to treat the ATDC5 cells. An MTT assay was adopted to detect the viability of ATDC5 cells with or without IL-1β induction, and cyclo-oxygenase-2 (COX-2) expression in IL-1β-induced ATDC5 cells was measured via reverse transcription-quantitative (RT-q)PCR and western blotting. To explore the effects of KT on proliferation and apoptosis in IL-1β-induced ATDC5 cells, COX-2 was overexpressed and RT-qPCR was employed to detect the mRNA expression of COX-2. The viability of IL-1β-induced ATDC5 cells was detected by using a Cell Counting Kit-8 assay. In addition, levels of apoptosis and apoptosis-related proteins were determined using TUNEL staining and western blotting, respectively. Additionally, the effects of KT on oxidative stress in IL-1β-induced ATDC5 cells were also investigated. The expression levels of nitric oxide (NO) and inducible NO synthase (iNOS) were detected via NO kit assay and western blotting, respectively. In addition, the expression levels of oxidative stress-related proteins, including reactive oxygen species (ROS), superoxide dismutase (SOD) and prostaglandin E2 (PGE2), were determined using ELISA. To investigate the effects of KT on the inflammatory response and extracellular matrix (ECM) degradation, ELISA and western blotting were adopted to detect inflammatory-related proteins and ECM degradation-related proteins. Results from MTT assay indicated that KT decreased ATDC5 cell viability in a concentration-dependent manner. The expression of COX-2 was found to be downregulated in IL-1β-induced ATDC5 cells after treatment with KT, according to RT-qPCR and western blotting results. KT inhibited apoptosis and the expression levels of NO, iNOS and inflammatory-related proteins in IL-1β-induced ATDC5 cells, while COX-2 overexpression reversed these inhibitory effects. However, the increased proliferation of IL-1β-induced ATDC5 cells after the stimulation of KT was decreased by COX-2 overexpression. Additionally, KT upregulated Bcl-2, SOD, type II collagen and aggrecan expression levels in IL-1β-induced ATDC5 cells, whereas Bax, ROS, matrix metallopeptidase (MMP)1 and MMP13 expression levels were downregulated. KT promoted the proliferation of IL-1β-induced ATDC5 cells, whereas COX-2 overexpression reversed the promotive effects of KT, revealing that KT could alleviate IL-1β-induced chondrocyte injury by suppressing COX-2 expression.

A Comparison of Topical Nepafenac with Ketorolac Tromethamine in Maintaining Pupilary Dilatation during Phacoemulsification

Background: The standard surgical procedure for cataract surgery now a days is phacoemulsification with intraocular lens (IOL) implantation, that gives excellent visual results. Stable and adequate mydriasis is equired throughout phacoemulsification surgery. Intraoperative pupil Constriction (miosis) is associated with an increased risk of intraoperative complications especially in difficult cases and it can result in prolonged surgical time.&#x0D; Objective: To compare the effectiveness of prophylactic administration of topical ketorolac tromethamine 0.5% and nepafenac 0.1% on maintaining mydriasis during phacomulsification when instilled for 1 hour (I drop every 15 minutes) before surgery.&#x0D; Material and Methods: In this study a total of 490 eyes were included (that is 245 eyes in each group), using efficacy of Nepafenac equal to 17.32% and that of ketorolac tromethamine equal to 27.89%, in terms of loss of pupil mydriasis from baseline till end of phacoemulsification. Power of test is equal to 80% and level of significance is equal to 5%. &#x0D; Results: In this study mean age in Group A (nepafenac 0.1%) was 62 year.&#x0D; while mean age in Group B (ketorolac tromethamine 0.5%) was 64 year with standard deviation&#x0D; ± 2.87. In Group A (nepafenac 0.1%),(55%) patients were male and (45%) patients were female.&#x0D; Where as in Group B (ketorolac tromethamine 0.5%), (57%) patients were male and (43%)&#x0D; patients were female.&#x0D; Conclusion: Our study concludes that Nepafenac 0.1% is more effective than ketorolac tromethamine 0.5% in&#x0D; maintenance of dilated pupil during phacoemulsification surgery.&#x0D; KEY WORDS: Nepafenac 0.1%, ketorolac tromethamine 0.5%, dilated pupil,&#x0D; phacoemulsification surgery

Application of different doses of fentanyl combined with ketorolac tromethamine for painless gastroscopy in elderly obese patients

Application of different doses of fentanyl combined with ketorolac tromethamine for painless gastroscopy in elderly obese patients

UV Spectrophotometric and stability indicating RP-HPLC methods for simultaneous estimation of Moxifloxacin HCl and Ketorolac tromethamine in bulk and ophthalmic dosage forms

It was the main goal of this study's research to develop simple UV-Spectrophotometric and Stability indicating RP-HPLC methods for the simultaneous estimation of Moxifloxacin HCl (MOX) and Ketorolac Tromethamine (KET) in bulk and ophthalmic dosage forms, as well as to conduct Forced Degradation experiments. When utilising linearity ranges between 1.0 and 9.0 g/ml for MOX and KET, correlation co-efficients &gt;0.990 were used in the UV Spectrophotometry test results. Acetonitrile (40:60 v/v) was the solvent of choice. MOX and KET were discovered to have wavelengths of 295 nm and 316 nm, respectively. Researchers discovered that the isobestic point was located at 308 nm. Both medicines were separated using RP-HPLC on a SHISHEDO C18, 2504.6mm, 5 micron size column with a mobile phase made up of 40:60 v/v acetonitrile and water with flow rate of 0.9 ml/min and UV detection at 308 nm. Moxifloxacin Hcl and Ketorolac Tromethamine had retention durations of 2.080 minutes and 4.400 minutes, respectively. Moxifloxacin Hcl and Ketorolac Tromethamine have linearities of 1.0-6.0 g/ml and 1.0-6.0 g/ml, respectively. For linearity, recovery, limit of detection, and limit of quantification statistical validation was performed on the technique. Accuracy and precision were also evaluated. Analytes are well-resolved from degradation products when medicines are subjected to a variety of stresses, such as acidic or alkaline pH values, high oxidation or photo-stability temperatures, or a combination of these circumstances. The accuracy, precision, linearity, limit of detection, limit of quantification, and robustness of the two proposed techniques were effectively validated. This means that both Moxifloxacin HCl and Ketorolac Tromethamine may be estimated simultaneously in bulk and ophthalmic dose forms using these two techniques.

Construction of multifunctional NH2-UiO-66 metal organic framework: sensing and photocatalytic degradation of ketorolac tromethamine and tetracycline in aqueous medium.

Existence of pharmaceutical residues in water has endangered environmental pollution worldwide, which makes it ineludible to develop prospective bifunctional materials which not only possess excellent fluorescence behaviour to monitor pharmaceuticals but also exhibit simultaneous photocatalytic removal efficiency. Strengthened by functionalized metal organic framework (MOF) materials, we present here an amine functionalized zirconium-based MOF NH2-UiO-66 which has been successfully synthesized using solvothermal approach. The as prepared MOF was subjected to numerous structural, morphological and compositional characterizations. Interestingly, featured by the excellent fluorescent intensity of MOF modulated by LMCT effect, NH2-UiO-66 was screened to detect pharmaceutical compounds with KTC and TC in aqueous solution. The prepared functionalized MOF showcased excellent sensing platform with magnificent response range (0‒3µM), lower limit of detection (160nM; KTC and 140nM; TC), excellent selectivity and influential anti-interference capability. More importantly, the practical utility of the proposed sensor was further explored for the determination of pharmaceutical drugs in real water samples with suitable recoveries. Simultaneously, the synthesized MOF also exhibited high photocatalytic efficiency towards the removal of KTC and TC under solar light irradiation. The degradation efficiency for KTC and TC was found to be 68.3% and 71.8% within 60 and 280min of solar light, respectively. Moreover, excellent recyclability was demonstrated by the current synthesized system over five cycles. Overall, this study presents a feasible route for the utilization of functionalized MOFs as potential dual functional materials towards the simultaneous detection and degradation of specific pharmaceuticals from aqueous medium.

Designing of pH-responsive ketorolac tromethamine loaded hydrogels of alginic acid: Characterization, in-vitro and in-vivo evaluation

pH-responsive hydrogels based on alginic acid grafted with acrylic acid and ethylene glycol dimethylacrylate in the presence of ammonium persulfate were developed for controlled delivery of Ketorolac tromethamine. The alginic acid based hydrogels were prepared by free radical polymerization technique. Increase in gel fraction was observed with the increase in alginic acid, acrylic acid, and ethylene glycol dimethylacrylate content. The dynamic swelling and drug release studies were conducted at two different pH values (pH 1.2 and 7.4). Maximum swelling and drug release were observed at pH 7.4. The characterization of prepared hydrogels was carried out by using Fourier transform infrared spectroscopy, thermogravimetric analysis, differential scanning calorimetry, powder x-ray diffraction, and scanning electron microscopy. Similarly, in-vivo study was performed on rabbits and greater plasma drug concentration was achieved by fabricated hydrogels as compared to drug solution and commercial product Keten. Conclusively, the fabricated hydrogels can be considered as a potential candidate for controlled delivery of Ketorolac tromethamine.

Пролонгована паравертебральна аналгезія для знеболювання у хворих після торакотомії

Актуальність. Торакотомія відноситься до одного з найбільш травматичних втручань в хірургії, що супроводжується вираженим гострим болем після операції та розвитком хронічного больового синдрому у віддаленому післяопераційному періоді. Мета дослідження. Порівняти ефективність та безпечність різних методів знеболювання хворих після торакотомії. Матеріали та методи. Після торакотомії 85 хворих було розподілено на три дослідні групи. Знеболювання проводили за допомогою пролонгованої паравертебральної аналгезії (ПВА) (19 хворих) і пролонгованої епідуральної аналгезії (ЕДА) (36 хворих) 0,2% розчином ропівакаїну зі швидкістю 6 мл/год (у паравертебральний або епідуральний простір). У контрольній групі (30 хворих) знеболювання проводилось внутрішньовенною, контрольованою пацієнтом аналгезією розчином морфіну. Як ад’ювантний анальгетик у всіх трьох дослідних групах використовували нестероїдний протизапальний препарат кеторолаку трометамін внутрішньом’язово. У ранньому післяопераційному періоді оцінювали рівень болю в стані спокою та під час фізичного навантаження дихальної мускулатури (виконання спірометрії), показники функції зовнішнього дихання (ФЗД), а також частоту та тип ускладнень застосованих методів знеболювання. У віддаленому післяопераційному періоді оцінювали частоту виникнення хронічного болю. Результати. У групах з пролонгованою ПВА і ЕДА інтенсивність больового синдрому протягом трьох діб післяопераційного періоду за візуальною аналоговою шкалою (ВАШ) у стані спокою була меншою порівняно з контрольною групою. У групі ПВА рівень болю був від 29,1 бала через чотири години після операції до 18,7 бала в кінці третьої доби; у групі ЕДА — від 24,2 до 20,3 бала відповідно; у контрольній групі — від 48,8 до 38,0 бала відповідно. Під час дослідження ФЗД інтенсивність болю в групах ПВА і ЕДА також була нижчою порівняно з контрольною групою і становила 33,8 бала в групі ПВА, 38,7 бала — в групі ЕДА, 61,2 — у контрольній групі. Частоту виникнення хронічного больового синдрому оцінювали через 6 місяців після операції. Було відібрано по 15 хворих із кожної групи. У контрольній групі хронічний больовий синдром розвинувся у 8 хворих (53 %), у групі ЕДА — у 5 хворих (33,3 %), у групі ПВА — у 3 хворих (20 %). Найменша кількість ускладнень і технічних невдач спостерігалась у групі ПВА. Висновки. У групі з пролонгованою ПВА порівняно з пролонгованою ЕДА рівень болю за ВАШ був нижчим, частота випадків хронічного болю меншою, а кількість побічних ефектів мінімальною. Пролонгована паравертебральна блокада у хворих після торакотомії дає змогу ефективно контролювати гострий післяопераційний біль та зменшує розвиток хронічного больового синдрому.

Clinical research for dose effects of ketorolac tromethamine on PCIA after hip arthroplasty

To observe effect and safety of different doses of ketorolac tromethamine in patient controlled intravenous analgesia (PCIA) after hip arthroplasty. 60 hip arthroplasty patients injected with 0.5 mg/kg ketorolac tromethamine before anesthesia were randomly divided into group A, B and C in which the patients were injected 2, 3 and 4 mg/kg ketorolac tromethamine after operation respectively. Compared with group A, MAP and HR in group B and group C were lower at T1 (3 h after operation) and T2 (6 h after operation). In group A, MAP and HR at T3 (24 h after operation) and T4 (48 h after operation) were lower than at T1. Compared with group A, NRS scores of group B and C were significantly lower during the analgesia. Compared with group A, ramesay sedation scores in group B and group C were significantly higher at T1 and T2; Harris hip scores of group B and group C were significantly higher at T3 and T4; the total number of pushing PCA pump and dezocine dosage were significantly decreased in group B and group C. Preemptive analgesia combined with postoperative analgesia on patients after hip replacement was appropriate.

Cyclodextrin/Adamantane-Grafted Polyethylene Glycol–Based Self-assembling Constructs for Topical Delivery of Ketorolac Tromethamine: Formulation, Characterization, and In Vivo Studies

Topical formulation of non-steroidal anti-inflammatory drugs (NSAIDs) exhibits many advantages over the oral administration route, such as avoiding the direct effect on GIT and avoiding the poor oral bioavailability of such drugs. Our study aims to develop a new self-assembling construct based on the hydrophobic interaction between adamantane terminated poly (ethylene glycol) polymers and polymerized β-cyclodextrin. The viscous constructs were developed from direct mixing of host and guest polymer solutions, indicating spontaneous formation without cross-linkers. The modified system was evaluated by different analyses, including X-ray diffractometry, electron microscopy, isothermal titration calorimetry, and rheological analysis. Moreover, such a system's ability for drug loading and release was investigated via the in vitro release of ketorolac tromethamine (KT) as a model of NSAIDs. Finally, the prepared formulas were applied on a rat paw edema model to prove the enhanced anti-inflammatory activities. The obtained results indicated that the modified constructs have a rubbery porous structure with an amorphous nature. Also, from rheological results, the modified system exhibited a viscous behavior with higher loss modulus (G″) compared with storage (G'). The inclusion complexation between cyclodextrin and adamantane moieties was proved by the recorded high binding constants with a 1:1 stoichiometric ratio. Furthermore, the results showed the successful KT incorporation into the modified system and quantitatively released through a semi-permeable membrane in a sustained fashion (over 24 h). Finally, the in vivo results of the medicated constructs showed a significant inhibition of the induced inflammation and swelling, indicating that the modified construct has a great utility for safe non-irritating topical delivery applications.

Acute iridocyclitis and cystoid macular edema related to kinked Hydrus® Microstent in advanced glaucoma

A 58-year-old male who underwent cataract extraction with combined intraocular lens and Hydrus® Microstent (Ivantis Inc, Irvine, CA, US) implantation 2 years ago in the right eye (OD) due to advanced glaucoma presented with blurry vision in right eye (OD) for 3 months. The visual acuity was 20/60 and slit-lamp examination indicated mild anterior chamber inflammation with unexposed, functioning tube shunt superotemporally in OD. Optical coherence tomography demonstrated cystoid macular edema (CME) with subretinal fluid. Fluorescein angiography demonstrated petaloid pattern leakage of CME. Gonioscopy revealed a kinked appearance of a Hydrus® Microstent protruding into the anterior chamber and causing iris chafing. Topical ketorolac tromethamine and prednisolone acetate were started. At the 2nd month of follow-up, the anterior chamber was quiet, and the CME resolved completely. Protruded kinked Hydrus® Microstent may lead to acute iridocyclitis and CME through iris chafing, which may be responsive to topical anti-inflammatory drops.

Comparison of the mean total loss of mydriasis with topical ketorolac tromethamine 0.5% and nepafenac 0.1% during phacoemulsification

Comparison of the mean total loss of mydriasis with topical ketorolac tromethamine 0.5% and nepafenac 0.1% during phacoemulsification

Chiral Resolution and Content Determination of Ketorolac Tromethamine using High-performance Liquid Chromatography

Background: Establishing R, S-enantiomer (S-KT and R-KT) chiral resolution and determination methods for KT are of great significance. Objective: This study aimed to establish a high-performance liquid chromatography (HPLC) method for the resolution and determination of ketorolac tromethamine (KT) enantiomers. Methods: A CHIRALPAK AGP column (0.4 × 10 cm, 5 μm) was used with 10 mmol/L ammonium acetate (pH 5.5) and isopropanol (97:3) as the mobile phase. The detection wavelength was 324 nm, the flow rate was 1.0 mL/min, the column temperature was 25°C, and the injection volume was 5 μL. Results: The resolution between S-KT and R-KT was 2.8. S-KT and R-KT demonstrated a good linear relationship in the range of 3-60 μg/mL (r &gt; 0.999). The average recoveries of S-KT and RKT were 99.2% and 99.8%, with relative standard deviations of 2.0% and 2.4%, respectively. Conclusion: The established method can be used for the resolution and determination of S-KT and R-KT.

Efficacy of Different Preemptive Analgesia on Postoperative Analgesia, Oxidative Stress, and Inflammatory Response after Gynecological Laparoscopic Surgery.

Objective To observe and compare the analgesic effects of oxycodone, pentazocine, and ketorolac tromethamine pre-emptive analgesia on gynecological laparoscopic patients after operation and the effects on oxidative stress and inflammatory reaction. Methods A total of 64 patients who underwent elective gynecological laparoscopic surgery in Yiwu Central Hospital from June 2019 to December 2020 were randomly divided into four groups (n = 16). Before anesthesia induction, oxycodone (group A), pentazocine (group B), ketorolac tromethamine (group C), and normal saline (group D) were, respectively, administered. Patients' mean arterial pressure (MAP) and heart rate (HR) changes, visual analogue scale (VAS), Bruggemann comfort scale (BCS), serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), blood glucose (CLU), serum cortisol level, postoperative adverse reactions, and additional analgesia were recorded at each time point. Results The MAP levels of T2 (immediate intubation), T3 (immediate catheter removal), and T4 (5 min after catheter removal) in the four groups were higher than those of T1 (quiescent state), and the HR levels T2, T3, and T4 were lower than those of T1 (P < 0.05). The MAP and HR levels of T2, T3, and T4 in patients of groups A, B, and C were lower than those of group D in the same period (P < 0.05). The VAS and BCS scores of groups A, B, and C at 1, 6, 12, and 24 h after operation were better than those of group D at the same time, and the scores of group A at 1 h and 6 h after operation were better than those of groups B and C at the same time (P < 0.05). The levels of serum TNF-α, IL-6, and CRP in the four groups of patients at 6, 12, and 24 h after operation were higher than those before operation, but those in groups A, B, and C were lower than those in group D, and those in group A were higher than those in groups B and C at 12 h and 24 h after operation (P < 0.05). The CLU and serum cortisol levels in the four groups were significantly higher at 6, 12, and 24 h after operation, but those in groups A, B, and C were lower than those in group D, and those in group A were lower than those in groups B and C at 6 and 12 h after operation (P < 0.05). There was no significant difference in the incidence of adverse reactions within 24 h between the four groups (P > 0.05). The incidence of additional analgesia in groups A, B, and C was lower than that in group D (P < 0.05). Conclusion Oxycodone, pentazocine, and ketorolac tromethamine are effective and safe in inhibiting postoperative pain and the generation of inflammatory factors and relieving inflammatory state in gynecological laparoscopic pre-emptive analgesia. Oxycodone has better postoperative analgesic effect because it can effectively alleviate stress reaction.

Effects of S(+)-ketamine combined with sufentanil for patient-controlled intravenous analgesia on the early recovery in elderly patients undergoing laparoscopic radical resection of rectal cancer

Objective: To observe the efficacy and safety of S(+)-ketamine combined with sufentanil for patient-controlled intravenous analgesia (PCIA) in elderly patients undergoing laparoscopic radical resection of rectal cancer and explore its impact on patients' early recovery. Methods: One hundred and ten patients undergoing laparoscopic radical resection of rectal cancer in Affiliated Cancer Hospital of Zhengzhou University from December 2020 to March 2021, were divided into two groups (n=55) using a random number table: group S received PCIA, with continuous infusion of S(+)-ketamine combined with sufentanil, while group C received PCIA, with continuous infusion of sufentanil. PCIA was initiated at the end of the surgery, and the formulations were as follows: group S, S(+)-ketamine (1.44 mg/kg), sufentanil (1.05 μg/kg), ketorolac tromethamine (2.0 mg/kg) and tropisetron (5 mg), in 100 ml of normal saline; group C: sufentanil (1.50 μg/kg), ketorolac tromethamine (2.0 mg/kg) and tropisetron (5 mg), in 100 ml of normal saline. Postoperative visual analogue scale (VAS) and Ramsay sedation scale were recorded at 6, 12, 24, 36, 48 h after the surgery. The incidence of remedial analgesia, the effective compressions number of PCI during 48 h after the operation. Time to first ambulation, time to first anal exhaust, time to resume oral feeding were recorded. The occurrence of adverse effects was compared between the two groups. Results: A total of 10 patients were excluded during the study, including 4 cases of conversion to laparotomy, 3 cases of dropping out of the study, and 3 cases with operation time more than 4 hours. Finally, 50 cases in group S and 50 cases in group C completed the study. There were no significant differences in VAS scores and Ramsay sedation sores at all time points between two groups (all P>0.05). Likewise, there were also no significant differences in the number of remedial analgesia and effective compressions of PCIA during 48 h after the operation between the two groups (both P>0.05). The total dosage of sufentanil consumption in group S [(64±9) μg] was lower than that in group C [(95±12) μg] within 48 h of PCIA, with a statistically significant difference (P<0.001). Time to first ambulation in group S was (1.1±0.2) d, which was shorter than that in group C [(1.6±0.5) d], and the difference was statistically significant (P<0.001). Likewise, time to first anal exhaust in group S [(1.3±0.4) d] was shorter than that in group C [(1.8±0.6) d], with a statistically significant difference (P<0.001). Additionally, time to resume oral feeding in group S was (2.5±0.6) d, which was shorter than that in group C [(3.1±0.7) d], and there was a statistically significant difference (P<0.001). The incidence of nausea, vomiting and pruritus in group S were 4.0%, 2.0% and 0, which were lower than that in group C (16.0%, 10% and 8.0%, respectively), with statistically significant differences (all P<0.05). No case with psychiatric symptoms was found in both groups. Conclusion: When used for postoperative intravenous analgesia in elderly patients undergoing laparoscopic radical resection of rectal cancer, S(+)-ketamine combined with sufentanil can provide satisfactory analgesic effects, decrease total consumption of sufentanil and the incidence of adverse effects, and thus facilitate patients' early recovery.

Polymeric Nanoparticles and Chitosan Gel Loading Ketorolac Tromethamine to Alleviate Pain Associated with Condyloma Acuminata during the Pre- and Post-Ablation.

This study describes the preparation and evaluation of two formulations, a hydrogel and a nanostructured system, containing ketorolac tromethamine as an anti-inflammatory agent for the local therapy against the inflammatory process derived from the surgical excision of Condyloma acuminata. Both formulations were physicochemically characterized. In vitro release profiles show that the nanoparticles release 92% ± 2.3 of the total ketorolac tromethamine encapsulated, while the chitosan gel releases 18.6% ± 0.2. The ex vivo permeation and distribution through human skin were also assayed and was observed how the main amount of ketorolac tromethamine is retained in the epidermis. In vivo studies were accomplished to evaluate the anti-inflammatory efficacy in mice which also involved the histological analysis to confirm the in vivo results. The nanoparticles present a significantly higher anti-inflammatory efficacy than chitosan gel. The tolerability of developed formulations was assessed by monitoring the biomechanical properties of the skin before and after application of both formulations. No statistical differences in trans-epidermal water loss and skin hydration with respect to the basal values were observed and the formulations exhibited higher anti-inflammatory activity compared to a reference ketotorlac tromethamine solution. Therefore, it can be concluded that both formulations can be proposed as outstanding candidates for offering a local anti-inflammatory therapeutical tool with potential clinical application.

Stability and compatibility of admixtures containing bupivacaine hydrochloride and ketorolac tromethamine for parenteral use

ObjectiveBupivacaine hydrochloride (BH) and ketorolac tromethamine (KT) are commonly used in parenteral admixtures to manage postoperative pain. However, stability and compatibility data for these admixtures applicable to current practice are...