Onset Time Of Action Research Articles

Clinical Research on Treatment of Migraine with Combination of Characteristic and Superior Techniques of Zhuang Medicine

Objective: To study the application effect of the combination of special advantages of Zhuang medical technology for migraine patients. Methods: 80 patients with migraine were selected and all were admitted to Mingxiu Branch of International Zhuang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from February 2019 to February 2020. Random number table method was used to divide patients into two groups, with 40 patients in each group. Among them, the patients in the study group were treated with the therapy combining characteristics of Zhuang medicine and superior technology, that is, Zhuang medicine meridian tendon therapy + Zhuang medicine lotus needle cupping blood stasis removal therapy + Zhuang medicine thread moxibustion therapy + Zhuang medicine acupuncture therapy; the patients in the control group were treated with conventional Western medicine. The efficacy of the two treatments were compared. Results: After treatment, the total effective rate of clinical treatment in the study group was higher than that in the control group (P < 0.05), and the visual analogue scale (VAS) score and integral improvement rate were higher than those in the control group (P < 0.05). The onset time of action was statistically shorter than that of the control group (P < 0.05). There was a statistically significant difference in the adverse reaction rate between the two groups (P < 0.05). Conclusion: The combination of Zhuang medicine’s characteristic and superior techniques for patients with migraine has a significant curative effect.

Effectiveness of 0.125% Bupivacaine versus 0.125% Ropivacaine in Epidural Labour AnalgesiaA Randomised Clinical Study

Introduction: Epidurally administered local anesthetics provide most effective analgesia during labour process. Among the available local anesthetics Bupivacaine and ropivacaine are the most commonly used drugs in concentrations ranging from 0.0625% to 0.125% and 0.08% to 0.125%, respectively. Both these drugs are weak bases, highly protein bound, highly lipid soluble, and have a pKa of 8.1, low unionised fraction, thus having a slightly longer time for onset of action but with a longer duration of action and have less transfer across the placenta. Hence, they are ideal drugs for use in labour analgesia. Aim: To compare the effectiveness of programmed intermittent bolus of 0.125% bupivacaine and 0.125% ropivacaine in low volumes in full term primigravidas for epidural labour analgesia. Materials and Methods: This randomised clinical study was conducetd at PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, between June 2020 and December 2021 among 80 full term primi parturients requiring normal vaginal delivery. They were randomly divided into two groups of 40 each. Group B received 10 mL of 0.125% bupivacaine and group R received 10 mL of 0.125% ropivacaine as initial bolus dose. Repeat doses of 5 mL was given every 60 minutes or when the patient had Visual Analogue Score (VAS) score >4 with a maximum dose of 10 mL/hr with a 20 minute interval between two doses. Parameters assessed were onset, duration, level and quality of analgesia, motor blockade, number of epidural top ups, total volume of drug consumed, mode of delivery, duration of labour, APGAR score, haemodynamics, patient satisfaction and complications. Data was entered in Microsoft Excel 2010 version and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: Both drugs were equally effective in terms of analgesia, maternal and foetal outcomes. Bupivacaine had a faster onset of action (7.075±0.916 min) compared to ropivacaine (8.225±0.891 min) (p-value=0.001). Ropivacaine had a shorter duration of action (43.1±2.30 min vs. 47.9±4.16 min in group B) (p-value=0.0001), requiring more top-up doses (5.2±0.46 versus 4.77±0.61 in group B) (p-value=0.0007), and more total volume of drug (38.5±3.08 mL versus 35.5±4 mL in group B) (p-value=0.002). It also caused lesser motor blockade (Bromage score of 1 in 1 parturient vs. 8 parturients in group B) (p-value=0.0129) and better overall maternal satisfaction score (excellent) in 30 parturients versus 25 parturients in group B. APGAR scores at 1 minute and 5 minutes were comparable between the two groups. Mean heart rates, mean blood pressures were also comparable between the two groups. There were no significant adverse effects in either groups. Conclusion: By providing minimal motor blockade and adequate analgesia 0.125% ropivacaine allows parturients to go through the labour process with excellent maternal satisfaction and minimal adverse effects compared to 0.125% bupivacaine

Evaluation of local anesthetic effects of Lidocaine-Ibuprofen ionic liquid stabilized silver nanoparticles in Male Swiss mice

A simple approach for the synthesis of Lidocaine-Ibuprofen ionic liquid stabilized silver nanoparticles (IL-AgNPs) was reported in this work. The shape, size and surface morphology of the Lidocaine-Ibuprofen ionic liquid stabilized AgNPs were characterized by using spectroscopic and microscopic techniques such as Ultraviolet-visible spectroscopy (UV–Visible), X-ray diffraction (XRD) analysis, Selected area electron diffraction (SAED), Transmission electron microscopy (TEM). TEM analysis showed the formation of 20–30nm size of IL-AgNPs with very clear lattice fringes. SAED pattern confirmed the highly crystalline nature of fabricated IL stabilized AgNPs. EDS results confirmed the formation of nanosilver. The fabricated IL-AgNPs were studied for their local anesthetic effect in rats. The results of local anesthetic effect showed that the time for onset of action by IL-AgNPs is 10min, which is significantly higher than that for EMLA. Further, tactile test results confirmed the stronger and faster local anesthetic effect of IL-AgNPs when compared to that of EMLA.

Simultaneous quantification of proposed anti-malarial combination comprising of lumefantrine and CDRI 97–78 in rat plasma using the HPLC–ESI-MS/MS method: application to drug interaction study

BackgroundLumefantrine is the mainstay of anti-malarial combination therapy in most endemic countries presently. However, it cannot be used alone owing to its long onset time of action. CDRI 97–78 is a promising trioxane-derivative anti-malarial candidate that is currently being investigated as a substitute for artemisinin derivatives owing to their emerging resistance.MethodsIn the present study, a sensitive, simple and rapid high-performance liquid chromatography coupled with positive ion electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) method was developed for the simultaneous determination of lumefantrine and CDRI 97-78’s metabolite, 97–63, in rat plasma using halofantrine as an internal standard. Lumefantrine and 97–63 were separated on a Waters Atlantis C18 (4.6 × 50 mm, 5.0 μm) column under isocratic condition with mobile phase consisting of acetonitrile: methanol (50:50, v/v) and ammonium formate buffer (10 mM, pH 4.5) in the ratio of 95:5 (v/v) at a flow rate of 0.65 mL/min.ResultsThe method was accurate and precise within the linearity range 3.9-500 ng/mL for both lumefantrine and 97–63 with a correlation coefficient (r2) of ≥0.998. The intra- and inter-day assay precision ranged from 2.24 to 7.14% and 3.97 to 5.90%, and intra- and inter-day assay accuracy was between 94.93 and 109.51% and 96.87 and 108.38%, respectively, for both the analytes. Upon coadministration of 97–78, the relative bioavailability of lumefantrine significantly decreased to 64.41%.ConclusionsA highly sensitive, specific and reproducible high-throughput LC-ESI-MS/MS assay was developed and validated to quantify lumefantrine and CDRI 97–78. The method was successfully applied to study the effect of oral co-administration of lumefantrine on the pharmacokinetics of 97–78 in male Sprague–Dawley rats and vice versa. Co-administration of 97–78 significantly decreased the systemic exposure of lumefantrine.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0684-5) contains supplementary material, which is available to authorized users.

Development of an Animal Fracture Model for Evaluation of Cement Augmentation Femoroplasty: An In Vitro Biomechanical Study

Osteoporotic hip fracture is the most severe kind of fracture with high morbidity and mortality. Patients' ambulation and quality of life are significantly affected by the fracture because only 50% regain their prefracture functional status, even if they undergo surgeries. There are many issues associated with the current preventive methods e.g., cost, side effects, patient compliance, and time for onset of action. Femoroplasty, the injection of bone cement into the proximal femur to augment femoral strength and to prevent fracture, has been an option with great potential. However, until now femoroplasty has remained at the stage of biomechanical testing. No in vivo study has evaluated its safety and effectiveness; there is not even an animal model for such investigations. The objective of this study was to develop a proximal femur fracture goat model that consistently fractures at the proximal femur when subject to vertical load, simulating osteoporotic hip fractures in human. Six pairs of fresh frozen mature Chinese goats' femora were obtained and randomly assigned into two groups. For the experimental group, a cylindrical bone defect was created at the proximal femur, while the control was left untreated. In addition, a configuration to mimic the mechanical axis of the goat femur was developed. When subjected to load along the mechanical axis, all the specimens from the bone defect group experienced femoral neck fractures, while fractures occurred at the femoral neck or other sites of the proximal femur in the control group. The biomechanical property (failure load) of the bone defect specimens was significantly lower than that of the control specimens (p<0.05). Osteoporotic hip fractures of humans were simulated by a goat fracture model, which may serve as a reference for future femoroplasty studies in vivo. The newly developed configuration simulating a femoral mechanical axis for biomechanical tests was practicable during the study.

Clinical research advances of the antidepressant effect of ketamine

Background Commonly used antidepressants have some defects including the delayed onset time of action and the low rate of effectiveness,whereas ketamine may exert a rapid and efficacious antidepressant effect.Objective This article reviews the clinical research advances in the antidepressant effect of ketamine.Content To summarize the antidepressant effects of ketamine in various depression and to elucidate the potential mechanisms of action and adverse reactions.Trend Further investigations regarding the antidepressant therapeutic protocol and the relevant mechanisms of action were needed on ketamine as a important new type of antidepressant. Key words: Ketamine; Antidepressant; Clinical research

Etomidate and Midazolam for Procedural Sedation in the Emergency Department of Queen Elizabeth Hospital: A Randomised Controlled Trial

Objective The objective of the study was to compare the effectiveness and safety of intravenous etomidate against midazolam in procedures which required sedation and analgesia in our emergency department. Methods The study was conducted in the emergency department of Queen Elizabeth Hospital from 1st November 2005 to 30th June 2006. Adult patients who required procedural sedation and analgesia were recruited and randomised into two groups, in which either etomidate or midazolam was used as the sedative agent. Vital parameters and depth of sedation were closely monitored until they regained full consciousness. Results a total of 87 patients were recruited and randomised into study and control groups, of which 78 patients completed the study and were analysed – 36 patients were in the midazolam group whereas 42 patients were in the etomidate group. There was no statistical difference in mean age, mean weight and procedures between the two groups. Mean time for onset of action was 1.8 minutes for the etomidate group versus 3.4 minutes for the midazolam group (p=0.003). There were no significant differences in total procedure time, total length of stay, pain score, satisfaction score and adverse effects. Conclusion Etomidate achieved adequate depth of sedation for painful procedures in significantly shorter time than midazolam. There were no differences in procedure time, length of stay, pain relief and patient's satisfaction between the two drugs.

Tumescent infiltration versus femoral nerve block for skin graft harvest-a prospective randomized study

ABSTRACTIn this prospective, randomized study, 60 patients requiring a single sheet of graft were randomized into 2 groups. Tumescent infiltration was used for anesthesia in one group and femoral nerve block in the other. The pain during administration of anesthesia, the time required for onset of action, the pain during graft harvest and the failure rates were recorded. Statistical comparison was done using Fischers Exact probability test for the failure rates and Mann Whitney- U test for the other parameters. The pain during administration was significantly higher for tumescent infiltration. The time for onset of action was significantly faster with femoral nerve block. The pain during harvest and the failure rates did not show any significant difference. We conclude that tumescent infiltration is more painful than femoral nerve block but equally effective as anesthesia with no difference in the failure and complication rates.

Tumescent infiltration versus femoral nerve block for skin graft harvest-a prospective randomized study

In this prospective, randomized study, 60 patients requiring a single sheet of graft were randomized into 2 groups. Tumescent infiltration was used for anesthesia in one group and femoral nerve block in the other. The pain during administration of anesthesia, the time required for onset of action, the pain during graft harvest and the failure rates were recorded. Statistical comparison was done using Fischers Exact probability test for the failure rates and Mann Whitney- U test for the other parameters. The pain during administration was significantly higher for tumescent infiltration. The time for onset of action was significantly faster with femoral nerve block. The pain during harvest and the failure rates did not show any significant difference. We conclude that tumescent infiltration is more painful than femoral nerve block but equally effective as anesthesia with no difference in the failure and complication rates.

Poster 68: Improved clinical outcomes in trigger points injections by combined use of lidocaine, toradol, and steroids

Objective: To test the use of a combination of lidocaine, ketorolac (Toradol), and steroids in trigger point injections. Design: Case-control study. Setting: Outpatient-based sports medicine practice at a major university hospital. Participants: 187 patients diagnosed with trigger points. With age- and sex-matched cases (group 1) and controls (group 2), 47 patients in the group 1 were treated with lidocaine alone and 42 in the group 2 were treated with a combination of lidocaine, Toradol, and steroid. Interventions: A combination of lidocaine, Toradol, and steroid injections. Main Outcome Measures: Patients were asked to chart pain on visual analog scale (VAS) for 7 days and to return to clinic for 1- and 3-month follow-ups. Results: Reported average pain relief on VAS in the group 1 was 6 points during the first 7 days compared with 2.5 points in the group 2. Complete resolution of symptoms (27% in group 1; 39% in group 2) and need or repeat injections (36% in group 1; 24% in group 2) were also noted. Conclusions: Patients treated with a combination of lidocaine, Toradol, and steroid had better pain control, needed fewer repeat injections, and had better resolution of symptoms than patients treated with lidocaine alone. Lidocaine offers pain relief within 1 to 2 minutes and persists for 15 to 20 minutes, Toradol offers pain relief after 45±30 minutes, and steroids take 3 to 5 days to affect the site. Besides the different time for onset of action, they also act on different pain receptors and thus offer a combined mode of treatment. This combination, however, should be used with caution and all the contraindications and drug interactions must be kept in mind.

Effects of salmeterol on secretion of phosphatidylcholine by alveolar type II cells

β-adrenergic agents enhance secretion of phosphatidylcholine (PC) by adult and fetal type II cells. We have previously shown that terbutaline stimulates secretion of PC by fetal type II cells, but the response wanes after 3.0 minutes. We studied the effects of salmeterol, a highly selective, long-acting β 2-adrenergic agonist that does not cause receptor desensitization, on PC secretion by adult type II alveolar cells in primary culture. Release of lactate-dehydrogenase was < 4% and did not vary with the concentration of salmeterol. Salmeterol stimulated PC secretion in a concentration-dependent manner. The maximum effective-concentration tested was 50 nM and the EC 50 was 11.40 ± 1.14 nM. Propranolol inhibited the effect of salmeterol on release of PC, confirming that the effects of salmeterol are mediated by β-receptors. OT 50, the time for onset of action, was 32.0 ± 1.6 minutes. RT 50, the time to achieve 50% recovery from maximal stimulation was, 393.0 ± 20.2 minutes. We conclude that salmeterol stimulates PC secretion by type II cells through activation of β-adrenergic receptors and has a longer duration of action (> 6 hours) compared to other β 2-agonists. Salmeterol may be a useful drug with which to study the role of receptor desensitization in the developmental changes in PC secretion.