Transdermal Nitroglycerin Patches Research Articles

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

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<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 < 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

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.

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.

Feasibility of Nitroglycerin Patch as a Pretreatment for the Distal Radial Approach: Study Protocol for a Randomized Controlled Trial (DRANG Study)

BackgroundThe distal radial approach (DRA) is a novel catheter cannulation technique to access the distal radial artery for coronary angiography (CAG). It is associated with less occurrence of puncture site occlusion than the conventional transradial approach. However, cannulation failure occasionally occurs due to difficulty in puncturing the smaller distal radial artery. Nitroglycerin is expected to improve the rate of successful DRA via its vasodilative and vasospasm-preventive effects. MethodsThe DRA in CAG using transdermal NitroGlycerin patch (DRANG) study is a single-center, double-arm, parallel-assignment, double-blinded, randomized, controlled trial. Eligible patients with angina pectoris who are scheduled to receive CAG via DRA at the National Cerebral and Cardiovascular Center will be enrolled and allocated to the nitroglycerin group (n = 46) or the no-treatment group (n = 46). The nitroglycerin group will receive a transdermal nitroglycerin patch pre-integrated with a covering material that completely conceals the patch on their upper arm on the puncture side. The no-treatment group will receive only the covering material. Applications are performed 2–8 h before puncture while the patient wears an eye mask. Physicians who are blinded to the allocation and have similar experience with DRA puncture will perform DRA using the Seldinger technique with a 22-gauge needle. The primary outcome is the rate of successful palpation-guided distal radial artery cannulation with the first puncture. The secondary outcomes are the rate of successful distal radial artery cannulation, number of punctures, procedure time, use of ultrasound guidance, diameter of the distal radial artery and changes before and after patch application, and occurrence of arterial vasospasm, occlusion, or hypotension. ConclusionsThis study will allow us to determine the impact of a transdermal nitroglycerin patch on the rate of successful DRA and validate its effectiveness as a DRA pretreatment. Trial registrationjRCTs051210128.

TCTAP A-087 Effect of Pre-procedural Transdermal Nitroglycerin Patch on Diameter of Distal Radial Artery in Anatomical Snuffbox

TCTAP A-087 Effect of Pre-procedural Transdermal Nitroglycerin Patch on Diameter of Distal Radial Artery in Anatomical Snuffbox

Observational Study to Compare Transdermal Nitroglycerin and Placebo Patch in Enhancing the Post-Operative analgesic Effect of Intrathecal Clonidine with Bupivacaine in Abdominal Hysterectomies

Background: Hyperbaric Bupivacaine 0.5% is the most commonly used for spinal anaesthesia.To improve thequality &amp; duration of analgesia many adjuvants have been used.Intrathecal clonidine binds with postsynapticalpha-2 receptors at the dorsal horn of the spinal cord,resulting in anti-nociceptive action.Transdermalnitroglycerin (tNTG) has been found to be converting nitroglycerin to Nitric Oxide(NO),which results inpain modulation in the central and peripheral nervous system by cyclic Guanosine Monophosphate(cGMP)through which the post-operative analgesia effect enhances.Method: Sixty patients Of ASA I/II aged between 20to60 years posted for hysterectomy under spinalanaesthesia were selected.Patients were randomly allotted into 2 equal groups.Group A received:Hyperbaric bupivacaine 0.5% (17.5 mg)+clonidine(50 mcg) + placebo patchGroup B received:hyperbaric bupivacaine0.5% (17.5 mg) + clonidine (50 mcg) + nitroglycerin (tntg)patch(nitroglycerin 25 mg/patch)We have observed onset and duration of sensory.and motor block,two segment regression time, duration ofanalgesia, hemodynamic changes and complication if any.Results: There was no statistically significant difference in demographic data and onset and duration ofmotor and sensory block. Duration of analgesia was significantly prolonged in clonidine with tNTG groupas compared to clonidine group with placebo group.Conclusion: Transdermal Nitroglycerin patch with intrathecal clonidine prolonged duration of analgesiawithout any changes in onset and duration of sensory and motor block.

To Determine the Safety and Efficacy of Transdermal Nitroglycerine Patch as Shortterm Tocolytic in Preterm Labor

Background and Objectives: Preterm labour complicates 5-10% of pregnancies and is a leading causeof neonatal morbidity and mortality worldwide. It is a major public health problem in terms of loss of life,long-term disability (cerebral palsy, blindness, deafness, chronic lung disease) and health care costs both inthe developing and the developed world.There is need for tocolytic therapy to reduce perinatal mortality and morbidity by delaying delivery at leastfor 48 hours to allow time for therapeutic effects of corticosteroidsMethodology : This study was undertaken at Sri Siddhartha medical college and hospital research centretumakuru between October 2017 to October 2019.76 Antenatal cases with gestational age 28weeks-37weeks as per the inclusion and exclusion criteria’s whowere admitted and clinically diagnosed as preterm labour were selected . The selected patients were treatedwith Nitro-glycerine patchResults : Success rate for acute tocolysis was 88.2%.Mean prolongation of pregnancy was 14.46 days andmean birth weight of babies was 2.19 kilograms. Most common side effect with Nitroglycerine patch washeadache (5.3%).Conclusion: Nitroglycerine patch is effective in suppression of preterm labor as short term tocolytic inprolongation of pregnancy. Nitroglycerine is well tolerated and safe for the mother and fetus with minorside effects

Nitroglycerin Is Not Associated with Improved Cerebral Perfusion in Acute Ischemic Stroke

The study was conducted to test the hypothesis that nitroglycerin (NTG) increases cerebral perfusion focally and globally in acute ischemic stroke patients, using serial perfusion-weighted imaging (PWI) magnetic resonance imaging measurements. Thirty-five patients underwent PWI immediately before and 72 h after administration of a transdermal NTG patch or no treatment. Patients with baseline mean arterial pressure (MAP) > 100 mmHg (NTG group, n = 20) were treated with transdermal NTG (0.2 mg/h) for 72 h, without a nitrate-free interval. Patients with MAP ≤ 100 mmHg (untreated group, n = 15) were not treated. The primary outcome measure was absolute cerebral blood flow (CBF) in the hypoperfused region at 72 h. The mean baseline absolute CBF in the hypoperfused region was similar in the NTG group (33.3 ± 10.2 ml/100 g/min) and untreated (32.7 ± 8.4 ml/100 g/min, p = 0.4) groups. The median (IQR) baseline infarct volume was 10.4 (2.5-49.3) ml in the NTG group and 32.6 (8.6-96.7) ml in the untreated group (p = 0.09). MAP change in the NTG group was 1.2 ± 12.6 and 8 ± 20.7 mmHg at 2 h and 72 h, respectively. Mean absolute CBF in the hypoperfused region at 72 h was similar in the NTG (29.9 ± 12 ml/100 g/min) and untreated groups (24.1 ± 10 ml/100 g/min, p = 0.8). The median infarct volume increased in untreated (11.8 (5.7-44.2) ml) than the NTG group (3.2 (0.5-16.5) ml; p = 0.033) on univariate analysis, however, there was no difference on regression analysis. NTG was not associated with improvement in cerebral perfusion in acute ischemic stroke patients.

Comparative study of oral Nifedipine tablet and transdermal Nitroglycerin patch in preterm labour

Preterm labour (PTL) is defined as the onset of labour in pregnancy from 28 weeks to 36weeks and 6 days. One of the most challenging problem of obstetrician in the era of modern obstetrics is the management of preterm labour and preterm births (PTB); Being the most common cause of perinatal morbidity and mortality PTB accounts for 70-80% of perinatal deaths. More than a million preterm infants die per year, worldwide. Aim: To Compare the Tocolytic effect of Oral Nifedipine tablet and Transdermal Nitroglycerin (TDN) patch in preterm labour and its effect on maternal and fetal outcome. Materials and Methods: It was a Double Blinded placebo controlled study conducted at Dr. D. Y. Patil Medical College, Hospital & Research Center, Pimpri, from November 2018 to April 2019. The study population comprised of patients who attended the casualty and outpatient department. Eighty-eight women with singleton pregnancy from 28weeks to 36weeks 6 days in preterm labour with intact membranes and cervical dilatation from 1 up to 3 cm; without contraindication for tocolysis were enrolled in the study. After taking the informed consent, subjects were randomised into two groups; 46 subjects in group A received oral Nifedipine tablet, out of which 4 left the study and 46 in group B received TDN patch. The variables analysed were, delay in delivery for 48 hours, 7 days or more than 7 days, period of gestation at delivery, effect on maternal and fetal outcome and side-effect profile of drugs. Result: The percentage of women delivering after 48 hours of administration of oral Nifedipine were 66.67% and TDN patch were 76%. Failure of tocolysis, defined as delivery within 48 hours, was significantly more with Nifedipine group (8/42-19.05%) as compared to TDN patch group (3/46-6.5%). Headache was significantly higher in group B as compared to group A (p< 0.001). Maternal tachycardia was more common in group A compared to group B (p< 0.001). Conclusion: Transdermal Nitroglycerin (TDN) patch is more effective than oral tablet Nifedipine in suppression of preterm labour and prolonging pregnancy. Although the rate of side effects were more with Nitroglycerin, most common was headache which can be controlled with analgesics. Cardiovascular side effect were nil compared with Nifedipine. Nitroglycerin is well tolerated and safe for the mother and fetus.

Effect of transdermal nitroglycerin compared with sildenafil citrate on Doppler indices in intrauterine growth restriction

Objective This study aimed to compare the effect of sildenafil citrate on pulsatility index of uterine, umbilical and middle cerebral arteries to that of nitroglycerine in cases of intrauterine growth restriction (IUGR). Background IUGR is one of the most common and serious complications of pregnancy. Sildenafil citrate and nitroglycerine are emerging as potential candidates for the treatment of IUGR through improving uteroplacental blood flow. Participants and methods Ninety singleton pregnancies, with IUGR and abnormal uterine and umbilical arteries Doppler, were included in the study and randomized into three groups to receive either oral sildenafil citrate (50 mg), a transdermal nitroglycerine patch (10 mg), or placebo. Maternal mean arterial blood pressure and the pulsatility index (PI) of uterine (Ut.A), umbilical (UA) and fetal middle cerebral (MCA) arteries were measured before and two hours after application of drugs. Results A significant reduction of Ut.A-PI occurred after application of both sildenafil citrate (16.7%, P = 0.001) and nitroglycerine (18.7%, P = 0.001). UA-PI also showed a significant decrease with both sildenafil citrate (17.8%, P = 0.001) and nitroglycerine (17.03%, P = 0.001), with no significant difference between the two drugs. No changes were observed in Doppler velocimetry in the placebo group, and no significant change in MCA-PI was observed in any group. Maternal arterial blood pressure decreased significantly with administration of both sildenafil citrate and nitroglycerine. Conclusion Sildenafil citrate has an effect similar to nitroglycerine in improving Doppler indices and blood flow of uterine and umbilical arteries in growth-restricted fetuses.

Benefits of Transdermal Nitroglycerine Patch in the Prevention of Preterm Labour

Benefits of Transdermal Nitroglycerine Patch in the Prevention of Preterm Labour

A Comparative Study between the Efficacy of Ritodrine Hydrochloride Versus Nitroglycerin Patch as a Short Term Tocolysis

AbstractBackground: Preterm birth continues to be a problem for obstetricians. Preterm birth complicates 8-10% of birth. Although the causes of preterm labour are not well understood, the burden of preterm birth is clear. The majority of neonatal deaths and over one third of infant deaths are linked to preterm birth. Methods to detect preterm labour at early stage include ultrasound examination of cervix and detection of biochemical markers of preterm labour in blood, saliva and cervicovaginal secretion. Given the methods to predict and prevent preterm birth are imperfect, attention focuses on the treatment of women admitted with preterm labour.Aim of the Work: The aim of the study to compare the safety and efficacy of transdermal nitroglycerine patch versus ritodrine hydrochloride in treatment preterm labour.Patients and Methods: This retrospective study was in-cluded 50 cases of threatened preterm labour attending the Obstetrics and Gynecology Department of Tanta University Hospital who were involved in this study. Woman were randomly divided in this retrospective study into two groups: Group 1: Included twenty five (25) patient, they received B-sympathomimetc ritodrine (yutopar). Ritodrine was giving in dose of: 150mg in 500ml saline infusion starting dose is 0.05mg/min this to be increased 0.05mg/min every 10-15 minutes (1ml contain 0.3mg and 1ml about 16 drops so 0.05mg about 3 drops) until a dose that provide tocolytic effect is reached or maternal tachycardia above 130 beats/minute occur. Group 2: Included twenty five (25) patients treated with 10mg nitrodermal patch directly applied on the abdominal skin.Inclusion Criteria: Pregnant woman in the age of 20-35 years, gestational age between 28-34 weeks, body mass index (25-30), singleton pregnancy, uterine contraction 2 per 10 minutes or 4 per 20 minutes, cervical dilatation 3 centimeters, effacement up to 80%, intact membranes and primigravida or multigravida.Exclusion Criteria: Fetal Fetal congenital anomalies, fetal growth restriction and fetal distress. Maternal Medical problems: Chronic hypertension, chronic renal disease, cardiac disease, diabetes mellitus, contraindi-cation to beta agonists, non-steroidal anti-inflammatory drugs and other tocolytics, cigarette smoker, anemia (HB less than 10mg/dl), thyroid disorders, maternal tachycardia .Obstetric problems: Preeclampsia, polyhydraminos and oligohydrami-nos, ante-partum hemorrhage and rupture of membranes and Chorioamnionitis. All patients were subjected to thorough history taking with special emphasis on gestational age (in weeks), history of medical disease) and clinical examination regarding blood pressure and body mass index. Obstetrical abdominal ultrasound was done for gestational age (BPD, AC, FL), amniotic fluid, viability. Routine investigations as fasting blood sugar blood group and Rh factor, blood urea, creatinine, haemoglobin concentration and analysis of urine albumin, sugar, microscopy, culture and sensitivity.Results: Equal percentage in cases which delivered in the same day and not responding to the drugs only 2 cases in each group present 8.0%. In the next day 3 cases delivered in group 1 present 12.0% and 1 case in group 2 present 4.0%. The delivery in the first 48 hours present failure rate of the drug, in our study the failure rate was 20% in group 1 and 12% in group 2. Labour by 7 day occur in 2 cases in each group presenting 8.0% in each group. Labour by 14 day occurred in 2 cases in group 1 and 1 case in group 2 presenting 8% and 4% respectively. Labour at 32 week occurred in 3 cases in group 1 and 2 cases in group 2 presenting 12% and 8% respectively. Labour at 34 week occurred in 4 cases in each group presenting 16% to each group. Labour at 37 week occurred in 6 cases in group 1 and 8 cases in group 2 presenting 24% and 32% respectively. Labour by 32 week occurred in 6 cases in group 1 and 2 cases in group 2 presenting 24 and 8 respectively. Labour by 34 week occurred in 2 cases in group 1 and 3 cases in group 2 presenting 8% and 12% respectively. Labour by 37 week occurred in 4 cases in group 1 and 6 cases in group 2 presenting 16% and 24%.Conclusion: Both glyceryltrinitrate and ritodrine were comparable in prolongation of gestation in patients in preterm labour, both in duration and in terms of success. The advantages of glyceryltrinitrate patch over ritodrine are lesser side effects and simplicity of administration and it also allows the patient to remain ambulatory.

Transdermal Nitroglycerin Enhances Lidocaine And Neostigmine for Intravenous Anesthesia in Patients Undergoing Hand Surgery. A Prospective Randomized Double Blind Placebo Control Study.

In a prospective randomized blind study, we investigated the effects of adding transdermal nitroglycerine for lidocaine and neostigmine for intravenous regional anesthesia in adult patients undergoing hand surgery. Patients and Methods Sixty patients (ASA grade I, aged 20-60 years) of both sexes were enrolled. The patients were randomly allocated to receive either 40ml of 0.5% lidocaine plus a transdermal placebo patch (control group n=15), 40ml of 0.5% lidocaine with 0.5mg of neostigmine plus a transdermal placebo patch (Neostigmine group, n=15), 40ml of 0.8% lidocaine plus a transdermal nitroglycerine patch (Nitroglycerine group, n=15) or 40ml of 0.5% lidocaine with 0.5mg of neostigmine plus a transdermal nitroglycerine patch (Neostigmine - Nitroglycerine group, n=15). All routine hemodynamic parameters and O2 saturation were monitored, surgical time, sensory and motor block onset times, sensory and motor block recovery times and time to first analgesic requirement were measured. Operative conditions and quality of anesthesia were also recorded. Results Sensory and motor block onset times were shorter in the neostigmine – nitroglycerine group compared with all other groups (p<0.05). Sensory block recovery time was significantly prolonged and the quality of anesthesia was better in the neostigmine – nitroglycerine group compared with all other groups (p<0.05). Conclusion We found that the addition of 0.5mg neostigmine to 40ml of 0.5% lidocaine for intravenous regional anesthesia with a 5mg transdermal nitroglycerine patch improved the operating conditions and quality of anesthesia and prolonged postoperative relief with no adverse effects.

A Study of Efficacy of Trans Dermal Nitroglycerine Patch in Enhancing Analgesia of Intrathecal Neostigmine Following Hyterectomies Under Bupivacaine Spinal Anaesthesia

A Study of Efficacy of Trans Dermal Nitroglycerine Patch in Enhancing Analgesia of Intrathecal Neostigmine Following Hyterectomies Under Bupivacaine Spinal Anaesthesia

Effect of Transdermal Nitroglycerin Patch on Intrathecal Neostigmine With

Effect of Transdermal Nitroglycerin Patch on Intrathecal Neostigmine With

English

OBJECTIVE: Comparison of oral nifedipine and transdermal nitroglycerin for tocolysis in preterm labour in the following effects, acute tocolytic effect, duration of prolongation of pregnancy, neonatal outcome. MATERIALS AND METHODS: Study on tocolysis in preterm labour was conducted in Government Rajaji Hospital from December 2010 to November 2011. 100 women with preterm labour randomly selected from the pregnant women attending antenatal OP and from labour ward from the department of obstetrics and gynecology. Out of which 50 women were recruited for oral nifedipine (initially 20mg, followed by 10mg till the contractions stop) and another 50 women were recruited for transdermal nitroglycerin patch (25 mg, directly applied over the skin of the abdomen). Inclusion criteria: Woman with singleton pregnancy with preterm labour from 28 – 36 weeks of gestation were selected for this study. Exclusion criteria: Pregnant women with preterm labour with premature rupture of membranes, fetal distress, major fetal congenital anomalies, chorioamnionitis antepartum hemorrhage, sensitivity or contra indication to nifedipine/nitrates, were excluded from this study. RESULTS: In both the groups time needed for tocolysis ranged from 2-12 hours. Mean time needed for tocolysis in group I was 4.55 hours and with group II, it was 6.09 hours. when acute tocolytic effect ( Prolongation of pregnancy beyond 48 hours) was considered, it was 45 women in group I and 36 women in group II. Mean duration of Prolongation of pregnancy with group I was 20.74 days and with group II, it was 13.5 days. In group I7 babies got admitted in new born ward, 16 babies in group II got admitted in new born ward. CONCLUSION: When compared with nitroglycerin, nifedipine is found to be safe and successful in achieving complete tocolysis and also effective in prolongation of pregnancy. Nifedipine has minimal maternal side effects and better neonatal outcome.

Comparison of Enhancement of Analgesic Effect of Intrathecal Neostigmine by Intrathecal Clonidine and Transdermal Nitroglycerin Patch on Bupivacaine Spinal Anesthesia.

Background:Relief of pain is very important goal intraoperatively and postoperatively. Neostigmine has been used successfully intrathecally with other agents such as clonidine and opioids for pain relief.Aims:This study aims to compare and evaluate the efficacy and safety of combining intrathecal (IT) neostigmine with IT clonidine and transdermal nitroglycerin (tNTG) patch for the relief of pain in patients after surgery.Settings and Design:This was a randomized, prospective, and comparative studyMaterials and Methods:In this study, recruited patients were randomly allocated into three groups. Groups I, II, and III received intrathecally 25 μg of neostigmine + 15 mg hyperbaric 0.5% bupivacaine, 25 μg of neostigmine + 25 μg clonidine + 15 mg hyperbaric 0.5% bupivacaine, and 25 μg of neostigmine + tNTG patch (3 cm × 5 cm, 5 mg/24 h) +15 mg hyperbaric 0.5% bupivacaine, respectively. Heart rate, mean arterial pressure, analgesic properties, and complications were assessed and compared among groups.Statistical Analysis:Mean and standard deviation were calculated. Test of analysis between two groups was done by t-test and among three groups by ANOVA, then P value was calculated.Results:Duration of analgesia was significantly longer in Group III in comparison to Group II (7.142 ± 1.81 vs. 4.408 ± 0.813 h) and was significantly longer in Group II in comparison to Group I (4.408 ± 0.813 vs. 2.583 ± 0.493 h). Analgesic requirement was significantly less in Group III in comparison to Group II (1.9 ± 0.76 vs. 2.5 ± 0.51) and was significantly less in Group II in comparison to Group I (2.5 ± 0.51 vs. 3.1 ± 0.48). Sedation score was found significantly high in Group II than other groups.Conclusion:Both IT clonidine and tNTG patch with bupivacaine + neostigmine spinal anesthesia were found effective in pain control. Results were found better with tNTG patch.