RESUMO
AIMS: The aim of this study was to evaluate the analgesic effectiveness and adverse reactions of ketorolac in comparison with other drugs when administered postoperatively after third molar surgery. METHODS: PubMed and Google Scholar were utilized to search for articles comparing the efficacy and safety of ketorolac and other analgesic agents after third molar surgery. Data from papers with a lower risk of bias were recorded. The overall evaluation of analgesia onset, general and subgroup evaluation of the number of patients requiring rescue analgesic medication, general and subgroup assessment of the study medication (satisfaction on the study drugs), and the overall estimation of adverse effects were performed using the Review Manager Software 5.3 to analyse the data and obtain the meta-analysis plot. RESULTS: The subgroup evaluation of the study medication showed that patients who received ketorolac 30 mg were more satisfied than those who were given parecoxib 1 mg (odds ratio [OR] = 8.57, 95% confidence interval [CI] = 3.66-20.08, P = .00001), parecoxib 2 mg (OR = 7.17, 95% CI = 2.88-17.86, P = .0001), parecoxib 5 mg (OR = 3.03, 95% CI = 1.69-5.41, P = .0002), and parecoxib 10 mg (OR = 2.42, 95% CI = 1.36-4.32, P = .003). Moreover, patients who received ketorolac reported fewer adverse reactions compared with those who had received opioid analgesics (OR = 0.14, 95% CI = 0.32-1.76, P = .0001). CONCLUSIONS: The data from this study demonstrates that the postoperative administration of ketorolac 30 mg presents better results on patient satisfaction when compared to parecoxib 1 mg to 10 mg, and presents a similar satisfaction to parecoxib 20 mg following third molar removal.
Assuntos
Cetorolaco , Dente Serotino , Analgésicos/efeitos adversos , Analgésicos Opioides/efeitos adversos , Anti-Inflamatórios não Esteroides , Método Duplo-Cego , Humanos , Cetorolaco/efeitos adversos , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Preparações Farmacêuticas , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVES: 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. METHODS: 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. RESULTS: 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%, Pâ=â1). Overall rates of PEP were not significantly different between the ketorolac and no ketorolac group (9% vs 13%, Pâ=â0.29); 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%, Pâ=â0.035). CONCLUSIONS: 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.
Assuntos
Cetorolaco , Pancreatite , Criança , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Cetorolaco/efeitos adversos , Ductos Pancreáticos , Pancreatite/etiologia , Pancreatite/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Fatores de RiscoRESUMO
Purpose: To compare management of postoperative pain after corneal collagen crosslinking (CXL) with oral gabapentin or ketorolac. Methods: Prospective interventional comparative case series in a single center. Patients undergoing epithelium-off (epi-off) or epithelium-on (epi-on) techniques performed by a single surgeon for progressive keratoconus were enrolled and randomly assigned to the ketorolac (10-mg tablets every 8 h) or the gabapentin (300-mg capsules every 8 h) group and instructed to take the medication for the first 3 postoperative days. Using a numeric scale of pain, scores were assessed for current pain (at the time of applying the questionnaire), and average pain over the preceding 24 h. Eye symptoms and systemic adverse events related to oral medication were also assessed. Results: Thirty-seven patients were included, with 22 (10 epi-on and 12 epi-off) assigned to the ketorolac group and 15 (7 epi-on and 8 epi-off) to the gabapentin group. No statistically significant differences were noted on the pain scale between groups at any point of the study, in the median pain scores of patients at the time of applying the questionnaire, nor in the severity of pain during the 24-h period before the assessment. Also, no differences were found among groups for the eye symptoms and the systemic adverse events. The median regression analysis showed no effect of the type of surgery or gender in the severity of pain. Conclusions: Both oral ketorolac and oral gabapentin can be used with similar results for pain and symptomatic control after epi-on or epi-off CXL procedures.
Assuntos
Córnea/metabolismo , Gabapentina/administração & dosagem , Ceratocone/cirurgia , Cetorolaco/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Colágeno/metabolismo , Reagentes de Ligações Cruzadas/administração & dosagem , Feminino , Gabapentina/efeitos adversos , Humanos , Cetorolaco/efeitos adversos , Masculino , Medição da Dor , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
The aim of the present study was to determine whether tizanidine, an alpha2-adrenoceptor agonist, is able to increase the anti-inflammatory and anti-nociceptive effects of naproxen and ketorolac with a low incidence of gastric injury and spontaneous activity in rats. The anti-inflammatory effect was assayed in a carrageenan test, and oral administration of tizanidine (ED40 =0.94±0.2mg/kg), naproxen (ED40=3.18±0.4mg/kg), and ketorolac (ED40=16.4±1.9mg/kg) showed a dose-dependent effect on inflammation. The anti-nociceptive effect was assayed in the formalin test, and administration of tizanidine (ED40=0.39±0.06mg/kg, p.o.), naproxen (ED40=33.9±3.9mg/kg, p.o.) or ketorolac (ED40=6.49±1mg/kg, p.o.) each showed a dose-dependent anti-nociceptive effect. The effects of combinations of tizanidine/naproxen and tizanidine/ketorolac were determined considering their ED40 at a rate of 1:1. Additionally, the tizanidine/naproxen and tizanidine/ketorolac combinations showed anti-inflammatory and anti-nociceptive effects. The tizanidine/ketorolac combination was more potent than tizanidine/naproxen, in both inflammatory (interaction index=0.03 tizanidine/ketorolac and 0.07 tizanidine/naproxen) and nociceptive (interaction index=0.005 tizanidine/ketorolac and 0.01 tizanidine/naproxen) processes. In both cases, tizanidine improved naproxen and ketorolac gastrointestinal tolerability by 50%. Furthermore, co-administration of tizanidine with naproxen or ketorolac did not modify the spontaneous activity in the same way as individual tizanidine administration. Considering that tizanidine increases the anti-inflammatory and anti-nociceptive effects of naproxen or ketorolac, with an increase in gastric tolerability, tizanidine could provide therapeutic advantages in the clinical treatment of inflammation and pain.
Assuntos
Clonidina/análogos & derivados , Cetorolaco/efeitos adversos , Cetorolaco/farmacologia , Naproxeno/efeitos adversos , Naproxeno/farmacologia , Analgésicos/efeitos adversos , Analgésicos/farmacologia , Animais , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/farmacologia , Clonidina/farmacologia , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Masculino , Ratos , Ratos Wistar , Estômago/efeitos dos fármacosRESUMO
BACKGROUND: Postoperative pain is the main symptom following a surgical event and is related to an inflammatory process involving cytokine secretion. This type of pain is usually treated with opioids such as morphine, whose analgesic efficacy is well known. However, it is unknown when compared with ketorolac in measuring proinflammatory cytokine levels. The aim of this study was to determine the postoperative analgesic effect with endovenous morphine on proinflammatory cytokine levels in patients who underwent laparoscopic choleystectomy. METHODS: We studied 40 patients who underwent laparoscopic cholecystectomy. Patients were randomized to receive morphine (0.05 mg/kg) or ketorolac (0.2 mg/kg) IV during gallbladder extraction and after the surgical event at the following dose: morphine (0.15 mg/kg) or ketorolac (0.7 mg/kg) for 40 min. Clinical evaluations included were hemodynamic, analgesic with visual analogue scale, and sedation (Ramsay scale). IL-1ß and TNF-a were measured pre- and postoperatively and after 12 h. Safety profile was evaluated with hemodynamic constants. Statistical analysis was carried out using Mann-Whitney U test and Fisher exact test. RESULTS: TNF-a was increased significantly in the immediate postoperative period and after 12 h in the morphine group. IL-1ß was not detected preoperatively, in the immediate postoperative period and 12 h after surgery the levels were similar in both groups. The main adverse event was respiratory depression, which occurred in the morphine group. CONCLUSIONS: Proinflammatory cytokines were increased after surgery, particularly TNF-a in the group receiving morphine. The use of morphine is safe postoperatively.
Assuntos
Analgésicos não Narcóticos/farmacologia , Colecistectomia Laparoscópica , Inflamação/prevenção & controle , Interleucina-1beta/sangue , Cetorolaco/farmacologia , Morfina/farmacologia , Entorpecentes/farmacologia , Dor Pós-Operatória/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Fator de Necrose Tumoral alfa/análise , Adulto , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Analgésicos não Narcóticos/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/farmacologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Inflamação/sangue , Inflamação/etiologia , Inflamação/fisiopatologia , Infusões Intravenosas , Interleucina-1beta/metabolismo , Cetorolaco/administração & dosagem , Cetorolaco/efeitos adversos , Cetorolaco/uso terapêutico , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/efeitos adversos , Morfina/uso terapêutico , Entorpecentes/administração & dosagem , Entorpecentes/efeitos adversos , Entorpecentes/uso terapêutico , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/fisiopatologia , Hemorragia Pós-Operatória/etiologia , Náusea e Vômito Pós-Operatórios/etiologia , Insuficiência Respiratória/induzido quimicamente , Fator de Necrose Tumoral alfa/metabolismo , Adulto JovemRESUMO
O controle da dor e da inflamação pós-operatória são constantes preocupações dos cirurgiões, bem como o bem-estar do paciente após o ato cirúrgico, esses fatores estão intimamente ligados ao sucesso dos procedimentos e técnicas aplicadas. O cetorolaco é um anti-inflamatório não esteroidal (AINE) não seletivo, que age indistintamente sobre as cicloxigenases 1 e 2 e está indicado no tratamento da dor pós-operatória ou processos dolorosos de intensidade moderada a grave. Esta revisão de literatura se propôs a elucidar os efeitos analgésicos e anti-inflamatórios do cetorolaco de trometamol aplicado tanto de forma preventiva quanto pre-emptiva no tratamento da dor, bem como suas reações adversas, apresentando vantagens e desvantagens deste fármaco. Diante da revisão de literatura abordada, os autores concluíram que: a analgesia pre-emptiva deve ser feita sempre que possível; o cetorolaco de trometamol apresenta maior eficácia analgésica que os opióides, porém, deve ser usado em curto prazo, pelo risco de desenvolver doenças gastrointestinais, além do cuidado da sua indicação que segue as recomendações comuns a todos os AINES empregados em odontologia.
The pain control and postoperatory inflammation are constant concerns of surgeons, as well as the welfare of the patient after surgery, these factors are closely linked to the success of the procedures and techniques. Ketorolac is a non steroid anti-inflammatory drug (NSAID) non-selective, which acts indiscriminately on cyclooxygenase 1 and 2 and is indicated for the treatment of postoperative pain or painful processes of moderate to severe intensity. This literature review aimed to elucidate the analgesic and anti- inflammatory ketorolac trometamol applied as a preventive and preemptive treatment of pain and its adverse reactions, presenting advantages and disadvantages of this drug. Given the literature review addressed, the authors concluded that: preemptive analgesia should be performed whenever possible; ketorolac trometamol shows greater efficacy than opioids, however, should be used in short term, at risk of developing gastrointestinal diseases, beyond the care of his statement following the recommendations common to all NSAIDs used in dentistry.
Assuntos
Anti-Inflamatórios , Cetorolaco de Trometamina/administração & dosagem , Cetorolaco de Trometamina/efeitos adversos , Cetorolaco de Trometamina/uso terapêutico , Cetorolaco/administração & dosagem , Cetorolaco/efeitos adversos , Cetorolaco/uso terapêuticoRESUMO
Prostaglandins control osteoblastic and osteoclastic function under physiological or pathological conditions and are important modulators of the bone healing process. The non-steroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase (COX) activity and consequently prostaglandins synthesis. Experimental and clinical evidence has indicated a risk for reparative bone formation related to the use of non-selective (COX-1 and COX-2) and COX-2 selective NSAIDs. Ketorolac is a non-selective NSAID which, at low doses, has a preferential COX-1 inhibitory effect and etoricoxib is a new selective COX-2 inhibitor. Although literature data have suggested that ketorolac can interfere negatively with long bone fracture healing, there seems to be no study associating etoricoxib with reparative bone formation. Paracetamol/acetaminophen, one of the first choices for pain control in clinical dentistry, has been considered a weak anti-inflammatory drug, although supposedly capable of inhibiting COX-2 activity in inflammatory sites. OBJECTIVE: The purpose of the present study was to investigate whether paracetamol, ketorolac and etoricoxib can hinder alveolar bone formation, taking the filling of rat extraction socket with newly formed bone as experimental model. MATERIAL AND METHODS: The degree of new bone formation inside the alveolar socket was estimated two weeks after tooth extraction by a differential point-counting method, using an optical microscopy with a digital camera for image capture and histometry software. Differences between groups were analyzed by ANOVA after confirming a normal distribution of sample data. RESULTS AND CONCLUSIONS: Histometric results confirmed that none of the tested drugs had a detrimental effect in the volume fraction of bone trabeculae formed inside the alveolar socket.
Assuntos
Animais , Masculino , Ratos , Acetaminofen/efeitos adversos , Analgésicos não Narcóticos/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Regeneração Óssea/efeitos dos fármacos , /efeitos adversos , Cetorolaco/efeitos adversos , Piridinas/efeitos adversos , Sulfonas/efeitos adversos , Análise de Variância , Acetaminofen/farmacologia , Analgésicos não Narcóticos/farmacologia , Anti-Inflamatórios não Esteroides/farmacologia , Ciclo-Oxigenase 1/efeitos adversos , Ciclo-Oxigenase 1/farmacologia , /farmacologia , Modelos Animais de Doenças , Consolidação da Fratura/efeitos dos fármacos , Cetorolaco/farmacologia , Piridinas/farmacologia , Ratos Wistar , Sulfonas/farmacologia , Fatores de TempoRESUMO
UNLABELLED: Prostaglandins control osteoblastic and osteoclastic function under physiological or pathological conditions and are important modulators of the bone healing process. The non-steroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase (COX) activity and consequently prostaglandins synthesis. Experimental and clinical evidence has indicated a risk for reparative bone formation related to the use of non-selective (COX-1 and COX-2) and COX-2 selective NSAIDs. Ketorolac is a non-selective NSAID which, at low doses, has a preferential COX-1 inhibitory effect and etoricoxib is a new selective COX-2 inhibitor. Although literature data have suggested that ketorolac can interfere negatively with long bone fracture healing, there seems to be no study associating etoricoxib with reparative bone formation. Paracetamol/acetaminophen, one of the first choices for pain control in clinical dentistry, has been considered a weak anti-inflammatory drug, although supposedly capable of inhibiting COX-2 activity in inflammatory sites. OBJECTIVE: The purpose of the present study was to investigate whether paracetamol, ketorolac and etoricoxib can hinder alveolar bone formation, taking the filling of rat extraction socket with newly formed bone as experimental model. MATERIAL AND METHODS: The degree of new bone formation inside the alveolar socket was estimated two weeks after tooth extraction by a differential point-counting method, using an optical microscopy with a digital camera for image capture and histometry software. Differences between groups were analyzed by ANOVA after confirming a normal distribution of sample data. RESULTS AND CONCLUSIONS: Histometric results confirmed that none of the tested drugs had a detrimental effect in the volume fraction of bone trabeculae formed inside the alveolar socket.
Assuntos
Acetaminofen/efeitos adversos , Analgésicos não Narcóticos/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Regeneração Óssea/efeitos dos fármacos , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Cetorolaco/efeitos adversos , Piridinas/efeitos adversos , Sulfonas/efeitos adversos , Acetaminofen/farmacologia , Analgésicos não Narcóticos/farmacologia , Análise de Variância , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Ciclo-Oxigenase 1/efeitos adversos , Ciclo-Oxigenase 1/farmacologia , Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase 2/farmacologia , Modelos Animais de Doenças , Etoricoxib , Consolidação da Fratura/efeitos dos fármacos , Cetorolaco/farmacologia , Masculino , Piridinas/farmacologia , Ratos , Ratos Wistar , Sulfonas/farmacologia , Fatores de TempoRESUMO
BACKGROUND: Meta-analyses report similar numbers needed to treat for nonsteroidal antiinflammatory drugs (NSAIDs) and opioids. Differences in baseline pain intensity among the studies from which these numbers needed to treat were derived may have confounded the results. NSAIDs have an opioid-sparing effect, but the importance of this effect is unclear. Therefore, the authors sought to compare the proportions of subjects who obtain pain relief with ketorolac versus morphine after surgery and to determine whether the opioid-sparing effect of an NSAID reduces the magnitude of opioid side effects. METHODS: The study was a double-blind, randomized controlled trial. The authors randomly assigned 1,003 adult patients to receive 30 mg ketorolac or 0.1 mg/kg morphine intravenously. They calculated the proportion of subjects who achieved at least 50% reduction in pain intensity 30 min after analgesic administration. Further, so long as pain intensity 30 min after analgesic administration was 5 or more out of 10, patients received 2.5 mg morphine every 10 min until pain intensity was 4 or less out of 10. The authors assessed the presence of opioid-related side effects. RESULTS: Five hundred patients received morphine and 503 received ketorolac. Fifty percent of patients in the morphine group achieved pain relief, compared with 31% in the ketorolac group (difference, 19%; 95% confidence interval, 13-25%). The ketorolac-morphine group required less morphine (difference, 6.5 mg; 95% confidence interval, -5.8 to -7.2) and had a lower incidence of side effects (difference, 11%; 95% confidence interval, 5-16%) than the morphine group. CONCLUSIONS: Opioids are more efficacious analgesics than NSAIDs, although historic data for these two drugs yield similar numbers needed to treat. Adding NSAIDs to the opioid treatment reduces morphine requirements and opioid-related side effects in the early postoperative period.