British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery.
Ketorolac is approved for the relief of postoperative pain but concerns have been raised over a possible risk of serious adverse effects and death. Two regulatory reviews in Europe on the safety of ketorolac found the data were inconclusive and lacked comparison with other non-steroidal anti-inflammatory drugs. The aim of this study was to compare the risk of serious adverse effects with ketorolac vs diclofenac or ketoprofen in adult patients after elective major surgery. ⋯ We conclude that ketorolac is as safe as ketoprofen and diclofenac for the treatment of pain after major surgery.
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Review Comparative Study
Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia.
We have reviewed the analgesic efficacies of rectal and parenteral paracetamol and tested the evidence for a possible additive analgesic effect of the combination of paracetamol with a non-steroidal anti-inflammatory drug (NSAID) in postoperative pain. ⋯ Considering the few studies available, evidence was found of a clinically relevant analgesic effect of rectal and parenteral paracetamol. Concurrent use of paracetamol and an NSAID was superior to paracetamol alone but no evidence was found of superior analgesic effect of the combination compared with the NSAID alone.
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We report a case of mechanical closure of the vocal cords with the laryngeal mask airway ProSeal (PLMA) in an anaesthetized, paralysed 59-yr-old, 88 kg female undergoing lower-limb vascular surgery. Near-complete airway obstruction developed after a size-5 PLMA was inserted and the cuff inflated with 20 ml of air. Fibreoptic inspection revealed that the PLMA was correctly positioned, but the vocal cords were closed. Withdrawal of air from the cuff and/or moving the head and neck into the sniffing position resolved this problem.
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Review Comparative Study
Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review.
Quantitative reviews of postoperative pain management have demonstrated that the number of patients needed to treat for one patient to achieve at least 50% pain relief (NNT) is 2.7 for ibuprofen (400 mg) and 4.6 for paracetamol (1000 mg), both compared with placebo. However, direct comparisons between paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) have not been extensively reviewed. The aims of this review are (i) to compare the analgesic and adverse effects of paracetamol with those of other NSAIDs in postoperative pain, (ii) to compare the effects of combined paracetamol and NSAID with those of either drug alone, and (iii) to discuss whether the adverse effects of NSAIDs in short-term use are justified by their analgesic effects, compared with paracetamol. ⋯ Paracetamol is a viable alternative to the NSAIDs, especially because of the low incidence of adverse effects, and should be the preferred choice in high-risk patients. It may be appropriate to combine paracetamol with NSAIDs, but future studies are required, especially after major surgery, with specific focus on a potential increase in side-effects from their combined use.