ABSTRACT
BACKGROUND: We aimed to compare the analgesic effects of intravenous ibuprofen to ketorolac after open abdominal hysterectomy. METHODS: This randomized double-blinded controlled trial included adult women scheduled for elective open abdominal hysterectomy. Participants were randomized to receive either 30 mg ketorolac (n = 50) or 800 mg ibuprofen (n = 50) preoperatively, then every 8 h postoperatively for 24 h. All participants received paracetamol 1 gm/6 h. Rescue analgesic was given if the visual analogue scale (VAS) for pain assessment was > 3. The primary outcome was the mean postoperative dynamic VAS during the first 24 h. Secondary outcomes were static VAS, intraoperative fentanyl consumption, postoperative morphine consumption, time to independent movement, and patient's satisfaction. RESULTS: Forty-six patients in the ibuprofen group and fifty patients in the ketorolac group were analyzed. The 24-h dynamic and static VAS were similar in the two groups. The median (quartiles) dynamic VAS was 1.1 (0.9, 1.9) in the ibuprofen group versus 1.0 (0.7, 1.3) in the ketorolac group, P-value = 0.116; and the median (quartiles) static VAS was 0.9 (0.6, 1.3) in the ibuprofen group versus 0.7 (0.4, 1.1) in the ketorolac group, P-value = 0.113. The intra- and postoperative analgesic requirements were also similar in the two groups. However, patient satisfaction was slightly higher in the ketorolac group than that in the ibuprofen group (median [quartiles]: 6 [5, 7] versus 5 [4, 7], respectively), P-value: 0.009. CONCLUSION: The two drugs, intravenous ibuprofen and ketorolac produced similar analgesic profile in patients undergoing open abdominal hysterectomy receiving multimodal analgesic regimen. NCT05610384, Date of registration: 09/11/2022 CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05610384. https://clinicaltrials.gov/ct2/show/NCT05610384.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal , Hysterectomy , Ibuprofen , Ketorolac , Pain, Postoperative , Humans , Ketorolac/administration & dosage , Ibuprofen/administration & dosage , Female , Hysterectomy/methods , Double-Blind Method , Pain, Postoperative/drug therapy , Pain, Postoperative/prevention & control , Middle Aged , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Adult , Administration, Intravenous , Pain Measurement/methods , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Non-Narcotic/therapeutic use , Patient SatisfactionABSTRACT
Doxorubicin (DOX) is a broad-spectrum antitumor antibiotic used in treatment of cancer. Its effect may be complicated by increased risk of cardiotoxicity. It was suggested that natural compounds with anticancer properties can be used in combination with DOX to decrease its dose and side effects. Indole-3-carbinol (I3C) is one of the phytochemicals that was shown to have anti-cancer effect. Our aim was to detect the possible chemosensitizing effects of I3C in DOX-induced cytotoxicity and the possible cardioprotective effects of I3C in DOX-induced cardiotoxicity. One hundred mice were divided into five equal groups: Control untreated group, solid Ehrlich carcinoma (SEC), SEC + DOX, SEC + I3C, SEC + DOX + I3C. Tumor volume, serum creatinine kinase and lactate dehydrogenase were measured. Also, tissue malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), sphingosine kinase-1 (SphK1) activity and interleukin-6 (IL-6) were determined. Parts of the tumor and cardiac tissues were subjected to histopathological examination. DOX or I3C alone or in combination induced significant increase in tumor CAT and SOD with significant decrease in tumor volume, tumor MDA, SphK1 activity and IL-6 and alleviated the histopathological changes with significant increase in the apoptotic index and significant decrease in tissue bcl2 compared to SEC group. Also, DOX induced cardiotoxicity which was ameliorated by I3C. In conclusion, DOX/I3C combination had a better effect than each of DOX or I3C alone against SEC in mice with marked improvement of the cardiotoxicity induced by DOX.
Subject(s)
Antibiotics, Antineoplastic/administration & dosage , Carcinoma, Ehrlich Tumor/drug therapy , Cardiotonic Agents/administration & dosage , Cardiotoxicity/drug therapy , Doxorubicin/administration & dosage , Indoles/administration & dosage , Animals , Anticarcinogenic Agents/administration & dosage , Carcinoma, Ehrlich Tumor/blood , Carcinoma, Ehrlich Tumor/physiopathology , Drug Interactions , L-Lactate Dehydrogenase/blood , Mice , Phosphotransferases (Alcohol Group Acceptor)/bloodABSTRACT
The cancer chemopreventive activity of the polysaccharide extracts (E1-E4) of Sargassum asperifolium, a brown alga in Red Sea shores in Egypt, was investigated. Tumour anti-initiation activity (the modulation of carcinogen metabolism) indicated that E3 and E4 were potent anti-initiators by inhibiting the carcinogen activator cytochrome P450-1A, and enhancing carcinogen detoxification enzymes glutathione-S-transferase. Only E4 significantly enhanced quinone reductase activity. All polysaccharide extracts possessed anti-promotion property by their anti-inflammatory activity. E3 and E4 dramatically induced the growth of spleen macrophages. E2, E3 and E4 significantly inhibited nitric oxide generation from lipopolysaccharide (LPS)-stimulated spleen macrophages, while E1, E3 and E4 led to significant inhibition of LPS-induced tumour necrosis factor-α. The extracts E1, E2 and E4 showed cytotoxicity against HepG2 cells, where E2 and E4 induced cell death due to apoptosis. In conclusion, E3 and E4 are promising cancer chemopreventive extracts, since they had tumour anti-initiating activity via their protective modulation of carcinogen metabolism.