Estudio Comparativo de la Efectividad Antiinflamatoria Postoperatoria al usar Dexametasona Endovenoso Versus Ketoprofeno Endovenoso previo a la exodoncia de terceros Molares Mandibulares Incluidos / Comparative Study of Postoperative Anti-inflammatory Effectiveness when Using intravenous Dexamethasone Versus Intravenous Ketoprofen Prior to Extraction of Mandibular third Molars Included

La exodoncia de terceros molares incluidos conlleva la mayoría de las veces un cuadro inflamatorio agudo, dolor postoperatorio y trismus. En la actualidad, se han propuesto diversos protocolos farmacológicos con el fin de prevenir estas complicaciones, donde los más utilizados son los analgésicos y corticoides. Comparar Dexametasona y Ketoprofeno endovenoso previo a la cirugía de terceros molares mandibulares incluidos, en el control del edema, dolor y trismus. Se realizó un estudio experimental, analítico de corte transversal, autorizado por el comité de ética de la Universidad Andrés Bello. Se escogieron 30 sujetos que requerían exodoncia de terceros molares mandibulares incluidos, de forma aleatoria 15 sujetos recibieron Dexametasona 4 mg endovenoso y 15 Ketoprofeno 200 mg endovenoso 30 minutos antes de la intervención. El procedimiento quirúrgico fue estandarizado, se evaluó el edema facial, trismus y dolor postquirúrgico a los 2 y 7 días terminada la cirugía. Se presentó una diferencia estadísticamente significativa solo en 2 mediadas faciales, de las 5 tomadas, al comparar el porcentaje de edema a los 7 días postoperatorias entre ambos grupos experimentales. La mayoría del grupo Dexametasona presentó un edema de mayor volumen en comparación al grupo Ketoprofeno. En relación al dolor y trismus, sólo se observan diferencias significativas en la intensidad del dolor evaluada a los 7 días, siendo mayor en el grupo Ketoprofeno. En las otras variables medidas, la presencia de odontosección en la cirugía generó una diferencia estadísticamente significativa, siendo mayor el edema en los que se les realizó odontosección. Esta diferencia se vio principalmente en el grupo Ketoprofeno evaluado a los 2 días postoperatorios. El uso de cualquiera de los 2 fármacos está bien indicado para aliviar el dolor e inflamación en este tipo de cirugía. Pese a que el grupo tratado con Dexametasona presentó menor dolor, no fue una diferencia significativa en comparación al grupo con Ketoprofeno.

The extraction of included third molars most of the time involves an acute inflammatory picture, postoperative pain and trismus. At present, various pharmacological protocols have been proposed in order to prevent these complications, where the most widely used are analgesics and corticosteroids. Compare Dexamethasone and Ketoprofen used intravenously prior to surgery of mandibular third molars included, in the control of edema, pain and trismus. An experimental, analytical, cross- sectional study was carried out, authorized by the ethics committee of the Andrés Bello University. Thirty subjects who required extraction of included mandibular third molars were chosen, 15randomly received intravenous Dexamethasone 4 mg and 15 intravenous Ketoprofen 200 mg 30 minutes before the intervention. The surgical procedure was standardized, facial edema, trismus and postoperative pain were evaluated at 2 and 7 days after the surgery. There was a statistically significant difference only in 2 facial measures, of the 5 taken, when comparing the percentage of edema at 7 postoperative days between both experimental groups. Most of the Dexamethasone group had a larger volume ede- ma compared to the Ketoprofen group. In relation to pain and trismus, significant differences were only observed in the intensity of pain evaluated at 7 days, being greater in the Ketoprofen group. In the other variables measured, the presence of a dental section in the surgery generated a statistically significant difference, with the edema being greater in those who underwent a dental section. This difference was mainly seen in the Ketoprofen group evaluated at 2 postoperative days. The use of any of the 2 drugs is well indicated to alleviate the pain and inflammation of the patient generated by the trauma caused by this type of surgery. Although the group treated with Dexamethasone presented less pain, it was not a significant difference compared to the group with Ketoprofen.

Ketoprofen hypersensibility and idiosyncratic response - a case report.

Context: Ketoprofen is widely used to remove pain. A steady increase on allergic reactions and photoallergic contact dermatitis related to ketoprofen has been reported when there is topical use. However, there are few documented cases of hypersensitivity when it is administered systemically.Objective: Present a case of hypersensitivity reaction after systemic administration of ketoprofen for pain control in nephritis crisis.Case description: A 43-years-old Caucasian man diagnosed with renal colic (kidney lithiasis), who was initially treated with 100 mg of tramadol (IV), followed by 4 mg of thiocolchicoside (IM) which caused no relief. Then 100 mg of ketoprofen was administered (IV). Right after the patient began to show hypersensitivity reaction type I characterized by intense coughing, rhinitis, angioedema, periorbital edema, rash, and scleral jaundice.Discussion and conclusion: Maybe it was a case of drug-induced liver disease, however therapeutic dosages of all administered drugs only once. The mechanisms involved were not investigated, but may be the result of allergic and immunologic aspects caused by ketoprofen and facilitated by a history of hypersensitivity to other NSAIDs as reported by the patient. As for jaundice can be attributed to drug toxicity since laboratory parameters did not reveal any evidence of liver disease.

Effects of NSAIDs and environmental oxygen pressure on bone regeneration / Efecto de los AINEs y la presión de oxígeno ambiental sobre la regeneración ósea

Objective: To evaluate the effects of administering diclofenac and ketoprofen, as well as the effects of environmental oxygen pressure variation on mandibular bone regeneration. Methods: Thirty-six guinea pigs were distributed into two equal groups. Mandibular bone defects were performed on both groups. Group A was monitored under oxygen pressure at altitude (3320msl, 107mm Hg). Group B was monitored at sea level oxygen pressure (150msl, 157mm Hg). Each group was subdivided into 3 equal groups (A1, A2, A3 and B1, B2, B3). Subgroups A1 and B1 were given diclofenac; subgroups A2 and B2 ketoprofen; subgroups A3 and B3 NaCl. Bone regeneration was evaluated histologically on days 15 and 30. Results: After 15 days in the group controlled at sea level, the level of osteoblasts presented by the control subgroup was significantly higher (28.00±2.65) compared to the diclofenac subgroup (16.00±6.25) and to the ketoprofen subgroup (18.00±4.36); (p=0.041). After 15 days in the group controlled at altitude, the level of osteoblasts was significantly higher in the control subgroup (38.00±5.29) compared to the diclofenac subgroup (21.67±6.35) and to the ketoprofen subgroup (19.33±2.52); p=0.007. After 30 days in the group at sea level there was no difference found in the cell counting; p>0.05. After 30 days in the group controlled at altitude, the level of osteoblast was significantly higher in the control subgroup (58.00±4.58) compared to the diclofenac subgroup (34.33±4.73) and the ketoprofen subgroup (34.00±11.14); (p=0.003). Conclusion: The administration of diclofenac and ketoprofen produced lower mandibular bone regeneration, the effect being significantly more negative at sea level.

Objetivo: Evaluar el efecto de la administración de diclofenaco y ketoprofeno y de la variación de la presión de oxígeno ambiental sobre la regeneración ósea mandibular. Métodos: Participaron 36 cobayos distribuidos en dos grupos iguales. A ambos grupos se les realizaron defectos óseos mandibulares. El Grupo A fue controlado bajo presión de oxígeno en altura (3320msnm, 107mm Hg). El Grupo B fue controlado bajo presión de oxígeno a nivel del mar (150msnm, 157mm Hg). Cada grupo fue dividido en 3 subgrupos iguales (A1, A2, A3 y B1, B2, B3). Los subgrupos A1 y B1 recibieron diclofenaco; A2 y B2, ketoprofeno; A3 y B3, NaCl. La regeneración ósea fue evaluada histológicamente a los 15 y 30 días. Resultados: A nivel del mar, a los 15 días, hubo una significativa mayor cantidad de osteoblastos en el subgrupo control (28,00±2,65) comparado con el subgrupo diclofenaco (16,00±6.25) y ketoprofeno (18,00±4.36); (p=0,041). En altura, a los 15 días, hubo una significativa mayor cantidad de osteblastos en el subgrupo control (38,00±5,29) comparado con el subgrupo diclofenaco (21,67±6,35) y ketoprofeno (19,33±2,52); p=0,007. A nivel del mar, a los 30 días, no se encontró diferencia en el conteo celular; p>0,05. En altura, a los 30 días, se encontró una significativa mayor cantidad de osteoblastos en el subgrupo control (58,00±4,58) comparado con el subgrupo diclofenaco (34,33±4,73) y ketoprofeno (34,00±11,14); (p=0,003). Conclusión: La administración de diclofenaco y ketoprofeno produjeron una menor regeneración ósea mandibular, siendo este efecto significativamente más negativo a nivel del mar.

Double-blind placebo-controlled randomized clinical trial of ginger ( Zingiber officinale Rosc.) addition in migraine acute treatment.

BACKGROUND: Previous studies have demonstrated the analgesic effects of ginger in different conditions, but evidence about its efficacy in migraine treatment is scarce. OBJECTIVE: This study aimed to evaluate the potential of ginger to improve acute migraine as an add-on strategy to standard treatment. METHODS: A double-blind placebo-controlled randomized clinical trial in the emergency room of a general hospital was conducted. Patients who sought medical care at the time of migraine attack were enrolled in this study. Only adults with episodic migraine (one to six migraine attacks per month) with or without aura were included. Sixty participants were randomized into two groups in which they received 400 mg of ginger extract (5% active ingredient) or placebo (cellulose), in addition to an intravenous drug (100 mg of ketoprofen) to treat the migraine attack. Patients filled a headache diary before, 0.5 h, 1 h, 1.5 h and 2 h after the medication. Pain severity, functional status, migraine symptoms and treatment satisfaction were also recorded. RESULTS: Patients treated with ginger showed significantly better clinical response after 1 h ( p = 0.04), 1.5 h ( p = 0.01) and 2 h ( p = 0.04). Furthermore, ginger treatment promoted reduction in pain and improvement on functional status at all times assessed. CONCLUSIONS: The addition of ginger to non-steroidal anti-inflammatory drugs may contribute to the treatment of migraine attack. This trial is registered at ClinicalTrials.gov (NCT02568644).

Efficacy of Ketoprofen With or Without Omeprazole for Pain And Inflammation Control After Third Molar Removal.

In view of the gastrointestinal problems generated by the ketoprofen use, the ketoprofen association with omeprazole is available on the market. However, this association efficacy in acute pain control has not been established. Bilateral extraction of lower third molars in similar positions is currently the most used model for the evaluation and investigation of the efficacy and pharmacological effects of new compounds for the treatment of acute postoperative pain. The randomized and crossover study consisted in evaluating the clinical efficacy of therapy performed by ketoprofen 100 mg (twice daily-b.i.d.) versus ketoprofen 200 mg + omeprazole 20 mg (once daily-q.d.) to pain, swelling and trismus control in the bilateral extraction model of lower third molars in similar positions in two different appointments, in 50 volunteers. Volunteers reported significantly less postoperative pain at various post-operative periods and consumed less rescue analgesic medication (acetaminophen 750 mg) throughout the study when they took the combination of ketoprofen 200 mg + omeprazole 20 mg (q.d.). Following administration of both study drugs, no gastrointestinal adverse reactions were reported by volunteers. Furthermore, the evaluations of the drugs in pain control by the volunteers were significantly favorable to ketoprofen 200 mg + omeprazole 20 mg (q.d.). For swelling and trismus control, the treatments presented similar results. In conclusion, when volunteers took ketoprofen 200 mg + omeprazole 20 mg (q.d.), they reported significantly less postoperative pain at various post-surgical periods and consumed less rescue analgesic medication throughout the study compared with ketoprofen 100 mg (b.i.d).

Efficacy of ketoprofen with or without omeprazole for pain and inflammation control after third molar removal

Abstract In view of the gastrointestinal problems generated by the ketoprofen use, the ketoprofen association with omeprazole is available on the market. However, this association efficacy in acute pain control has not been established. Bilateral extraction of lower third molars in similar positions is currently the most used model for the evaluation and investigation of the efficacy and pharmacological effects of new compounds for the treatment of acute postoperative pain. The randomized and crossover study consisted in evaluating the clinical efficacy of therapy performed by ketoprofen 100 mg (twice daily-b.i.d.) versus ketoprofen 200 mg + omeprazole 20 mg (once daily-q.d.) to pain, swelling and trismus control in the bilateral extraction model of lower third molars in similar positions in two different appointments, in 50 volunteers. Volunteers reported significantly less postoperative pain at various post-operative periods and consumed less rescue analgesic medication (acetaminophen 750 mg) throughout the study when they took the combination of ketoprofen 200 mg + omeprazole 20 mg (q.d.). Following administration of both study drugs, no gastrointestinal adverse reactions were reported by volunteers. Furthermore, the evaluations of the drugs in pain control by the volunteers were significantly favorable to ketoprofen 200 mg + omeprazole 20 mg (q.d.). For swelling and trismus control, the treatments presented similar results. In conclusion, when volunteers took ketoprofen 200 mg + omeprazole 20 mg (q.d.), they reported significantly less postoperative pain at various post-surgical periods and consumed less rescue analgesic medication throughout the study compared with ketoprofen 100 mg (b.i.d).

Resumo Em vista dos problemas gastrointestinais gerados pelo uso do cetoprofeno, a associação do cetoprofeno com o omeprazol está disponível no mercado. No entanto, esta eficácia de associação no controle da dor aguda não foi estabelecida. A extração bilateral de terceiros molares inferiores em posições semelhantes é atualmente o modelo mais utilizado para a avaliação e investigação da eficácia e efeitos farmacológicos de novos compostos para o tratamento da dor aguda pós-operatória. O estudo randomizado e cruzado consistiu na avaliação da eficácia clínica da terapia com cetoprofeno 100 mg (duas vezes ao dia-b.i.d.) versus cetoprofeno 200 mg + omeprazol 20 mg (uma vez ao dia-q.d.) para o controle da dor, do edema e do trismo no modelo bilateral de terceiros molares inferiores em posições semelhantes em duas consultas diferentes, em 50 voluntários. Os voluntários relataram significativamente menos dor pós-operatória em vários períodos pós-operatórios e consumiram menos medicação analgésica de socorro (acetaminofeno 750 mg) durante todo o estudo quando tomaram a combinação de 200 mg de cetoprofeno + 20 mg de omeprazol (q.d.). Após a administração de ambas as drogas do estudo, nenhuma reação adversa gastrointestinal foi relatada pelos voluntários. Além disso, as avaliações das drogas no controle da dor pelos voluntários foram significativamente favoráveis ​​ao cetoprofeno 200 mg + omeprazol 20 mg (q.d.). Para o controle do edema e do trismo, os tratamentos apresentaram resultados semelhantes. Em conclusão, quando os voluntários tomaram 200 mg de cetoprofeno + 20 mg de omeprazol (q.d.), eles relataram significativamente menos dor pós-operatória em vários períodos pós-cirúrgicos e consumiram menos medicação analgésica de socorro durante o estudo comparado com 100 mg de cetoprofeno (b.i.d).

Evaluación de dolor en niños hospitalizados en servicios de salud públicos y privados de Uruguay / Pain assessment in children hospitalized in public and private health institutions in Uruguay

El dolor es un problema de salud frecuentemente no reconocido e ignorado en pediatría.. Objetivo::reportar la prevalencia de dolor en niños hospitalizados: las 24 horas previas y en el momento de la entrevista. De los pacientes con dolor actual describir: intensidad y tratamiento indicado.. Metodología::estudio transversal, el 6/12/13 en el Centro Hospitalario Pereira Rossell (CHPR) y el 20/1/14 en otras instituciones del país. Se incluyeron los menores de 15 años hospitalizados. Se consideró paciente con dolor cuando el niño o su cuidador referían haberlo experimentado en las 24 horas previas y/o en el momento de la entrevista. Variables: edad, sexo, motivo de ingreso, trastorno cognitivo, tratamiento analgésico indicado, vía e intervalo de administración, tratamiento adyuvante y medidas no farmacológicas. La intensidad se evaluó mediante escalas.. Resultados::se encontraron: 168 niños hospitalizados, 109 en el CHPR; prevalencia de: dolor en las 24 horas previas: 35% (59/168) y en el momento de la encuesta: 15,5% (26/168). De los niños con dolor actual la intensidad era: leve 8/26, moderado 14/26 y severo 4/26. No tenían indicación de fármacos analgésicos: 9/26. El analgésico más indicado fue dipirona (11/17) y la asociación más prescripta: dipirona-ketoprofeno (5/17). Se constató: indicación de intervalo no adecuado: 7/17; vía intravenosa: 12/17; tratamiento adyuvante y medidas no farmacológicas: 1 cada uno.. Conclusiones::se constataron niños hospitalizados con dolor y déficits diversos en los tratamientos indicados. Es necesario que las instituciones sanitarias aborden este problema como parte de su política institucional.

Pain is a health problem often unrecognized and ignored in pediatrics. Objective: to report the prevalence of pain in hospitalized children: 24 hours before and during the interview. To describe intensity and prescribed treatment in patients with current pain. Methods: transversal study, on 06/12/13 at Pereira Rossell Hospital Center (PRHC) and on 20/1/14 in other institutions. Hospitalized children under 15 years old were included. “Patient in pain” was considered when the child or caregiver reported pain experienced in the previous 24 hours and/or at the time of the interview. Variables: age, gender, reason for admission, cognitive disorder, analgesic treatment indicated, route of administration, dosing interval, adjuvant and non-pharmacological treatments. Validated scales were used to assess intensity. Results: 168 hospitalized children, 109 at PRHC; prevalence of pain in the previous 24 hours: 35% (59/168) and during the interview: 15.5% (26/168). Intensity of pain found in children with current pain was: 8/26 mild, 14/26 moderate and 4/26 severe; 9/26 did not have any analgesic prescription. The most prescribed analgesic was: dipirone (11/17) and most prescribed association was: dipirone-ketoprofen (5/17). Interdose interval was inappropriate in 7/17; intravenous route of administration was indicated in 12/17; adjuvant and non-pharmacological treatments were found in one patient each. Conclusions: hospitalized children in pain and several problems in analgesic treatment prescription were found. Institutional policies directed to address this problem in management are needed.

Pomegranate seed oil nanoemulsions improve the photostability and in vivo antinociceptive effect of a non-steroidal anti-inflammatory drug.

The combination of pomegranate seed oil and ketoprofen in nanoemulsions aiming to improve the antinociceptive effect was evaluated according to the writhing test and Complete Freud's Adjuvant induced paw inflammation in mice. The formulations showed adequate characteristics and improved ketoprofen's photostability against UVC radiation exposure. The dialysis bag technique showed that 100% of the drug was released from the nanoemulsions after 3h and the oil amount had no influence on the releasing. Furthermore, time- and dose-response curves were obtained to determine the antinociceptive effect of the formulations. In the post-test, the nanoemulsion containing ketoprofen significantly reduced abdominal constrictions in time-response curve, showing effect up to 12h while the free ketoprofen showed effect up to 3h. In addition, the blank nanoemulsion presented a reduction of abdominal constriction up to 1h of pre-treatment. Regarding the dose-response curve, the free ketoprofen presents effect at 0.5mg/Kg dose and nanoemulsion at 1.0mg/Kg dose. Time- and dose-response curves were performed to determine the antinociceptive effect in inflammatory pain. After the evaluation of mechanical allodynia testing at the Von Frey Hair, the free ketoprofen showed effect up to 6h while nanoemulsions presented effect up to 10h. Moreover, acute toxicity was performed with ALT and AST activity evaluations and urea levels. After 7 days of treatment, no toxic effects for nanoemulsions were found. In conclusion, ketoprofen-loaded pomegranate seed oil nanoemulsions presented adequate characteristics and a high antinociceptive activity in the animal models tested.

Comparação da eficácia clínica do cetoprofeno, associado ou não ao omeprazol, no controle da dor, edema e trismo em exodontias de terceiros molares inferiores / Comparison of the clinical efficacy of ketoprofen, associated or not with omeprazole, in the control of pain, swelling and trismus in lower third molar removal

A prescrição do cetoprofeno pode gerar reações adversas, como por exemplo, problemas gastrintestinais. Devido a este fato há disponível no mercado a associação do cetoprofeno com omeprazol. Porém, a eficácia desta associação no controle agudo da dor ainda não foi estabelecida. Portanto, nos propusemos a avaliar a eficácia clínica da terapia realizada com comprimidos de cetoprofeno 100 mg duas vezes ao dia versus a terapia realizada com o cetoprofeno 200 mg + omeprazol 20 mg uma vez ao dia, ambos administrados durante 4 dias, por via enteral, no controle da dor, edema e trismo no modelo de extração bilateral de terceiros molares inferiores em posições semelhantes e em dois momentos cirúrgicos distintos. Este estudo randomizado, duplo-cego e cruzado foi composto por 50 voluntários com idade média de 24 ± 5 anos. Foi utilizado o teste t pareado para os dados paramétricos expressos em média ± desvio padrão e o teste de Wilcoxon para os dados não paramétricos expressos em mediana ± intervalo interquartil. O nível de significância adotado foi de 5%. Quando os voluntários utilizaram cetoprofeno 200 mg + omeprazol 20 mg uma vez ao dia, relataram significativamente menos dor em vários períodos pós-cirúrgicos e consumiram menos medicação de socorro (paracetamol 750 mg) em comparação a quando utilizaram cetoprofeno 100 mg duas vezes ao dia. Além disso, as avaliações dos medicamentos no controle da dor pós-cirúrgica por parte dos voluntários foram significativamente mais favoráveis à combinação cetoprofeno 200 mg + omeprazol 20 mg. Para o controle do edema e trismo, os tratamentos farmacológicos apresentaram resultados semelhantes. Após a análise dos resultados concluímos que cetoprofeno 200 mg + omeprazol 20 mg uma vez ao dia apresentou melhores resultados no controle da dor após extrações de terceiros molares inferiores quando comparado ao cetoprofeno de 100 mg duas vezes ao dia.(AU)

In view of the gastrointestinal problems generated by the use of ketoprofen, the association of ketoprofen with omeprazole is available on the market. However, the efficacy of this association in the acute control of pain has not been established. Therefore, the objective of the present study was to evaluate the clinical efficacy of therapy performed with ketoprofen 100 mg twice daily versus therapy performed with ketoprofen 200 mg + omeprazole 20 mg once daily, both administered enterally to control pain, swelling and trismus in the bilateral extraction model of lower third molars in similar positions in two different appointments. The present randomized, double-blind, crossover study consisted of 50 volunteers with a mean age of 24 ± 5 years. The paired t test was used for the parametric data expressed as mean ± standard deviation and the Wilcoxon test for non-parametric data expressed as median ± interquartile range. The level of significance was 5%. When volunteers took ketoprofen 200 mg + omeprazole 20 mg once daily, they reported significantly less postoperative pain at various post-operative periods and consumed less rescue analgesic medication (acetaminophen 750 mg) throughout the study compared to ketoprofen 100 mg twice daily. In addition, the evaluations of the drugs in the control of postoperative pain by the volunteers were significantly favorable to ketoprofen 200 mg + omeprazole 20 mg once daily as compared with ketoprofen twice daily. For the control of swelling and trismus, the treatments presented similar results. Therefore, it can be concluded that ketoprofen 200 mg + omeprazole 20 mg once daily presented better results in postoperative pain control after extractions of the lower third molars when compared to ketoprofen 100 mg twice daily.(AU)

Evaluación de dolor en niños hospitalizados en servicios de salud públicos y privados de Uruguay / Pain assessment in children hospitalized in public and private health institutions in Uruguay

El dolor es un problema de salud frecuentemente no reconocido e ignorado en pediatría. Objetivo: reportar la prevalencia de dolor en niños hospitalizados: las 24 horas previas y en el momento de la entrevista. De los pacientes con dolor actual describir: intensidad y tratamiento indicado. Metodología: estudio transversal, el 6/12/13 en el Centro Hospitalario Pereira Rossell (CHPR) y el 20/1/14 en otras instituciones del país. Se incluyeron los menores de 15 años hospitalizados. Se consideró paciente con dolor cuando el niño o su cuidador referían haberlo experimentado en las 24 horas previas y/o en el momento de la entrevista. Variables: edad, sexo, motivo de ingreso, trastorno cognitivo, tratamiento analgésico indicado, vía e intervalo de administración, tratamiento adyuvante y medidas no farmacológicas. La intensidad se evaluó mediante escalas. Resultados: se encontraron: 168 niños hospitalizados, 109 en el CHPR; prevalencia de: dolor en las 24 horas previas: 35% (59/168) y en el momento de la encuesta: 15,5% (26/168). De los niños con dolor actual la intensidad era: leve 8/26, moderado 14/26 y severo 4/26. No tenían indicación de fármacos analgésicos: 9/26. El analgésico más indicado fue dipirona (11/17) y la asociación más prescripta: dipirona-ketoprofeno (5/17). Se constató: indicación de intervalo no adecuado: 7/17; vía intravenosa: 12/17; tratamiento adyuvante y medidas no farmacológicas: 1 cada uno. Conclusiones: se constataron niños hospitalizados con dolor y déficits diversos en los tratamientos indicados. Es necesario que las instituciones sanitarias aborden este problema como parte de su política institucional.

Comparative efficacy of nimesulide and ketoprofen on inflammatory events in third molar surgery: a split-mouth, prospective, randomized, double-blind study.

This study aimed to compare the effect of nimesulide and ketoprofen on inflammatory parameters related to the surgical removal of third molars. A split-mouth, prospective, randomized, double-blind study was conducted in patients undergoing removal of four third molars. Eighteen eligible patients were allocated to one of two groups to receive treatment two times a day with either ketoprofen 100 mg or nimesulide 100 mg for a period of 3 days. The rescue medication intake (number) and pain intensity were evaluated at 6, 12, 24, and 48 h, and at 7 days postoperatively. Swelling and maximum mouth opening were evaluated at 24 h, 72 h, and 7 days postoperatively. The peak pain score occurred at 6h after surgery in the nimesulide group and at 12h in the ketoprofen group. There was no statistically significant difference between the groups, although pain relief was observed after 48 h in the nimesulide group and after 7 days in the ketoprofen group. For each group, there was a statically significant difference in pain scores among the studied periods (P<0.0001). None of the patients required rescue medication. There was a statistically significant difference in maximum mouth opening between the preoperative and postoperative periods (P<0.0001). Ketoprofen and nimesulide were effective at controlling pain, swelling, and trismus after the surgical removal of third molars.

A comparison of pre and post-operative vedaprofen with ketoprofen for pain control in dogs.

BACKGROUND: This prospective randomized blinded clinical study aimed to investigate the potential of vedaprofen for preventive analgesia, comparing its analgesic effects with ketoprofen administered post-operatively in dogs undergoing maxillectomy or mandibulectomy. RESULTS: Pain control was effective and rescue analgesia was not necessary in any group. Pain scores were not significantly different between groups. The respiratory rate and rectal temperature were decreased in all groups at extubation until 6 hours post-extubation compared to baseline. Cortisol and epinephrine levels were increased only at 0.5 hours after extubation in all groups compared to baseline. CONCLUSIONS: Vedaprofen did not present any preventive analgesic effect. Pre- and postoperative vedaprofen were as effective as ketoprofen for postoperative pain control.

O cetoprofeno como oportunidade terapêutica no estresse oxidativo: uma revisão / Ketoprofen as a therapeutic opportunity in oxidative stress: a review

O cetoprofeno é um anti-inflamatório não esteroidal, antipirético e analgésico amplamente utilizado na prática clínica para o tratamento de artrite reumatóide e outras doenças inflamatórias. Seu mecanismo de ação está baseado na inibição não seletiva da COX, porém esta inibição também promove alguns efeitos adversos. Diferentes pesquisas demonstram que o estresse oxidativo pode estar relacionado com o aparecimento dos efeitos adversos provocados pelo cetoprofeno. Em contrapartida, diversos estudos apontam a participação do estresse oxidativo no ambiente inflamatório. Portanto, tornou-se promissor o estudo da relação entre o cetoprofeno, a inflamação e o estresse oxidativo. Diante deste fato, o objetivo deste trabalho é revisar a literatura a fim de reunir informações sobre a ação do cetoprofeno diante do estresse oxidativo, presente no processo inflamatório, e o aparecimento dos efeitos adversos provocados pelo uso deste fármaco.(AU)

The ketoprofen is a non steroidal anti-inflammatory, antipyretic and analgesic widely used in clinical practice for the treatment of rheumatoid arthritis and other inflammatory diseases. Its mechanism of action is based on non-selective COX inhibition, but this inhibition also leads to some adverse effects. Different researches have shown that oxidative stress may be associated with the onset of adverse effects caused by ketoprofen. On the other hand, several studies point to the involvement of oxidative stress in the inflammatory environment. Therefore, it has become promising study the relationship between the ketoprofen, inflammation and oxidative stress. Considering this fact, the aim of this paper is to review the literature in order to gather information on the effect of ketoprofen on the oxidative stress present in the inflammatory process, and the appearance of adverse effects of using this drug.(AU)

Uso da perfusão regional intravenosa com gentamicina no tratamento de osteomielite traumática em equino: relato de caso / Regional intravenous infusion of use for the treatment of traumatic in equine osteomyelitis: a case report / Uso de infusión intravenosa con gentamicina regional en el tratamiento de traumático en osteomielitis equina: un caso

Relata-se o caso do atendimento de um equino, com osteomielite traumática, segundo relato do proprietário o animal havia sofrido uma queda sobre um obstáculo (mata-burro), e o mesmo passou a apresentar dificuldade de locomoção, claudicação intensa e perda de escore corporal. Após diagnóstico clínico, institui-se o tratamento com gentamicina Enrofloxacina e cetoprofeno, além de bandagem ortopédica e tala de PVC e ferradura com extensão de talão. O tempo médio para resolução clínica foi de 35 dias. Após o término do tratamento o animal aguarda procedimento cirúrgico.(AU)

We report the case of care for a horse with traumatic osteomyelitis, according to reports from the ownerthe animal had suffered a fali on an obstacle (cattle guard), and even went to present limited mobility, severe lamenes sand loss of body condition. After clinical diagnosis, establishing by treatment with gentamicin and enrofloxacinke to profen and ortopedic bandage, splint PVC and horseshoe extending bead. The median time to clinical resolutionwas 35 days. After the end of treatment the animal awaiting surgery.(AU)

Se presenta el caso de la atención a un caballo con osteomielitis traumática, según informan desde el dueno del animal había sufrido una caída en un obstáculo (protector de ganado), e incluso lIegó a presentar unamovilidad limitada, cojera severa y Ia pérdida de Ia puntuación cuerpo. Tras el diagnóstico clínico, establecer medianteel tratamiento con gentamicina y ketoprofeno enrofloxacina y férula ortopédica y PVC vendaje y de herradura que se extiende de talón. La mediana de tiempo hasta Ia resolución clínica fue de 35 días. Después de que el finaldei tratamiento de Ia cirugía de los animales a Ia espera.(AU)

Uso da perfusão regional intravenosa com gentamicina no tratamento de osteomielite traumática em equino: relato de caso / Regional intravenous infusion of use for the treatment of traumatic in equine osteomyelitis: a case report / Uso de infusión intravenosa con gentamicina regional en el tratamiento de traumático en osteomielitis equina: un caso

Relata-se o caso do atendimento de um equino, com osteomielite traumática, segundo relato do proprietário o animal havia sofrido uma queda sobre um obstáculo (mata-burro), e o mesmo passou a apresentar dificuldade de locomoção, claudicação intensa e perda de escore corporal. Após diagnóstico clínico, institui-se o tratamento com gentamicina Enrofloxacina e cetoprofeno, além de bandagem ortopédica e tala de PVC e ferradura com extensão de talão. O tempo médio para resolução clínica foi de 35 dias. Após o término do tratamento o animal aguarda procedimento cirúrgico.

We report the case of care for a horse with traumatic osteomyelitis, according to reports from the ownerthe animal had suffered a fali on an obstacle (cattle guard), and even went to present limited mobility, severe lamenes sand loss of body condition. After clinical diagnosis, establishing by treatment with gentamicin and enrofloxacinke to profen and ortopedic bandage, splint PVC and horseshoe extending bead. The median time to clinical resolutionwas 35 days. After the end of treatment the animal awaiting surgery.

Se presenta el caso de la atención a un caballo con osteomielitis traumática, según informan desde el dueno del animal había sufrido una caída en un obstáculo (protector de ganado), e incluso lIegó a presentar unamovilidad limitada, cojera severa y Ia pérdida de Ia puntuación cuerpo. Tras el diagnóstico clínico, establecer medianteel tratamiento con gentamicina y ketoprofeno enrofloxacina y férula ortopédica y PVC vendaje y de herradura que se extiende de talón. La mediana de tiempo hasta Ia resolución clínica fue de 35 días. Después de que el finaldei tratamiento de Ia cirugía de los animales a Ia espera.

Eficacia de la analgesia preventiva con ketoprofeno, comparada con la administrada al finalizar las colecistectomías laparascópicas en el Hospital Nacional Arzobispo Loayza - periodo de Agosto 2012 a Marzo 2013 / Effectiveness of preventive analgesia with ketoprofen, compared with the administered to the end of laparascopic cholecystectomies in the National Hospital Arzobispo Loayza - period from August 2012 to March 2013

Objetivo: Evaluar si el uso de Ketoprofeno en analgesia preventiva, proporciona adecuada analgesia postoperatoria en Colecistectomías laparoscópicas. Comparar si el uso de Ketoprofeno (a dosis de 2mg/kg) en analgesia preventiva, proporciona analgesia con mejor eficacia, a la administrada al finalizar la cirugía para el control de dolor postoperatoria en pacientes sometidos a colecistectomías laparoscópicas. Material y métodos: Se diseñó un estudio observacional no experimental. La población total fue de 80 pacientes, el total del sexo femenino fue 69 y masculino 11. Hubo dos grupos; Grupo de estudio: 30 pacientes elegidos por "conveniencia y decisión del anestesiólogo titular responsable de la paciente". Grupo control: 30 pacientes en las que el anestesiólogo titular responsable del paciente decida no proporcionar analgesia preventiva y administre analgesia al finalizar la cirugía. Resultados: En el grupo A la edad media fue de 46 ± 17 años, el sexo femenino representó el 52.5 por ciento y en el grupo B la edad media fue 50 ± 18 años, el sexo masculino fue 33.8 por ciento mientras el femenino representó 52.5 por ciento del total. El 68.7 tuvo ASA I y el 31.2 por ciento tuvo ASA II. No hubo diferencias significativas entre los grupos en relación al consumo de remifentanilo y propofol según la inducción y el consumo total. Conclusión: Se concluye que al emplear analgesia preventiva con aines se mantiene la estabilidad hemodinámica durante el intra- operatorio esto aunado a una anestesia endovenosa total. La reducción del consumo de Propofol y Remifentanilo no fue significativa para ambos grupos. Existe evidencia que Ketoprofeno brinda buena analgesia en el post operatorio esto objetivado a través de la escala EVA (p<=0.05). La mayoría de los pacientes egresaron de sala de operaciones despiertos, tranquilos y colaboradores. El porcentaje de complicaciones fue escaso para ambos grupos. El trabajo muestra un resultado exitoso sobre analgesia preventiva ya que...

Nonsteroidal anti-inflammatory therapy: changes on renal function of healthy dogs.

PURPOSE: To evaluate the renal function in healthy dogs submitted to nonselective and preferential COX-2 nonsteroidal anti-inflammatory drug (NSAID) therapy. METHODS: Twenty four healthy dogs were distributed into four groups (G) (n=6): ketoprofenG--treated with ketoprofen; nimesulideG--treated with nimesulid; meloxicanG--treated with meloxican; and etodolacG--treated with etodolaco. All the dogs received the NSAIDs for 10 days by oral route. Physical examination and renal function (urinalysis, urinary sodium and gamma-glutamyl transpeptidase (GGT), serum urea, creatinine, potassium and sodium, and endogenous creatinine clearance) were evaluated before, after five and ten days (T0, T5 and T10) of the treatment in all groups. RESULTS: Changes were observed in urinalysis, with a significant increase in renal cells in the urine at T5 and T10 in nimesulideG. Significant reduction in urinary sodium in nimesulideG at T5 was observed. The clearance values were lower in ketoprofenG at T10. CONCLUSIONS: Meloxicam and etodolac were the drugs that have proven to be safer for short-term therapy in healthy dogs in relation to renal function. NSAIDs ketoprofen and nimesulide should be used judiciously in dogs with renal dysfunction, since there are promoted changes in renal function.

Nonsteroidal anti-inflammatory therapy: changes on renal function of healthy dogs

PURPOSE: To evaluate the renal function in healthy dogs submitted to nonselective and preferential COX-2 nonsteroidal anti-inflammatory drug (NSAID) therapy. METHODS: Twenty four healthy dogs were distributed into four groups (G) (n=6): ketoprofenG - treated with ketoprofen; nimesulideG - treated with nimesulid; meloxicanG - treated with meloxican; and etodolacG - treated with etodolaco. All the dogs received the NSAIDs for 10 days by oral route. Physical examination and renal function (urinalysis, urinary sodium and gamma-glutamyl transpeptidase (GGT), serum urea, creatinine, potassium and sodium, and endogenous creatinine clearance) were evaluated before, after five and ten days (T0, T5 and T10) of the treatment in all groups. RESULTS: Changes were observed in urinalysis, with a significant increase in renal cells in the urine at T5 and T10 in nimesulideG. Significant reduction in urinary sodium in nimesulideG at T5 was observed. The clearance values were lower in ketoprofenG at T10. CONCLUSIONS: Meloxicam and etodolac were the drugs that have proven to be safer for short-term therapy in healthy dogs in relation to renal function. NSAIDs ketoprofen and nimesulide should be used judiciously in dogs with renal dysfunction, since there are promoted changes in renal function.

[Infusional therapy: an alternative for shouder pain post-laparoscopy]. / Terapia infusional: una alternativa en dolor de hombro post laparoscopia

INTRODUCTION: Neuraxial anesthesia in upper abdominal laparoscopic surgery decreases perioperative morbidity and mortality. However, shoulder pain is common and difficult to control. Use of a major opioid (e.g., fentanyl) for the control of this event may depress respiratory function. This is why we believe that a safe and effective therapeutic control of this disease pain is a multimodal analgesic scheme which we have called infusional therapy. OBJECTIVE: To compare various schemes for controlling shoulder pain secondary to pneumoperitoneum. METHODS: Nonrandomized clinical trial with 56 patients ASA I-II divided into four groups undergoing laparoscopic cholecystectomy. Group I (n= 15) managed with ketorolac 1 mg kg, group II (n = 12) ketoprofen 100 mg, group III (n = 14) ketoprofen 50 mg + 50 mg tramadol, and group IV (n = 15) ketoprofen 100 mg + 100 mg tramadol. The following ariables were analyzed: presence and intensity of pain, analgesia rescue and operative time. RESULTS: Group I had more shoulder pain events compared to other groups (p= 0.002) in the same way the group IV required less rescue analgesia (p= 0.034). CONCLUSION: preemptive analgesia to infusional therapy with ketoprofen-tramadol at doses of 100 mg each is safe for laparoscopic surgery.

Antecedentes: en cirugía laparoscópica del hemiabdomen superior la anestesia neuroaxial disminuye la morbilidad y mortalidad perioperatorias; sin embargo, el dolor de hombro es una afección frecuente de difícil control. Puesto que los fármacos opioides mayores (fentanilo) para el control del dolor deprimen la función respiratoria, consideramos que la terapia infusional es un tratamiento seguro y eficaz. Objetivo: comparar diversos esquemas analgésicos para el control del dolor de hombro secundario al neumoperitoneo. Material y método: ensayo clínico no aleatorizado, efectuado en 56 pacientes ASA I-II en cuatro grupos con colecistectomía laparoscópica. El grupo I (n= 15) se trató con ketorolaco 1 mg/kg, el grupo II (n= 12) con ketoprofeno 100 mg, el grupo III (n= 14) con ketoprofeno 50 mg más tramadol 50 mg, y el grupo IV (n= 15) con ketoprofeno 100 mg más tramadol 100 mg. Las variables analizadas fueron: dolor y su intensidad, analgesia de rescate y tiempo quirúrgico. Resultados: en el grupo I hubo más episodios de dolor de hombro que en el resto de los grupos (p= 0.002); el grupo IV requirió menos analgesia de rescate (p= 0.034). Conclusión: la analgesia preventiva con terapia infusional con ketoprofeno-tramadol, a dosis de 100 mg, es segura para pacientes intervenidos mediante cirugía laparoscópica.