Topical Analgesia with Lidocaine Plus Diclofenac Decreases Pain in Benign Anorectal Surgery: Randomized, Double-blind, and Controlled Clinical Trial.

OBJECTIVE: The aim of this study is to evaluate the efficacy and safety of a topical formulation containing lidocaine plus diclofenac (CLIFE1) compared to lidocaine (CLIFE2), to decrease pain in benign anorectal surgery (BARS) to date not evaluated. More than 50% of patients undergoing BARS, especially hemorrhoidectomy, suffer from moderate and severe postoperative pain. This remains an unresolved problem that could be addressed with the new CLIFE1 topical treatment. METHODS: A multicenter, randomized double-blind, active-controlled parallel-group superiority trial, was conducted in two Spanish hospitals. Patients undergoing BARS (hemorrhoids, anal fistula and anal fissure) were randomized at the end of surgery at a 1:1 ratio to receive first dose either CLIFE1 (n = 60) or CLIFE2 (n = 60) anorectal topical treatment, and after every 12 h for the first three postoperative days and once a day from the fourth to sixth. The primary outcome was average of pain decrease after topical treatment, measured with visual analogue scale (VAS) by the patients themselves, the evening in the surgery day and four times daily for the first three postoperative days. RESULTS: The results of 120 patients included out of 150 selected undergoing BARS show a decrease in pain after CLIFE1 topical treatment (7.47 ± 13.09) greater than with CLIFE2 (4.38 ± 6.75), difference -3.21 95% CI (-5.75; -0.68), p = 0.008, decreasing significantly postoperative pain ( ≥ 9 mm, VAS) in 35% of patients undergoing benign anorectal surgery, compared to 18.33 % treated with lidocaine. CONCLUSIONS: The CLIFE1 topical treatment shows better analgesic efficacy than CLIFE2 in BARS.

[The use and attitudes of adolescents toward addictive substances: a prevalence study]. / Consumo y actitudes de los adolescentes frente a sustancias adictivas: Encuesta de prevalencia.

OBJECTIVE: The purpose of this study was to know the use of addictive substances by adolescents of the city of Barcelona (Catalonia, Spain). PATIENTS AND METHODS: Data were obtained from an anonymous and self-administered questionnaire about tobacco use, alcohol use and non-institutionalized drug abuse. participants were students in 3 degrees BUP (16-17 years old) of twelve institutes that are representative of the different districts of the city. The survey was made during the 1991-1992 school year. RESULTS: Among the 426 individuals included, 32.2% reported use of tobacco, 59.2% alcohol, and 16.4% marijuana. Tobacco use was higher among females (p = 0.05), and that of alcohol (p < 0.0001) and other drugs (p = 0.02) higher among males. The parents' smoking behavior was significantly associated with the use of non-institutionalized drugs (p = 0.01). There was a positive and significant association among the use of all three kinds of addictive substances (p < 0.0001). CONCLUSIONS: The prevalence of tobacco, alcohol and non-institutionalized drug use by students in this age range is high. Compared with previous studies in this population we can appreciate a decreasing trend of use.