methimazole and Pain

The aim of this study was to compare safety and efficacy of catheter-mediated femoral nerve block analgesia with systemic pain therapy in patients with proximal femoral fractures in the pre-operative and post-operative setting using a protocol for coordinating pain management.. In a prospective randomised trial of patients attending the emergency department, 100 individuals were selected with a clinically diagnosed proximal femoral fracture. Patients were divided into two equal groups A and B. Group A (n=50) received a catheter-mediated femoral nerve block with 1% prilocaine (40 ml) and post-operatively 0.2% ropivacaine (30 ml) 6 hourly. Group B (n=50) initially received intravenous metamizol (1 g) and a fixed combination of oral tilidine (100 mg) + naloxone (8 mg). Patients aged 90 years or more received a reduced dose (tilidine 75 mg + naloxone 6 mg). In the post-operative period regular oral ibuprofen (400 mg, 8 hourly) in addition to oral tilidine (50 mg) + naloxone (4 mg) was given as required for break through pain. Pain intensity was measured using a verbal rating scale (VRS) from 1 to 5: pain free (=1), mild pain (=2), moderate pain (=3), severe pain (=4), excruciating pain (=5). Pain scores were recorded at rest (R), during passive anteflection (30 degrees) of the hip (PA) on arrival and at 15 and 30 min after initial administration of analgesia. Thereafter, recordings were made 4 times a day up to the third post-operative day.. Pain scores were comparable for both groups on admission (VRS in R 2.50 vs. 2.46; VRS during PA 4.30 vs. 4.34). Significant pain relief was achieved in both groups following initial administration of analgesia, but the total pain scores in group A were significantly lower than in group B (VRS in R 1.22 vs. 1.58, p<0.01 and VRS during PA 2.66 vs. 3.26; p<0.001). No difference was noted between the two groups during the first 3 post-operative days. No severe complications occurred as a result of analgesia, however, the catheter was dislodged in 20% of patients in group A resulting in the need for systemically administered analgesia.. All patients presenting with proximal femoral fractures should receive adequate analgesia within the emergency department even prior to radiographic imaging. Femoral nerve block should be considered as the method of choice. The insertion of a femoral nerve block catheter has the dual advantage of early analgesia permitting repeated clinical examination in addition to continued post-operative pain management. The cumbersome logistics inherent in this technique within the clinical setting limits its practical application. An initial single-shot regional nerve block followed by a systemic post-operative analgesia protocol was considered an appropriate alternative. The execution of safe, consistent and appropriate regional nerve block anaesthesia is reliant on formal guidelines and protocols as agreed by the multidisciplinary teams involved with patient-directed pain management and good clinical practice.

Topics: Acute Disease; Aged; Aged, 80 and over; Amides; Analgesics, Opioid; Anesthetics, Local; Catheterization; Female; Femoral Neck Fractures; Femoral Nerve; Humans; Male; Methimazole; Middle Aged; Models, Organizational; Naloxone; Narcotic Antagonists; Nerve Block; Pain; Pain Measurement; Pain, Postoperative; Prilocaine; Prospective Studies; Ropivacaine; Tilidine

The analgesic effect and the tolerability of alpha-methyl-4-(2-thienyl-carbonyl)phenylacetic acid (suprofen, Suprol) syrup 200 mg and metamizole syrup 500 mg were compared in a randomized single-blind study including hospitalized patients with severe to moderate chronic pain. The 2 treatment groups consisted of 30 subjects each and were homogeneous as to the demographic data. Pain intensity was appreciated by the investigator prior to the treatment and on days 2, 3, and 5 of the study; pain relief was assessed on days 2, 3, and 5 of the therapy. Although pain intensity was on treatment with suprofen more markedly reduced than with metamizole, there was no statistically significant difference between the 2 treatment groups (chi 2-test). The Mann-Whitney test revealed that on days 3 and 5 pain relief with suprofen was significantly superior to that with metamizole. According to the investigator's final global evaluation, suprofen syrup 200 mg had very good to good effect in 70% of the cases, whereas the effectiveness of metamizole was rated good to very good in 44%. Side-effects manifesting themselves as gastric irritation and nausea were recorded for 3 patients on suprofen and 2 subjects on metamizole.

Topics: Adult; Aged; Chronic Disease; Clinical Trials as Topic; Female; Humans; Male; Methimazole; Middle Aged; Pain; Phenylpropionates; Random Allocation; Suprofen

2-Amino-5-tert-butyl-2-oxazoline (ATBO, 2) was synthetized from 3,3-dimethyl-2-iodobutyl isocyanate via N-(3,3-dimethyl-2-iodobutyl) urea (1). The structures of compounds 1 and 2 are based on analytical and spectroscopic data. Compound 2 induced in rats and mice a peripheral antinociceptive effect through both spinal and supraspinal mechanisms. ATBO did not impair motor coordination or activity of the experimental animals.

Topics: Acetates; Acetic Acid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Dose-Response Relationship, Drug; Male; Methimazole; Mice; Morphine; Motor Activity; Naloxone; Oxazoles; Pain; Pain Measurement; Postural Balance; Rats; Rats, Wistar

The authors studied 389 Graves' hyperthyroid patients receiving either high propylthiouracil (PTU) or methimazole (MMI) daily doses or low doses to evaluate whether adverse effects were related to the thionamide drugs or its daily dose regimen. Group 1 patients (n = 286) received high PTU (728 +/- 216 mg/day, n = 92) or MMI (60 +/- 19 mg/day, n = 94) doses, and group 2 patients (n = 103) were treated with low PTU (255 +/- 85 mg/day, n = 39) or MMI (23 +/- 10 mg/day, n = 64) doses. Major adverse effects were observed in 11 (2.8%) patients. Of these, four (1.0%) had agranulocytosis, two (0.5%) were granulocytopenic and five (1.3%) had hepatotoxicity. Agranulocytosis occurred in two patients from each group, 0.7% and 1.9%, respectively from group 1 and group 2. There was no significant difference between the groups or the types of thionamide. There also was no correlation with the patients' age. All of the patients were hyperthyroid, and its onset occurred in the first to third month of treatment. Full recovery was achieved in all cases after drug withdrawal. Four of 5 patients with hepatotoxicity were treated with high PTU doses, and one patient received low MMI doses (p less than .05). All patients were euthyroid. Arthralgias, skin rash and gastric intolerance, the minor adverse effects of thionamides studied, were observed in 52 (13.4%) of the patients. Although no significant differences were found, most of the patients experiencing side effects were from group 1 an received MMI therapy. These adverse effects did not demand drug withdrawal.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Agranulocytosis; Chemical and Drug Induced Liver Injury; Child; Dose-Response Relationship, Drug; Drug Eruptions; Graves Disease; Humans; Hyperthyroidism; Joints; Methimazole; Middle Aged; Pain; Propylthiouracil; Stomach Diseases

A hyperthyroid patient treated with methimazole for three weeks developed proximal muscle weakness, myalgia, arthralgia, and fever, and thyrotoxic myopathy was diagnosed. The signs and symptoms spontaneously abated when antithyroid medication was discontinued. This case identified a complication of thionamide treatment mimicking thyrotoxic myopathy and points to the therapeutic necessity of making such a differentiation.

Topics: Adult; Diagnosis, Differential; Female; Fever; Humans; Hyperthyroidism; Joint Diseases; Methimazole; Muscular Diseases; Pain