urografin-76 and Pain

We performed a randomized, double-blind prospective study comparing pain experienced during peripheral and aortic angiography with two different contrast agents. Sixty patients, receiving a total of 107 injections, were randomized to receive either ioxaglate (Hexabrix) or sodium-meglumine diatrizoate (Renografin-76). Subjects scored the pain they experienced on a 10-point visual analog scale, and the physician also scored their discomfort on a five point scale. Hemodynamic parameters were monitored during the procedure in all patients, and subsequent hematology, serum chemistry, and urinalysis were performed in 19 of the 60 patients. There was a significant reduction in the degree of pain experienced by the Ioxaglate group compared to the reference group (p less than 0.001). The patients in the Hexabrix group had a mean pain score of 1.3 compared to the patients in the Renografin-76 group who had a mean pain score of 6.1. The two groups did not differ in their hemodynamic responses to the contrast agents, and no significant differences were noted in the subsequent laboratory measures.

Topics: Adult; Aged; Angiography; Clinical Trials as Topic; Diatrizoate; Diatrizoate Meglumine; Double-Blind Method; Drug Combinations; Hemodynamics; Humans; Ioxaglic Acid; Middle Aged; Pain; Random Allocation

The hemodynamic and electrophysiologic alterations induced by ionic contrast agents during cardiac angiography are well described. Recently nonionic contrast agents have become available for cardiac angiography. To evaluate the safety of these new agents, a double-blind randomized study was performed comparing a new nonionic agent (iopamidol) with a commonly used ionic contrast agent (Renografin-76). Eighty-one patients undergoing left ventriculography and coronary angiography were included; 41 received iopamidol and 40 received sodium meglumine diatrizoate (Renografin-76). After left ventriculography, there was a decrease in the arterial pressure with both contrast agents. However, the severity and the duration of hypotension were both significantly greater with Renografin-76 compared with the new nonionic agent (p less than 0.001). After selective injections of the coronary arteries, electrocardiographic analysis demonstrated that the increase in the QT interval (p less than 0.0002) and the changes in both the ST segment and T wave amplitude (p less than 0.001) were significantly greater in the Renografin-76 group compared with the iopamidol group. During coronary angiography, 8 of the 40 patients receiving Renografin-76 required temporary pacing for sinus pauses of 2.5 seconds or more, and 2 of the 40 also developed ventricular fibrillation. None of the 41 patients receiving iopamidol had these complications. This report demonstrates that the electrocardiographic changes, the severity and duration of hypotension and the incidence of serious arrhythmias are significantly greater with Renografin-76 than with iopamidol. Thus, this new nonionic agent appears to enhance the safety of cardiac angiography.

Topics: Aged; Angiocardiography; Arrhythmias, Cardiac; Clinical Trials as Topic; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Double-Blind Method; Drug Combinations; Electrocardiography; Heart Valve Diseases; Hemodynamics; Humans; Iopamidol; Iothalamic Acid; Male; Middle Aged; Pain; Random Allocation; Thorax

Fifty-one patients were analyzed after a randomized double-blind study comparing Hexabrix and Renografin 60 in peripheral arteriography. The arteriographic studies and the volumes of contrast material used in both groups were similar. Hexabrix caused significantly less pain and discomfort than Renografin 60, and the diagnostic quality of the radiographs was comparable. A slightly higher incidence of minor side effects was noted in the Hexabrix group, mostly nausea and vomiting and urinary retention.

Topics: Angiography; Arterial Occlusive Diseases; Contrast Media; Diatrizoate; Diatrizoate Meglumine; Double-Blind Method; Drug Combinations; Female; Humans; Iodobenzoates; Ioxaglic Acid; Male; Pain; Random Allocation; Triiodobenzoic Acids

Complications of popliteal cysts may closely mimic the clinical features of a deep venous thrombosis. We assessed the sensitivity and specificity of the non-invasive procedures of radionuclide venography and popliteal space ultrasound examination compared with those of contrast venography and arthrography, respectively, and then prospectively studied 23 non-surgical patients with acutely painful, swollen calves to determine the utility of these techniques. The cause of this symptom was popliteal cyst complications in 10 patients, deep venous thrombosis in seven patients, and both conditions in two patients. Radionuclide venography was highly reliable and ultrasound examination was specific but only moderately sensitive in these studies. The painful, swollen calf may be investigated adequately in most cases by means of noninvasive invasive techniques; contrast venography and arthrography should be reserved for only a minority of patients.

Topics: Adult; Aged; Arthrography; Cysts; Diagnosis, Differential; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Evaluation Studies as Topic; Female; Humans; Leg; Male; Middle Aged; Pain; Phlebography; Popliteal Vein; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thrombophlebitis; Ultrasonography

This prospective study compares immediate and delayed patient discomfort in 177 patients following shoulder arthrography using intraarticular combinations of metrizamide, meglumine/sodium diatrizoate, meglumine diatrizoate, lidocaine, epinephrine, and air. Patients receiving conventional ionic monomeric positive contrast media had a 60% (90/150) incidence of moderate or severe delayed exacerbation of their baseline symptoms; only 14% (3/21) of patients receiving metrizamide, a nonionic contrast medium, had similar levels of postprocedural discomfort. Morbidity was somewhat diminished with the use of double-contrast (45%, 34/75) rather than single-contrast (75%, 56/75) examinations, and with avoidance of sodium-containing contrast agents or epinephrine. Nonionic or monovalent polymeric contrast media, despite their present high cost, may be the agents of choice if single-contrast arthrography is performed in joints (such as the shoulder, hip, and temporomandibular) associated with a high incidence of post-procedural pain.

Topics: Air; Contrast Media; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Epinephrine; Humans; Metrizamide; Pain; Prospective Studies; Radiography; Random Allocation; Shoulder Joint; Surveys and Questionnaires