For the Fragile Patient at Risk for Fractures, Several Bisphosphonates Prove Their Worth Compared With Placebo
The authors conducted a systematic review and network analysis of 46 randomized trials to assess the effectiveness of bisphosphonates in preventing fractures in fragile patients. The study included alendronic acid (Fosamax and Fosamax Once Weekly, Merck Sharp & Dohme), risedronic acid (Actonel and Actonel Once a Week, Warner Chilcott UK), ibandronic acid (Bonviva, Roche Products), and zoledronic acid (Aclasta, Novartis Pharmaceuticals UK). All treatments were significantly effective versus placebo in patients at high risk of fracture. However, benefit-to-risk ratio was minimal in patients at low risk, especially given the side effects of gastrointestinal problems and development of influenza-type symptoms with bisphosphonates. (See Davis S, Martyn-St James M, Sanderson J, et al. A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures. Health Technol Assess. 2016;20(78):1-406.)
Comparison of 3 Doses of IV Ketorolac for Acute Pain in the ED Found Lowest Dose Effective
To determine the lowest effective does of ketorolac for treating acute pain in the emergency department, the authors of this study conducted a randomized, double-blind trial in 240 patients on the efficacy of 10, 15 and 30 mg ketorolac. The end point was pain relief within 30 minutes. The analgesic efficacy among the 3 doses was similar, indicating that the lowest dose of 10 mg of ketorolac provided effective pain relief within 30 minutes, without the danger of increasing adverse actions. (See Motov S, Yasavolian M, Likourezos A, et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med. 2016;Dec 16. pii: S0196-0644(16)31244-6. doi: 10.1016/j.annemergmed.2016.10.014.)
Melatonin Shows Promise in Treating Ischemic Brain Injury
Melatonin appears to have many roles in improving brain survival after traumatic injury including stroke. It seems to reduce the inflammatory effect, maintain blood-brain barrier protection and decrease downstream adverse reactions. Further studies are indicated. (See Ramos E, Patino P, Reiter RJ, et al. Ischemic brain injury: New insights on the protective role of melatonin. Free Radic Biol Med. 2017;Jan 6;104:32-53. doi: 10.1016/j.freeradbiomed.2017.01.005. [Epub ahead of print.])
Open-Label Placebo Study Shows Value in Treating Low Back Pain
The authors randomized 97 adults with persistent low back pain for more than 3 months to receive either open-label placebo (OLP) treatment or treatment as usual (TAU) for 3 weeks. Decrease in pain and reduced disability were greater in the OLP group. Also, when the TAU group was given OLP pills for a second 3-week period, pain relief was better. The conclusion drawn was that OLP pills presented in a positive way may be helpful in the management of low back pain. (See Carvalho C, Caetano JM, Cunha L, et al. Open-label placebo treatment in chronic low back pain: a randomized controlled trial. Pain. 2016;157(12):2766-2772.)
After Cesarean Delivery, No Postoperative Pain Difference Between TAP Block and Bupivacaine Wound Infiltration
Eighty patients were randomized to receive transversus abdominis plane (TAP) block or wound infiltration using bupivacaine after cesarean section under spinal anesthesia. No significant difference was detected regarding postoperative fentanyl consumption, pain scores, and patient satisfaction in parturients. The incidence of side effects (nausea and vomiting and pruritis) was low in both groups. (See Tawfik MM, Mohamed YM, Elbadrawi RE, et al. Transversus abdominis plane block versus wound infiltration for analgesia after cesarean delivery: a randomized controlled trial [published online ahead of print December 15, 2016]. Anesth Analg. doi:10.1213/ANE.0000000000001724.)