OBJECTIVE: The general objective of this meta-analysis was to determine the efficacy of HSS versus mannitol in decreasing cerebral edema. The specific objectives were to compare the magnitude of decrease in intracranial pressure (ICP), the changes in cerebral perfusion pressure (CPP), mean arterial pressure (MAP), serum sodium and serum osmolality, between administrations of mannitol versus HSS.

METHOD: Systematic online search was conducted through MEDLlNE, PubMed and Cochrane Database. Search terms used were (mannitol) AND (hypertonic saline solution OR HSS OR hypertonic) AND (intracranial pressure OR ICP OR cerebral edema) AND (stroke OR cerebrovascular OR brain injury). A free text search was also done via Yahoo and Google search engine. Only randomized clinical controlled trials of adults with cerebral edema, due to traumatic brain injury, ischemic or hemorrhagic stroke were included. Interventions encompassed either mannitol or HSS. The outcomes measured include ICP, CPP, MAP, serum sodium and serum osmolality. Primary outcome measured was the magnitude of decline in ICP after giving the osmotic agents. Secondary outcomes were the effects of treatment to the CPP, MAP, serum sodium and serum osmolality. Analysis was done through mean change from baseline, and reported as Weighted Mean Difference (WMD) and 95% Confidence Interval (CI).

RESULTS: Four randomized clinical trials compared mannitol versus HSS in decreasing cerebral edema. A total of 70 patients and 196 episodes of increased ICP were treated with the either hypertonic saline solution or mannitol. The pooled analysis for the mean change from baseline was statistically significant and favored HSS treatment (p
Humans ; Adult ; Intracranial Pressure ; Saline Solution, Hypertonic ; Mannitol ; Brain Edema ; Arterial Pressure ; Search Engine ; Confidence Intervals ; Brain Injuries, Traumatic ; Brain Injuries ; Cerebrovascular Circulation ; Stroke ; Pubmed ; Osmolar Concentration ; Sodium

Objective: To determine the efficacy of cooled plain lubricant jelly in preventing pain during urethral catheterization compared to plain lubricant jelly at room temperature. Materials and Methods: This study is randomized, single-blind trial conducted at UERMMMC from June 1 to October 1, 2007. The patients were allocated to two groups: group 1 (control)- using plain lubricant jelly at room temperature (22 Ã
Urethral Catheterization ; Visual Analog Scales

INTRODUCTION: Transrectal ultrasound guided needle biopsy of prostate is considered a minor procedure but it is associated with significant discomfort and pain. Rectal administration of lidocaine gel during biopsy is safe, simple and effective with no major morbidity. Tramadol is used for relief of moderate to severe pain and the parenteral preparation has been used prior to prostate biopsy. Since TRUS-guided needle biopsy of the prostate is an outpatient procedure and both parenteral and oral tramadol are effective in moderate to severe pain, it is the purpose of this study to compare the efficacy of oral tramadol with that of rectally instilled lidocaine gel prior to TRUS guided needle biopsy of the prostate.

MATERIALS AND METHODS: All male patients fifty and above who had indications for prostatic biopsy were enrolled in the study. Twenty eight patients were randomized into 2 groups, the control (group 1) and experimental (group 2). In group 1, a placebo capsule was given 1 hour prior to the biopsy and 15cc of 2% lidocaine gel was administered intrarectally 10 minutes before the biopsy. In group 2, the patients received a capsule of tramadol 50mg 1 hour prior to the biopsy and 15cc of K-Y jelly was administered intrarectally 10 minutes prior to the biopsy. The VAS pain was measured during insertion of the probe, during the biopsy and 10 minutes after. The mean difference in pain scores per group were compared using the independent T-test.

RESULTS: Twenty eight patients completed the procedure, fourteen were randomized to receive intrarectal lidocaine gel and the other fourteen received oral tramadol. Results showed that oral tramadol demonstrated less pain during insertion of the ultrasound rectal probe 19.57+/-SD 10.82 versus 34.28 +/- SD 19.31 (p = 0.032). During the biopsy proper the, control group had a mean VAS score of 36.86 +/-SD 21.12 and the tramadol group had a mean VAS score of 32.29 +/-SD 19.01 which was not statistically significant (p=0.528).The VAS scores ten minutes after the biopsy showed that the tramadol group had a lower mean of 10.43 +/-SD 11.65 versus 15.79 +/-SD 16.81 for the lidocaine group which was not statistically significant (p = 0.409). Each group had a 21% (3/14) incidence of adverse events and comparison showed no statistical significant difference (p= 0.645).

DISCUSSION: Tramadol, with its dual mechanism of action provides a kind of combined/adjuvant pain therapy. The advantage of using tramadol is that it is a centrally acting analgesis which effectively decreases the pain during distention of the anal sphincter and insertion of the needle into the prostate gland. Conclusion: Our data confirms that both techniques of non-invasive methods of analgesia duirng prostate biopsy are efficacious in reducing patient pain and discomfort, however oral tramadol significantly decreased the pain during probe insertion and was noted to be cheaper.

Human ; Male ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Prostatic Neoplasms ; Biopsy ; Prostate ; Tramadol