A double blinded randomized clinical trial of perioperative ketorolac 15 mg versus 30 mg, evaluated by visual analog score in orthopedic and ear-nose and throat patients

Objective: Ketorolac is a non-steroid anti-inflammatory drug for intravenous use, with analgesic and anti-inflammatory effects and known for its potent influence on moderate to severe postoperative pain. The literature has shown that 30mg i.v. perioperative ketorolac is efficient, well-tolerated and decreases postoperative pain scores. There is no consensus in the literature on whether or not non-steroid anti-inflammatory drugs increase postoperative bleeding. This rare but possibly severe adverse reaction justifies further research into ketorolac dose-dependant postoperative pain scores. The study aims were to evaluate the difference between 15mg and 30mg perioperative i.v. ketorolac on postoperative VAS scores and secondary analgesia consumption after orthopedic or ear, nose and throat surgery. Methods: A comparative double-blinded randomized controlled trial included 69 patients, aged 18-65 years, undergoing ear, nose and throat or orthopedic surgery. Patients were randomized to receive either 15mg or 30mg i.v. ketorolac 30 minutes prior to the end of the surgery. Postoperative pain was recorded at 0, 15, 30, 60 and 90 minutes after arriving at the post-anesthesia care unit. The total amount of supplement analgesia consumed was calculated when the patient left the postoperative care unit or after 90 minutes. Results: A two-sided t-test showed the following: VAS t0: p=0.068 (95% CI 1.564 - 2.780); VAS t15: p=0.078 (95% CI 1.641 - 2.868); VAS t30: p=0.056 (95% CI 1.751 - 3.070); VAS t60: p=0.210 (95% 1.600 - 3.119); and VAS t90: p=0.124 (95% 1.120 - 3.230). The mean postoperative oral morphine equivalent was 9.1mg [5-20 mg] in the 15 mg group and 7.9 mg [2.5-20 mg] in the 30 mg group (two- sided t-test, p=0.526 95% CI -2.21-4.25). Conclusion: Our study demonstrated that 15 mg i.v. perioperative ketorolac exerts the same postoperative pain relief as 30 mg and does not result in a higher secondary analgesia consumption. [Arch Clin Exp Surg 2017; 6(3.000): 120-125

Olfactory and Gustatory Outcomes Including Health-Related Quality of Life 3–6 and 12 Months after Severe-to-Critical COVID-19: A SECURe Prospective Cohort Study

Background: Long-term follow-up studies of COVID-19 olfactory and gustatory disorders (OGDs) are scarce. OGD, parosmia, and dysgeusia affect health-related quality of life (HRQoL) and the ability to detect potential hazards. Methods: In this study, 29 patients reporting OGD 1 month after severe-to-critical COVID-19 were tested at 3–6 months and retested at 12 months in case of hyposmia/anosmia. We used Sniffin Sticks Threshold, Discrimination, and Identification (TDI) test, Sniffin Sticks Identification Test (SIT16), Brief Smell Identification Test (BSIT), taste strips, and HRQoL. The patients were part of the prospective SECURe cohort. Results: Overall, 28% OD (TDI), 12% GD, 24% parosmia, and 24% dysgeusia (questionnaire) at 3–6 months (n = 29) and 28% OD (TDI), 38% parosmia, and 25% dysgeusia (questionnaire) at 12 months (n = 8) were observed. OGD decreased HRQoL: For 13%, it had a negative effect on daily life and, for 17%, it affected nutrition, 17% reported decreased mood, and 87–90% felt unable to navigate everyday life using their sense of smell and taste. A comparison of SIT16 and BSIT to TDI found sensitivity/specificity values of 75%/100% and 88%/86%. Conclusions: This is the first study to examine TDI, SIT16, BSIT, taste strips, and HRQoL up to 1 year after severe-to-critical COVID-19. The patients suffering from prolonged OGD, parosmia, and dysgeusia experienced severely decreasing HRQoL. We recommend including ear–nose–throat specialists in multidisciplinary post-COVID clinics

Head-to-Head Comparison of Nasopharyngeal, Oropharyngeal and Nasal Swabs for SARS-CoV-2 Molecular Testing

Nasopharyngeal swabs (NPS) are considered the gold standard for SARS-CoV-2 testing but are technically challenging to perform and associated with discomfort. Alternative specimens for viral testing, such as oropharyngeal swabs (OPS) and nasal swabs, may be preferable, but strong evidence regarding their diagnostic sensitivity for SARS-CoV-2 testing is still missing. We conducted a head-to-head prospective study to compare the sensitivity of NPS, OPS and nasal swabs specimens for SARS-CoV-2 molecular testing. Adults with an initial positive SARS-CoV-2 test were invited to participate. All participants had OPS, NPS and nasal swab performed by an otorhinolaryngologist. We included 51 confirmed SARS-CoV-2-positive participants in the study. The sensitivity was highest for OPS at 94.1% (95% CI, 87 to 100%) compared to NPS at 92.5% (95% CI, 85 to 99%) (p = 1.00) and lowest for nasal swabs at 82.4% (95% CI, 72 to 93%) (p = 0.07). Combined OPS/NPS was detected in 100% of cases, while the combined OPS/nasal swab increased the sensitivity significantly to 96.1% (95% CI, 90 to 100%) compared to that of the nasal swab alone (p = 0.03). The mean Ct value for NPS was 24.98 compared to 26.63 for OPS (p = 0.084) and 30.60 for nasal swab (p = 0.002). OPS achieved a sensitivity comparable to NPS and should be considered an equivalent alternative for SARS-CoV-2 testing

Relation of Pulmonary Diffusing Capacity Decline to HRCT and VQ SPECT/CT Findings at Early Follow-Up after COVID-19: A Prospective Cohort Study (The SECURe Study)

A large proportion of patients exhibit persistently reduced pulmonary diffusion capacity after COVID-19. It is unknown whether this is due to a post-COVID restrictive lung disease and/or pulmonary vascular disease. The aim of the current study was to investigate the association between initial COVID-19 severity and haemoglobin-corrected diffusion capacity to carbon monoxide (DLco) reduction at follow-up. Furthermore, to analyse if DLco reduction could be linked to pulmonary fibrosis (PF) and/or thromboembolic disease within the first months after the illness, a total of 67 patients diagnosed with COVID-19 from March to December 2020 were included across three severity groups: 12 not admitted to hospital (Group I), 40 admitted to hospital without intensive care unit (ICU) admission (Group II), and 15 admitted to hospital with ICU admission (Group III). At first follow-up, 5 months post SARS-CoV-2 positive testing/4 months after discharge, lung function testing, including DLco, high-resolution CT chest scan (HRCT) and ventilation-perfusion (VQ) single photon emission computed tomography (SPECT)/CT were conducted. DLco was reduced in 42% of the patients; the prevalence and extent depended on the clinical severity group and was typically observed as part of a restrictive pattern with reduced total lung capacity. Reduced DLco was associated with the extent of ground-glass opacification and signs of PF on HRCT, but not with mismatched perfusion defects on VQ SPECT/CT. The severity-dependent decline in DLco observed early after COVID-19 appears to be caused by restrictive and not pulmonary vascular disease

Subjective smell and taste reports and numerical rank scale (NRS) score at 0, 30, 90 and 180 days after follow-up.

Subjective smell and taste reports and numerical rank scale (NRS) score at 0, 30, 90 and 180 days after follow-up.</p