Postoperative pain was evaluated at the recovery room, 24 and 48 h after surgery. Only 24 h of pain score was included in this study. Pain score was obtained from the patients by the visual analog scale (VAS) with 10 cm length from 0 (no pain) to 10 (the most severe pain) [18 (link)]. In this study, postoperative pain control in both groups using the same regimen. Intravenous analgesics were including ketorolac 30 mg (Yung Shin Pharm. Ind. Co., Ltd., Taichung, Taiwan) and morphine 10 mg. Oral analgesics were including acetaminophen 500 mg (Yung Shin Pharm. Ind. Co., Ltd., Taichung, Taiwan) and naproxen 250 mg (China Chemical and Pharmaceutical Co., Ltd., Hsinchu, Taiwan). Intramuscular analgesic was Dynastat 40 mg (Pfizer, New York City, NY, USA).
Dynastat
Manufactured by Pfizer
Sourced in United States
Dynastat is a versatile laboratory instrument designed for the analysis and characterization of various materials and samples. It is a high-precision device capable of performing dynamic mechanical analysis (DMA) measurements. The core function of Dynastat is to measure the viscoelastic properties of solid and semi-solid materials, providing valuable insights into their structural and mechanical behavior.
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8 protocols using dynastat
1
Postoperative Pain Assessment and Management
2
Perioperative NSAID Celecoxib Protocol
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Patients in the RRG were given the NSAIDs COX-2 inhibitor Celecoxib Capsule (200 mg, Pfizer, Inc., New York, NY, USA) orally bid. from the second day before surgery. Intravenous NSAIDs COX-2 inhibitor was administered Q12H for the first 3 days after the operation with Parichib Sodium for injection (Dynastat, 40 mg, Pfizer Inc.), followed by oral administration of Celecoxib Capsule on the fourth day (200 mg, bid).
3
Anesthetic Management in Thyroid Surgery
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Intermittent treatments with the aforementioned sedative were given intraoperatively for all patients to maintain a desired level of sedation. Inadequate block to the surgical area was supplemented with 10 mg ketamine. If the patient still experienced pain despite supplementation, it was defined as a local anesthetic failure and managed with conversion to general anesthesia. Respectively, esmolol and urapidil hydrochloride were given intravenously when the heart rate or the systolic blood pressure increased more than 20% as compared with the baseline value. Additionally, 5–10 mg of intravenous ephedrine was administered if the systolic blood pressure decreased to 80 mmHg or when it decreased more than 30% as compared with the baseline value. Atropine was administered if the heart rate declined to 50 beats/min. For postoperative pain management, parecoxib (Dynastat®, Pfizer Inc, NY) 40 mg was given on the first evening after surgery to all patients. On the ward, 50 mg of meperidine was given intramuscularly if pain score was 4 or higher at rest.
Thyroid surgery was performed according to a standardized procedure by the same surgeons and the anesthetic was administered by senior consultant anesthetists. Data collection and statistical analysis were performed by two other junior anesthetists.
Thyroid surgery was performed according to a standardized procedure by the same surgeons and the anesthetic was administered by senior consultant anesthetists. Data collection and statistical analysis were performed by two other junior anesthetists.
4
Postoperative Rehabilitation Protocol for Knee Surgeries
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After the surgery, both groups were treated with ice packs to relieve the edema of the affected knee. All the patients received 40 mg q12h parecoxib (Dynastat; Pfizer Inc., USA) intramuscular injection within postoperative 24 hours, with sequential 200 mg bid oral celecoxib (Celebrex; Pfizer Inc., USA) for anti-inflammatory and analgesic therapy for six to eight weeks. Under the guidance of physical therapists, the patients started isometric quadriceps exercises to prevent muscle atrophy and performed ankle pump exercises to prevent deep venous thrombosis (DVT) after recovery from anesthesia. After postoperative 24 hours, all the patients began passive knee flexion exercises using the CPM device three times a day for two weeks to improve knee ROM until the affected knee gradually achieved the maximal ROM. Moreover, the two groups started squatting training and full weight-bearing from the second week after surgery.
5
Induction of Anorexia and Inhibition
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To induce anorexia, 100 μL LPS (O55:B5, Sigma Aldrich, St. Louis, MO; 10 μg/kg) was given i.p. The unspecific COX-inhibitor indomethacin (Confortid; Alpharma, Langenfeld, Germany; 5 mg/kg) and the COX-2 specific inhibitor parecoxib (Dynastat; Pfizer, New York, NY; 10 mg/kg) were given i.p. at a volume of 100 μL. These doses were selected from previous studies (Nilsberth et al., 2009 (link), Ruud et al., 2013a (link)) and tested by titration to robustly inhibit anorexia induced by the given dose of LPS. Indomethacin (Confortid) was also administered intracerebroventricularly (i.c.v.; 15 μg in 3 μL). The COX-1 specific inhibitor SC-560 (Cayman chemicals, Ann Arbor, MI; 30 mg/kg in 300 μL) was given by gavage. The selected dose has previously been show to robustly inhibit COX-1 in a food intake paradigm (Ruud et al., 2013a (link)). Indomethacin, parecoxib and LPS were diluted in saline, whereas SC-560 was diluted in a mixture of methylcellulose and tween 80. Due to the problem with tolerance against LPS, each animal was only given LPS once.
6
Parecoxib Timing in Rodent Injury
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Single animals were allocated by computerized randomization into two parecoxib intervention groups or a control group (i.e. 22 animals in each group). The study staff was blinded to the group and outcome allocation.
All animals received injections (parecoxib or saline, volume 0.04 ml intramuscular) twice a day for six days perioperatively; a total of 12 injections. The daily dose of parecoxib (Dynastat; Pfizer, Puurs, Belgium) was estimated to be 6.4 mg/kg body weight, using allometric scaling based on the basic calorific demand, which is increased by a factor of four in rats compared with humans.15 (link)-17 (link) The ‘parecoxib immediate’ (Pi) group received the first dose of parecoxib 30 minutes preoperatively, then on days 0 to 2 postoperatively, and then saline injections on days 3 to 5. The ‘parecoxib delayed’ (Pd) group received saline injections on days 0 to 2, then parecoxib injections on days 3 to 5. The control (C) group received saline injections on days 0 to 5, and no COX inhibitors. All animals were killed at four weeks.
All animals received injections (parecoxib or saline, volume 0.04 ml intramuscular) twice a day for six days perioperatively; a total of 12 injections. The daily dose of parecoxib (Dynastat; Pfizer, Puurs, Belgium) was estimated to be 6.4 mg/kg body weight, using allometric scaling based on the basic calorific demand, which is increased by a factor of four in rats compared with humans.15 (link)-17 (link) The ‘parecoxib immediate’ (Pi) group received the first dose of parecoxib 30 minutes preoperatively, then on days 0 to 2 postoperatively, and then saline injections on days 3 to 5. The ‘parecoxib delayed’ (Pd) group received saline injections on days 0 to 2, then parecoxib injections on days 3 to 5. The control (C) group received saline injections on days 0 to 5, and no COX inhibitors. All animals were killed at four weeks.
7
Postoperative Multimodal Analgesia Protocol
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Patients were administered with 40 mg parecoxib (Dynastat, Pfizer, USA) diluted to 5 mL with 0.9% normal saline every 12 h after operation for about 3 days followed by an oral nonsteroidal anti-inflammatory drug (60 mg of Loxoprofen Sodium Tablets Tid, Daiichi Sankyo, Japan). Patient-controlled analgesia (1 mg morphine/press) was used in each case for 3 days after surgery. There was no precedent or morphine loading injection. Where applicable, aminophenol oxycodone (Mallinckrodt Inc., USA) had been used as emergency analgesics.
8
Ketamine and COX-2 Inhibitor Effects in Rats
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Experiments were performed in 36 adult female Sprague-Dawley rats (BioLASCO Animal Center, Taipei, Taiwan) weighing 250 g. Our experiments were performed in three groups: i) a saline group (0.9% saline; control), ii) a ketamine group (ketamine 25 mg/kg per day by i.p. injection 15 ), and iii) a ketamine þ Cox-2 inhibitor group [ketamine combined with COX-2 inhibitor (parecoxib sodium; Dynastat [Pfizer, New York, New York]) 10 mg/kg per day by i.p. injection 23 ]; each group was treated for 28 days. The study protocol was approved by the Animal Care and Treatment Committee of Kaohsiung Medical University. All experiments were conducted according to the guidelines for laboratory animal care. All efforts were made to minimize animal stress.
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