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New Treatment Approaches of Oral Mucositis: A Review of Literature
Narges Gholizadeh, Nafiseh Sheykhbahaei, Maryam-Sadat Sadrzadeh-Afshar
May-August 2016, 6(2):66-72
Oral mucositis (OM) is described as inflammation of the mucosa in the oral cavity which is caused by destruction of the oral mucosal epithelial cells and growth suppression secondary to cancer treatment in the form of radiotherapy or chemotherapeutic drug substances. It is the most debilitating condition and the most common complication in cancer patients. It appears first by thinning of oral tissues which leads to erythema. As these tissues become thinner, ulceration eventually occurs. Potential complications include pain, increased risk of local and systemic infections, bleeding and insufficient food intake and may lead to breaks in treatment sessions. It is usually associated with pain, increased risk of infection and dysphasia and may lead to inadequate hydration and impaired nutritional status. Traditional management of OM has involved patient compliance and education, hydration, nutritional support, use of saline rinses, topical and systemic pain relief and infection surveillance and treatment. The PubMed, Medline, Ovid, Science Direct and Google were searched from 1998 to 2015. The search terms used for medical subject heading were 'oral mucositis' and 'new treatments of mucositis'. Unfortunately, there is not a single method which is capable of preventing or eliminating OM in an efficient way. In this article, we reviewed new therapeutic methods of OM including cryotherapy, honey and coffee, propolis, low-level laser therapy, growth factors, stem cell therapy, hyaluronic acid-based substances and matrix metalloprotease blockers.
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Premedication with oral gabapentin versus intravenous paracetamol for post-operative analgesia after tibial fracture surgery
Mohammad Khalili, Hesameddin Modir, Afsaneh Norouzi, Abolfazl Mohammadbeigi, Seyed Arash Bagherinejad Somesara
September-December 2017, 7(3):115-118
Much attention has been devoted to the management of post-operative pain. Pain reduction brings more comfort and leads to faster recovery and mobilisation of a patient. In addition, it reduces thromboembolic events and eventually the length of hospital stay and cost of treatment. This study was conducted to compare the efficacy of gabapentin versus paracetamol for post-operative analgesia after tibial fracture surgery.
Materials and Methods:
This study was designed as a randomised, controlled clinical trial, in which 96 patients undergoing elective tibial fracture surgery under general anaesthesia were divided into three groups (gabapentin, paracetamol and placebo). Half an hour before induction of anaesthesia, patients received 300 mg oral gabapentin or 1000 mg paracetamol or 100 ml normal saline (these two latter as intravenous infusions) according to their groups. Surgery was performed under general anaesthesia, with similar anaesthetic regimen for all patients. The pain intensity was measured using a visual analogue scale ruler at 2, 4 and 6 h after operation. Collected data were recorded then and analysed using the statistical software SPSS.
At 2, 4 and 6 h after surgery, no significant differences were observed between the two paracetamol and gabapentin groups in terms of pain intensity. Pain intensity in the placebo group was significantly higher than the two case groups. Mean opioid consumption as a rescue intervention was not significantly different between the three groups. However, the placebo group included a larger number of patients requiring opioid analgesics, which was significantly different.
A significant pain reduction was observed in both case groups as compared to placebo. Gabapentin and paracetamol had similar efficacies in post-operative analgesia after tibial fracture surgery. No difference was found between the three groups in terms of mean opioid analgesic requirements.
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