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Effectiveness and tolerability of once-daily nimesulide versus ibuprofen in pain management after surgical extraction of an impacted third molar: A 24-hour, double-blind, randomized, double-dummy, parallel-group study
Bocanegra, Mildred
Seijas, Alberto
González Yibirín, María
Current Therapeutic Research, Clinical and Experimental
Nimesulide is a nonsteroidal, anti-inflammatory drug that hasbeen used for a wide range of acute and chronic pain. A once-daily formulation of nimesulide is now commercially available, but its effectiveness in pain management after dental surgery has not been assessed.
The aim of this study was to assess the analgesic effectiveness and tolerability of oral treatment with once-daily nimesulide versus ibuprofen q6h over 24 hours in patients with postoperative pain associated with surgical extraction of an impacted third molar.
This 24-hour, double-blind, randomized, double-dummy, parallel-groupstudy was conducted at a private practice in Caracas, Venezuela. Patients aged between 12 and 60 years with moderate to severe pain after extraction of an impacted third molar were enrolled. Patients were randomized to receive a single dose of nimesulide (300-mg tablet) or ibuprofen (400-mg tablets) q6h for 24 hours. For double-dummy design, patients in the nimesulide group also received ibuprofen placebo tablets, to be taken q6h for 24 hours, and patients in the ibuprofen group received a nimesulide placebo tablet. The primary end points were pain intensity (PI) and pain relief scores over 24 hours. Secondary end points included total pain relief, PI difference (PID), sum of PID (SPID), time to first measurable change in PI (ie, PID ≥ 10 mm), and use of rescue medication (acetaminophen). Patients also rated the treatment's effectiveness as very poor to very good on questioning by the study investigator. Spontaneously reported adverse effects (AEs) were recorded.
Eighty-six patients were enrolled (56 females, 30 males), with 43 patientsper treatment group (mean age: nimesulide group, 25.2 years; ibuprofen group, 24.2 years). The baseline characteristics were statistically similar between the 2 groups. Compared with baseline, mean PI scores were significantly lower in both treatment groups at all time points throughout the study (P < 0.001). Mean PI scores were significantly lower in the nimesulide group compared with the ibuprofen group at 15 and 45 minutes and 1 hour after study drug administration (P ≤ 0.049). Time to first measurable change in PI was within the first 15 minutes in 22 patients (52%) in the nimesulide group and in 14 patients (33%) in the ibuprofen group (P = 0.03). Analgesia lasted 24 hours with nimesulide and ibuprofen (PI scores at 24 hours, 9.4 and 3.6, respectively). The mean PR score was significantly lower in the nimesulide group compared with the ibuprofen group at 1 hour after study drug administration (P = 0.049). Compared with baseline, PID and SPID were significantly higher in both treatment groups throughout the study (P < 0.001). Significantly more patients in the nimesulide group than in the ibuprofen group reported that treatment provided effective pain relief (82% vs 73%; P = 0.013). No AEs were reported in either treatment group throughout the study. Use of rescue medication was statistically similar between the nimesulide and ibuprofen groups (38% and 31%, respectively).
In this study of patients with moderate to severe pain afterextraction of impacted third molars, nimesulide and ibuprofen provided effective 24-hour relief. However, the results suggest that the analgesic effect of nimesulide had a faster onset (<15 minutes) and was stronger (based on patient opinion) than that of ibuprofen. Both study drugs were well tolerated.
nimesulide; ibuprofen; dental pain; programmed liberation
Related Articles
Tramadol and acetaminophen tablets for dental pain.
Medve, R. A.
Wang, J.
Karim, R.
Anesthesia Progress
The purpose of this work was to compare the efficacy and time to analgesia of a new tramadol/acetaminophen combination tablet to those of tramadol or acetaminophen (APAP) alone. A meta-analysis was performed of 3 separate single-dose, double-blind, parallel-group trials in patients with moderate or severe pain following extraction of 2 or more third molars. Patients in each study were evenly randomized to a single dose of tramadol/APAP (75 mg/650 mg), tramadol 75 mg, APAP 650 mg, ibuprofen 400 mg, or placebo. Active control with ibuprofen was used to determine model sensitivity. Pain relief (scale, 0-4) and pain intensity (scale, 0-3) were reported at 30 minutes after the dose and then hourly for 8 hours. Total pain relief over 8 hours (TOTPAR8) and the sum of pain intensity differences (SPID8) were calculated from the hourly scores. Time to onset of pain relief was determined by the double-stopwatch technique, and patients were advised to wait at least 2 hours before taking supplemental analgesia. Patients assessed overall efficacy (scale, 1-5) upon completion. In all, 1197 patients (age range, 16-46 years) were evaluable for efficacy; treatment groups in each study were similar at baseline. Pain relief was superior to placebo (P < or = .0001) for all treatments. Pain relief provided by tramadol/ APAP was superior to that of tramadol or APAP alone, as shown by mean TOT-PAR8 (12.1 vs 6.7 and 8.6, respectively, P < or = .0001) and SPID8 (4.7 vs 0.9 and 2.7, respectively, P < or = .0001). Estimated onset of pain relief was 17 minutes (95% CI, 15-20 minutes) for tramadol/APAP compared with 51 minutes (95% CI, 40-70 minutes) for tramadol, 18 minutes (95% CI, 16-21 minutes) for APAP, and 34 minutes (95% CI, 28-44 minutes) for ibuprofen. Median time to supplemental analgesia and mean overall assessment of efficacy were greater (P < .05) for the tramadol/APAP group (302 minutes and 3.0, respectively) than for the tramadol (122 minutes and 2.0) or APAP (183 minutes and 2.7) monotherapy groups. A new combination analgesic, tramadol/APAP, is superior to tramadol or APAP alone with respect to pain relief and duration of action. It is also superior to tramadol alone with respect to time to onset.
Related Articles
The Analgesic Efficacy of Preoperative Oral Ibuprofen and Acetaminophen in Children Undergoing Adenotonsillectomy: A Randomized Clinical Trial
Mahgoobifard, Maziar
Mirmesdagh, Yalda
Imani, Farsad
Najafi, Atabak
Nataj-Majd, Masoomeh
Anesthesiology and Pain Medicine
Adenotonsillectomy is one of the most common surgical procedures in children. Several complications and morbidities are common after nasal surgeries and the most common is pain. Several techniques have been employed to reduce the severity of postoperative pain. One of the preoperative techniques is pre-emptive analgesia through preventive central hypersensitization. This technique is performed by applying analgesic methods before the onset of nociceptive stimuli, consequently decreasing postoperative analgesics requirements.
Preoperative oral drug administration for pain analgesia is performed in several methods. The aim of this study was to compare the analgesic effects of preoperatively administration of oral acetaminophen and ibuprofen.
Patients and Methods:
In a double-blinded, randomized placebo-controlled study, sixty 4-12 years old ASA I or II children scheduled for elective adenotonsillectomy, were assigned to receive either acetaminophen 15 mg/kg, ibuprofen 10 mg/kg or placebo 30 minutes before the operation. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), upon arrival to the post anesthetic care unit (PACU) and ward. Findings were analyzed by SPSS version 17 using variance analysis and Tukey's test.
The average pain intensities were significantly lower in acetaminophen group based on the CHEOPS in both PACU and ward compared to ibuprofen or placebo groups; but there was no difference in pain intensity between the ibuprofen and placebo groups. Pain intensity in PACU in Acetaminophen group was 7.05 ± 0.64 vs. 8.38 ± 1.20 in placebo group and 8.14 ± 0.85 in ibuprofen group, pain intensity in ward in the acetaminophen group was 6.0.87 ± 0.85in the acetaminophen group, vs. 8.04 ± 1.02 in placebo group, and 7.78 ± 0.78 in ibuprofen group.
This study showed that administration of oral acetaminophen 30 minutes preoperatively, resulted in significantly lower pain intensity in children undergoing adenotonsillectomy in PACU and ward, compared to ibuprofen and placebo.
Acetaminophen; Ibuprofen; Pain, Postoperative
Related Articles
Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial
Hay, Alastair D
Costelloe, Céire
Redmond, Niamh M
Montgomery, Alan A
Fletcher, Margaret
Hollinghurst, Sandra
Peters, Tim J
BMJ : British Medical Journal
Objective To investigate whether paracetamol (acetaminophen) plus ibuprofen are superior to either drug alone for increasing time without fever and the relief of fever associated discomfort in febrile children managed at home.
Design Individually randomised, blinded, three arm trial.
Setting Primary care and households in England.
Participants Children aged between 6 months and 6 years with axillary temperatures of at least 37.8°C and up to 41.0°C.
Intervention Advice on physical measures to reduce temperature and the provision of, and advice to give, paracetamol plus ibuprofen, paracetamol alone, or ibuprofen alone.
Main outcome measures Primary outcomes were the time without fever (<37.2°C) in the first four hours after the first dose was given and the proportion of children reported as being normal on the discomfort scale at 48 hours. Secondary outcomes were time to first occurrence of normal temperature (fever clearance), time without fever over 24 hours, fever associated symptoms, and adverse effects.
Results On an intention to treat basis, paracetamol plus ibuprofen were superior to paracetamol for less time with fever in the first four hours (adjusted difference 55 minutes, 95% confidence interval 33 to 77; P<0.001) and may have been as good as ibuprofen (16 minutes, −7 to 39; P=0.2). For less time with fever over 24 hours, paracetamol plus ibuprofen were superior to paracetamol (4.4 hours, 2.4 to 6.3; P<0.001) and to ibuprofen (2.5 hours, 0.6 to 4.4; P=0.008). Combined therapy cleared fever 23 minutes (2 to 45; P=0.025) faster than paracetamol alone but no faster than ibuprofen alone (−3 minutes, 18 to −24; P=0.8). No benefit was found for discomfort or other symptoms, although power was low for these outcomes. Adverse effects did not differ between groups.
Conclusion Parents, nurses, pharmacists, and doctors wanting to use medicines to supplement physical measures to maximise the time that children spend without fever should use ibuprofen first and consider the relative benefits and risks of using paracetamol plus ibuprofen over 24 hours.
Trial registration Current Controlled Trials ISRCTN26362730.
Related Articles
Prospective, randomized, open-label, pilot clinical trial comparing the effects of dexamethasone coadministered with diclofenac potassium or acetaminophen and diclofenac potassium monotherapy after third-molar extraction in adults
Bamgbose, Babatunde Olamide
Akinwande, Jelili Adisa
Adeyemo, Wasiu Lanre
Ladeinde, Akinola Ladipo
Arotiba, Godwin Toyin
Ogunlewe, Mobolanle Olugbemiga
Current Therapeutic Research, Clinical and Experimental
Patients who experience pain, swelling, and trismus after third-molar extraction are reported to experience a 3-fold higher rate of adverse effects (AEs) on quality of life compared with those who are asymptomatic after this surgery. Therefore, investigators emphasize the necessity for better control of this triad of sequelae. Steroids can reduce the risk for physiologic processes of inflammation, thereby suppressing the development of inflammation.
The aim of this study was to compare the effects of dexamethasone 8 mg IM and diclofenac potassium (K) 50 mg PO, dexamethasone 8 mg IM and acetaminophen 1000 mg PO, and monotherapy with diclofenac K 50 mg PO on postoperative pain, swelling, and trismus after surgical removal of third molars.
This prospective, randomized, open-label pilot study was conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos, Nigeria. Patients were randomly allocated to 1 of 3 treatment groups: concomitant treatment with dexamethasone 8 mg IM and diclofenac K 50 mg PO or acetaminophen 1000 mg PO, or monotherapy with diclofenac K 50 mg PO. Overall analgesic efficacy of the drug combinations was assessed for 7 days postoperatively using a 4-point categorical pain-intensity rating scale (0 = no pain; 1 = mild pain; 2 = moderate pain; and 3 = severe pain). Facial swelling was measured in 1 dimension on days 1, 2, and 7 after surgery using a tape measure placed from the tip of the tragus, to gonion, to the tip of the contralateral tragus, and trismus was assessed using interincisal mouth-opening ability, measured using a vernier-calibrated caliper on postoperative days 1, 2, and 7. Tolerability was assessed using direct questioning of the patients at follow-up visits.
A total of 150 patients (50 per treatment group) were included in the analysis (76 women, 74 men; mean [SD] age, 26.8 [5.04] years [range, 18–45 years]; 100% Nigerian). The proportion of patients reporting no pain on the pain-intensity rating scale was significantly higher in the group receiving dexamethasone and diclofenac K compared with that in the groups receiving dexamethasone and acetaminophen or diclofenac K monotherapy (44% vs 22% and 24%, respectively; both, P < 0.05). Facial swelling was significantly less with dexamethasone and diclofenac K or dexamethasone and acetaminophen compared with diclofenac K alone (day 1: P = 0.013 and P = 0.011, respectively; day 2: P = 0.002 and P = 0.004, respectively). However, trismus relief was statistically similar between the 3 treatment groups on postoperative days 1 and 2. No AEs or complications were recorded.
In this open-label pilot study, concomitant treatment with dexamethasone and diclofenac K provided significant relief of postsurgical pain and swelling compared with dexamethasone and acetaminophen or monotherapy with diclofenac K after third-molar extraction in these patients.
dexamethasone; diclofenac potassium; acetaminophen; third-molar extraction
Related Articles
Ibuprofen with or without an antiemetic for acute migraine headaches in adults
Rabbie, Roy
Derry, Sheena
Moore, R Andrew
McQuay, Henry J
The Cochrane database of systematic reviews
Migraine is a common, disabling condition and a burden for the individual, health services and society. Many sufferers do not seek professional help, relying instead on over-the-counter analgesics. Co-therapy with an antiemetic should help to reduce symptoms commonly associated with migraine headaches.
To determine efficacy and tolerability of ibuprofen, alone or in combination with an antiemetic, compared to placebo and other active interventions in the treatment of acute migraine headaches in adults.
Search methods
We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies through 22 April 2010.
Selection criteria
We included randomised, double-blind, placebo- or active-controlled studies using self-administered ibuprofen to treat a migraine headache episode, with at least 10 participants per treatment arm.
Data collection and analysis
Two review authors independently assessed trial quality and extracted data. Numbers of participants achieving each outcome were used to calculate relative risk and number needed to treat (NNT) or harm (NNH) compared to placebo or other active treatment.
Main results
Nine studies (4373 participants, 5223 attacks) compared ibuprofen with placebo or other active comparators; none combined ibuprofen with a self-administered antiemetic. All studies treated attacks with single doses of medication. For ibuprofen 400 mg versus placebo, NNTs for 2-hour pain-free (26% versus 12% with placebo), 2-hour headache relief (57% versus 25%) and 24-hour sustained headache relief (45% versus 19%) were 7.2, 3.2 and 4.0, respectively. For ibuprofen 200 mg versus placebo, NNTs for 2-hour pain-free (20% versus 10%) and 2-hour headache relief (52% versus 37%) were 9.7 and 6.3, respectively. The higher dose was significantly better for 2-hour headache relief than the lower dose. Soluble formulations of ibuprofen 400 mg were better than standard tablets for 1-hour, but not 2-hour headache relief.
Associated symptoms of nausea, vomiting, photophobia and phonophobia and functional disability were reduced within 2 hours, and fewer participants used rescue medication with ibuprofen compared with placebo. Similar numbers of participants experienced adverse events, which were mostly mild and transient.
Ibuprofen 400 mg did not differ from rofecoxib 25 mg for 2-hour headache relief, 24-hour headache relief or use of rescue medication.
Authors' conclusions
Ibuprofen is an effective treatment for acute migraine headaches, providing pain relief in about half of sufferers, but complete relief from pain and associated symptoms for only a minority. NNTs for all efficacy outcomes were better with 400 mg than 200 mg in comparisons with placebo, and soluble formulations provided more rapid relief. Adverse events were mostly mild and transient, occurring at the same rate as with placebo.
Administration, Oral; Analgesics, Non-Narcotic [* therapeutic use]; Antiemetics [* therapeutic use]; Drug Therapy, Combination [methods]; Ibuprofen [* therapeutic use]; Migraine Disorders [* drug therapy]; Randomized Controlled Trials as Topic; Adult; Humans
Related Articles
Comparison of the effects of ibuprofen and acetaminophen on PGE2 levels in the GCF during orthodontic tooth movement: a human study
Shetty, Niveditha
Patil, Anand K
Ganeshkar, Sanjay V
Hegde, Srinidhi
Progress in Orthodontics
Pain is among the most cited negative effects of orthodontic treatment. Non-steroidal anti-inflammatory drugs seem to be an effective option for minimizing this but can have adverse effects on tooth movement owing to their ability to block prostaglandin synthesis. Acetaminophen has been suggested as the analgesic of choice during orthodontic treatment as it showed no effect on orthodontic tooth movement in previous animal studies. The purpose of this study was to compare the effects of ibuprofen and acetaminophen on the prostaglandin E2 (PGE2) levels of the gingival crevicular fluid (GCF) during orthodontic tooth movement in human subjects.
A total of 42 patients (mean age 18 ± 4.5 years) were randomly divided into three equal groups: ibuprofen, acetaminophen, and control groups. Maxillary canines were distalized with 150 g of force delivered by NiTi coil springs. GCF samples were obtained before (baseline) and after spring activation at 24, 48, and 168 h. The PGE2 content of the GCF was determined using enzyme-linked immunosorbent assay.
PGE2 levels in all groups increased significantly by 24 and 48 h of force application and decreased to baseline levels by 168 h. No significant difference was found between the acetaminophen and control groups at any time point. There was a significant decrease in PGE2 levels in the ibuprofen group at 24 and 48 h when compared to the other two groups.
Acetaminophen showed no significant effect on prostaglandin synthesis and may be the safe choice compared to ibuprofen for relieving pain associated with orthodontic tooth movement.
Related Articles
DUEXIS® (ibuprofen 800 mg, famotidine 26.6 mg): a new approach to gastroprotection for patients with chronic pain and inflammation who require treatment with a nonsteroidal anti-inflammatory drug
Bello, Alfonso E.
Therapeutic Advances in Musculoskeletal Disease
Chronic pain conditions affect at least 116 million US adults and more than one-third of adults worldwide. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used extensively for the treatment of chronic pain due to their efficacy as anti-inflammatory and analgesic agents. Gastrointestinal toxicity is the most well known adverse effect of NSAID therapy and it may manifest as dyspepsia, ulcers, or bleeding. Current guidelines for the management of patients who require NSAIDs for chronic pain and inflammation recognize the potential toxicity associated with these drugs and the need for gastroprotection. DUEXIS® (ibuprofen 800 mg, famotidine 26.6 mg) is a proprietary combination, immediate release tablet containing 800 mg of ibuprofen and 26.6 mg of famotidine. The efficacy of DUEXIS® taken three times daily has been demonstrated in two large-scale controlled clinical trials (Registration Endoscopic Studies to Determine Ulcer Formation of HZT-501 Compared with Ibuprofen: Efficacy and Safety Studies (REDUCE) and REDUCE-2) which showed that this new formulation significantly reduced the risk of endoscopic upper gastrointestinal ulcers compared with ibuprofen alone (REDUCE-1, p < 0.0001, REDUCE-2, p <0.05). DUEXIS® was also superior to ibuprofen in decreasing the risk for gastric ulcers (REDUCE-1, p < 0.001, REDUCE-2, p < 0.05) as well as duodenal ulcers (REDUCE-1, p < 0.05, REDUCE-2, p < 0.05). Safety results from these two studies indicated that treatment-emergent adverse events occurred in 55% of patients treated with DUEXIS® versus 58.7% for ibuprofen, and serious adverse events were recorded for 3.2% of patients treated with DUEXIS® versus 3.3% of those on ibuprofen. Adverse events leading to discontinuation occurred in 6.7% of patients treated with DUEXIS® and 7.6% for ibuprofen. The combination of ibuprofen and famotidine in a single tablet has the potential to improve adherence to gastroprotective therapy in patients who require NSAID treatment and the use of a histamine type 2 receptor antagonist rather than a proton-pump inhibitor may decrease the risk for clinically significant drug interactions and adverse events (e.g. interaction with clopidogrel, fracture, pneumonia, Clostridium difficile infection).
chronic pain; famotidine; gastrointestinal; ibuprofen; proton-pump inhibitor; ulcer
Related Articles
The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol
Tanner, Trevor
Aspley, Sue
Munn, Andrew
Thomas, Tracy
BMC Clinical Pharmacology
Ibuprofen and paracetamol differ in their mode of action and related therapeutic effects, suggesting that combined administration may offer improved analgesia. Reported here are the results of two studies on the pharmacokinetic properties of a novel ibuprofen (200 mg) and paracetamol (500 mg) fixed-dose combination tablet.
Both studies were open-label, randomised studies in healthy volunteers: Study 1 was a four-way crossover, single-dose study; Study 2 was a two-way cross-over, repeat-dose study.
Pharmacokinetic parameters for ibuprofen and paracetamol were similar for the combination and monotherapy tablets (values falling within the 80% to 125% acceptable bioequivalence range) except for the rate of absorption of paracetamol from the combination (tmax), which was significantly faster compared with monotherapy (median difference 10 minutes; p < 0.05). Mean plasma concentrations of both drugs were higher, earlier, following administration of the combination tablet compared with monotherapy. Mean plasma levels at 10 and 20 minutes were 6.64 μg.mL-1 and 16.81 μg.mL-1, respectively, for ibuprofen from the combination, compared with 0.58 μg.mL-1 and 9.00 μg.mL-1, respectively, for monotherapy. For paracetamol, mean plasma levels at 10 and 20 minutes were 5.43 μg.mL-1 and 14.54 μg.mL-1, respectively, for the combination compared with 0.33 μg.mL-1 and 9.19 μg.mL-1, respectively, for monotherapy. The rate of absorption of both ibuprofen and paracetamol was significantly delayed when the combination tablet was administered in the fed versus fasted state; median delay was 25 minutes for ibuprofen (p > 0.05) and 55 minutes for paracetamol (p < 0.001). The pharmacokinetic parameters were comparable irrespective of whether the combination tablet was given twice or three times daily; systemic exposure was, however, approximately 1.4 times greater for both drugs when given three times daily.
Administration of ibuprofen and paracetamol in a fixed-dose combination tablet does not significantly alter the pharmacokinetic profiles of either drug, except for enhancing the rate of paracetamol absorption, offering potential therapeutic benefits in relation to the onset of analgesia. Concentrations of both drugs reached previously reported therapeutic levels when the combination tablet was administrated in the fed or fasted state. Three times daily dosing may offer enhanced therapeutic effect for longer than twice daily dosing.
Related Articles
Efficacy of Standard Doses of Ibuprofen Alone, Alternating, and Combined With Acetaminophen for the Treatment of Febrile Children
Paul, Ian M.
Sturgis, Sarah A.
Yang, Chengwu
Engle, Linda
Watts, Heidi
Berlin, Cheston M.
Clinical therapeutics
Many pediatricians recommend, and many parents administer, alternating or combined doses of ibuprofen and acetaminophen for fever. Limited data support this practice with standard US doses.
This study compared the antipyretic effect of 3 different treatment regimens in children, using either ibuprofen alone, ibuprofen combined with acetaminophen, or ibuprofen followed by acetaminophen over a single 6-hour observation period.
Febrile episodes from children aged 6 to 84 months were randomized into the 3 treatment groups: a single dose of ibuprofen at the beginning of the observation period; a single dose of ibuprofen plus a single dose of acetaminophen at the beginning of the observation period; or ibuprofen followed by acetaminophen 3 hours later. Ibuprofen was administered at 10 mg/kg; acetaminophen at 15 mg/kg. Temperatures were measured hourly for 6 hours using a temporal artery thermometer. The primary outcome was temperature difference between treatment groups. Adverse-event data were not collected in this single treatment period study.
Sixty febrile episodes in 46 children were assessed. The mean (SD) age of the children was 3.4 (2.2) years, and 31 (51.7%) were girls. Differences among temperature curves were significant (P < 0.001; the combined and alternating arms had significantly better antipyresis compared with the ibuprofen-alone group at hours 4 to 6 (hour 4, P < 0.005; hours 5 and 6, P < 0.001). All but one of the children in the combined and alternating groups were afebrile at hours 4, 5, and 6. In contrast, for those receiving ibuprofen alone, 30%, 40%, and 50% had temperatures >38.0°C at hours 4, 5, and 6, respectively (hour 4, P < 0.002; hours 5 and 6, P < 0.001).
During a single 6-hour observation period for these participating children, combined and alternating doses of ibuprofen and acetaminophen provided greater antipyresis than ibuprofen alone at 4 to 6 hours.
fever; antipyretic; acetaminophen; ibuprofen
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Two-agent analgesia versus acetaminophen in children having bilateral myringotomies and tubes surgery
Rampersad, Sally
Jimenez, Nathalia
Bradford, Heidi
Seidel, Kristy
Lynn, Anne
Paediatric anaesthesia
The objective of this study was to determine whether the incidence of emergence agitation (EA) can be reduced by adding an additional, faster onset, non-IV analgesic, intranasal fentanyl or intramuscular (im) ketorolac to rectal acetaminophen.
To compare the incidence of EA after analgesia with two agents vs acetaminophen alone in pediatric patients after bilateral myringotomy procedures (BM&T).
Anesthesia for BM&T is usually performed with volatile anesthetics as a single agent without securing intravenous access. The anesthetic agent most commonly used is sevoflurane; however, EA has been reported in up to 67% of patients. Emergence agitation is distressing for parents, can impair the ability of nursing staff to adequately monitor the child, and can result in a child injuring him/herself if it is severe.
A standardized anesthetic was used with oral midazolam premedication and sevoflurane for induction, and maintenance of anesthesia. All patients received 40 mg·kg−1 rectal acetaminophen, group 1 received acetaminophen alone, group 2 received acetaminophen and 1 mcg·kg−1 of intranasal fentanyl, and group 3 received acetaminophen and 1 mg·kg−1 of intramuscular ketorolac. Incidence of EA was compared using chi-square test between the acetaminophen group alone vs the two-agent analgesia groups combined.
There were no differences in demographic and clinical characteristics between the two groups. There were no statistically significant differences between the three groups for the incidence of EA at any time point during recovery from anesthesia nor were there any significant differences in pain scores or side effects. No significant side effects because of the administration of a second analgesic agent were reported.
We conclude that two-agent analgesia is not superior to acetaminophen alone for decreasing the incidence of EA after inhalation anesthesia with sevoflurane for BM&T surgery. Our overall incidence of EA was low compared to previous studies, which could potentially have decreased our ability to detect differences between groups.
ear tube surgery; children; postoperative analgesia; emergence agitation; intranasal fentanyl; intramuscular ketorolac
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Prophylactic Use of Oral Acetaminophen or IV Dexamethasone and Combination of them on Prevention Emergence Agitation in Pediatric after Adenotonsillectomy
Sajedi, Parvin
Baghery, Kivan
Hagibabie, Ezzat
Mehr, Asieh Maghami
International Journal of Preventive Medicine
The present study was aimed to evaluate the efficacy of acetaminophen plus dexamethasone on post-operative emergence agitation in pediatric adenotonsillectomy.
A total of 128 patients were randomized and assigned among four groups as: Intravenous (IV) dexamethasone, oral acetaminophen, IV dexamethasone plus oral acetaminophen, placebo. Group 1 received 0.2 mg/kg dexamethasone plus 0.25 mg/kg strawberry syrup 2 h before surgery. Group 2 received 20 mg/kg oral acetaminophen (0.25 ml/kg) with 0.05 ml/kg IV normal saline. Group 3 received 20 mg/kg acetaminophen and 0.2 mg/kg dexamethasone intravenously. Group 4 received 0.25 ml/kg strawberry syrup and 0.05 ml/kg normal saline. Agitation was measured according to Richmond agitation sedation score in the post anesthetic care unit (PACU) after admission, 10, 20 and 30 min after extubation. Pain score was measured with FACE scale. Nurse satisfaction was measured with verbal analog scale. If agitation scale was 3 ≥ or pain scale was 4 ≥ meperidine was prescribed. If symptoms did not control wit in 15 min midazolam was prescribed. Patients were discharged from PACU according Modified Alderet Score. Data were analyzed with ANOVA, Chi-square, and Kruskal-Wallis among four groups. P < 0.05 was considered statistically significant.
A total of 140 patients were recruited in the study, which 12 of them were excluded. Thus, 128 patients were randomized and assigned among four groups. The four treatment groups were generally matched at baseline data. Median of pain score in 0, 10, 20 and 30 min after extubation were different between each study group with the control group (<0.001, 0.003 respectively). Also median of agitation score in 0, 10, 20 and 30 min after extubation were different between each study group with the control group (<0.001). Incidence of pain and incidence of agitation after extubation were not statistically identical among groups (P < 0.001 and P = 0.002 respectively). Mean of recovery time, duration of agitation and 1st time to agitation appearance, meperidine and midazolam consumption, nurse satisfaction and complication frequency were not statistically identical among groups (P < 0.001).
Acetaminophen, dexamethasone and combination of them are superior to placebo for prevention of agitation after adenotonsillectomy in children. Furthermore combinations of both drugs are superior to acetaminophen or dexamethasone separately.
Acetaminophen; adenotonsillectomy; dexamethasone; postoperative agitation
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Single dose oral analgesics for acute postoperative pain in adults
Moore, R Andrew
Derry, Sheena
McQuay, Henry J
Wiffen, Philip J
The Cochrane database of systematic reviews
Thirty-five Cochrane Reviews of randomised trials testing the analgesic efficacy of individual drug interventions in acute postoperative pain have been published. This overview brings together the results of all those reviews and assesses the reliability of available data.
To summarise data from all Cochrane Reviews that have assessed the effects of pharmaceutical interventions for acute pain in adults with at least moderate pain following surgery, who have been given a single dose of oral analgesic taken alone.
We identified systematic reviews in The Cochrane Library through a simple search strategy. All reviews were overseen by a single Review Group, had a standard title, and had as their primary outcome numbers of participants with at least 50% pain relief over four to six hours compared with placebo. For individual reviews we extracted the number needed to treat (NNT) for this outcome for each drug/dose combination, and also the percentage of participants achieving at least 50% maximum pain relief, the mean of mean or median time to remedication, the percentage of participants remedicating by 6, 8, 12, or 24 hours, and results for participants experiencing at least one adverse event.
Main results
The overview included 35 separate Cochrane Reviews with 38 analyses of single dose oral analgesics tested in acute postoperative pain models, with results from about 45,000 participants studied in approximately 350 individual studies. The individual reviews included only high-quality trials of standardised design and outcome reporting. The reviews used standardised methods and reporting for both efficacy and harm. Event rates with placebo were consistent in larger data sets. No statistical comparison was undertaken.
There were reviews but no trial data were available for acemetacin, meloxicam, nabumetone, nefopam, sulindac, tenoxicam, and tiaprofenic acid. Inadequate amounts of data were available for dexibuprofen, dextropropoxyphene 130 mg, diflunisal 125 mg, etoricoxib 60 mg, fenbufen, and indometacin. Where there was adequate information for drug/dose combinations (at least 200 participants, in at least two studies), we defined the addition of four comparisons of typical size (400 participants in total) with zero effect as making the result potentially subject to publication bias and therefore unreliable. Reliable results were obtained for 46 drug/dose combinations in all painful postsurgical conditions; 45 in dental pain and 14 in other painful conditions.
NNTs varied from about 1.5 to 20 for at least 50% maximum pain relief over four to six hours compared with placebo. The proportion of participants achieving this level of benefit varied from about 30% to over 70%, and the time to remedication varied from two hours (placebo) to over 20 hours in the same pain condition. Participants reporting at least one adverse event were few and generally no different between active drug and placebo, with a few exceptions, principally for aspirin and opioids.
Drug/dose combinations with good (low) NNTs were ibuprofen 400 mg (2.5; 95% confidence interval (CI) 2.4 to 2.6), diclofenac 50 mg (2.7; 95% CI 2.4 to 3.0), etoricoxib 120 mg (1.9; 95% CI 1.7 to 2.1), codeine 60 mg + paracetamol 1000 mg (2.2; 95% CI 1.8 to 2.9), celecoxib 400 mg (2.5; 95% CI 2.2 to 2.9), and naproxen 500/550 mg (2.7; 95% CI 2.3 to 3.3). Long duration of action (8 hours) was found for etoricoxib 120 mg, diflunisal 500 mg, oxycodone 10 mg + paracetamol 650 mg, naproxen 500/550 mg, and celecoxib 400 mg.
Not all participants had good pain relief and for many drug/dose combinations 50% or more did not achieve at last 50% maximum pain relief over four to six hours.
Authors' conclusions
There is a wealth of reliable evidence on the analgesic efficacy of single dose oral analgesics. There is also important information on drugs for which there are no data, inadequate data, or where results are unreliable due to susceptibility to publication bias. This should inform choices by professionals and consumers.
Administration, Oral; Analgesics [*administration & dosage; adverse effects]; Pain, Postoperative [*drug therapy]; Review Literature as Topic; Tooth Extraction [adverse effects]; Adult; Humans
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Effects of the Antifungals Voriconazole and Fluconazole on the Pharmacokinetics of S-(+)- and R-(−)-Ibuprofen
Hynninen, Ville-Veikko
Olkkola, Klaus T.
Leino, Kari
Lundgren, Stefan
Neuvonen, Pertti J.
Rane, Anders
Valtonen, Mika
Vyyryläinen, Hanna
Laine, Kari
Antimicrobial Agents and Chemotherapy
Our objective was to study the effects of the antifungals voriconazole and fluconazole on the pharmacokinetics of S-(+)- and R-(−)-ibuprofen. Twelve healthy male volunteers took a single oral dose of 400 mg racemic ibuprofen in a randomized order either alone, after ingestion of voriconazole at 400 mg twice daily on the first day and 200 mg twice daily on the second day, or after ingestion of fluconazole at 400 mg on the first day and 200 mg on the second day. Ibuprofen was ingested 1 h after administration of the last dose of voriconazole or fluconazole. Plasma concentrations of S-(+)- and R-(−)-ibuprofen were measured for up to 24 h. In the voriconazole phase, the mean area under the plasma concentration-time curve (AUC) of S-(+)-ibuprofen was 205% (P < 0.001) of the respective control value and the mean peak plasma concentration (Cmax) was 122% (P < 0.01) of the respective control value. The mean elimination half-life (t1/2) was prolonged from 2.4 to 3.2 h (P < 0.01) by voriconazole. In the fluconazole phase, the mean AUC of S-(+)-ibuprofen was 183% of the control value (P < 0.001) and its mean Cmax was 116% of the control value (P < 0.05). The mean t1/2 of S-(+)-ibuprofen was prolonged from 2.4 to 3.1 h (P < 0.05) by fluconazole. The geometric mean S-(+)-ibuprofen AUC ratios in the voriconazole and fluconazole phases were 2.01 (90% confidence interval [CI], 1.80 to 2.22) and 1.82 (90% CI, 1.72 to 1.91), respectively, i.e., above the bioequivalence acceptance upper limit of 1.25. Voriconazole and fluconazole had only weak effects on the pharmacokinetics of R-(−)-ibuprofen. In conclusion, voriconazole and fluconazole increased the levels of exposure to S-(+)-ibuprofen 2- and 1.8-fold, respectively. This was likely caused by inhibition of the cytochrome P450 2C9-mediated metabolism of S-(+)-ibuprofen. A reduction of the ibuprofen dosage should be considered when ibuprofen is coadministered with voriconazole or fluconazole, especially when the initial ibuprofen dose is high.
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Alternating ibuprofen and acetaminophen in the treatment of febrile children: a pilot study [ISRCTN30487061]
Nabulsi, Mona M
Tamim, Hala
Mahfoud, Ziyad
Itani, Mohammad
Sabra, Ramzi
Chamseddine, Fadi
Mikati, Mohammad
BMC Medicine
Alternating ibuprofen and acetaminophen for the treatment of febrile children is a prevalent practice among physicians and parents, despite the lack of evidence on effectiveness or safety. This randomized, double-blind and placebo-controlled clinical trial aims at comparing the antipyretic effectiveness and safety of a single administration of alternating ibuprofen and acetaminophen doses to that of ibuprofen mono-therapy in febrile children.
Seventy febrile children were randomly allocated to receive either a single oral dose of 10 mg/kg ibuprofen and 15 mg/kg oral acetaminophen after 4 hours, or a similar dose of ibuprofen and placebo at 4 hours. Rectal temperature was measured at baseline, 4, 5, 6, 7 and 8 hours later. Endpoints included proportions of afebrile children at 6, 7 and 8 hours, maximum decline in temperature, time to recurrence of fever, and change in temperature from baseline at each time point. Intent-to-treat analysis was planned with statistical significance set at P < 0.05.
A higher proportion of subjects in the intervention group (83.3%) became afebrile at 6 hours than in the control group (57.6%); P = 0.018. This difference was accentuated at 7 and 8 hours (P < 0.001) with a significantly longer time to recurrence of fever in the intervention group (mean ± SD of 7.4 ± 1.3 versus 5.7 ± 2.2 hours), P < 0.001. Odds ratios (95%CI) for defervescence were 5.6 (1.3; 23.8), 19.5 (3.5; 108.9) and 15.3 (3.4; 68.3) at 6, 7 and 8 hours respectively. Two-way ANOVA with repeated measures over time revealed a significantly larger decline in temperature in the intervention group at times 7 (P = 0.026) and 8 (P = 0.002) hours.
A single dose of alternating ibuprofen and acetaminophen appears to be a superior antipyretic regimen than ibuprofen mono-therapy. Further studies are needed to confirm these findings.
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Ibuprofen versus acetaminophen with codeine for the relief of perineal pain after childbirth: a randomized controlled trial
Peter, Elizabeth A.
Janssen, Patricia A.
Grange, Caroline S.
Douglas, M. Joanne
CMAJ: Canadian Medical Association Journal
Pain from episiotomy or tearing of perineal tissues during childbirth is often poorly treated and may be severe. This randomized double-blind controlled trial was performed to compare the effectiveness, side effects and cost of, and patient preference for, 2 analgesics for the management of postpartum perineal pain.
A total of 237 women who gave birth vaginally with episiotomy or a third- or fourth-degree tear between August 1995 and November 1996 at a tertiary-level teaching and referral centre for obstetric care in Vancouver were randomly assigned to receive either ibuprofen (400 mg) (n = 127) or acetaminophen (600 mg) with codeine (60 mg) and caffeine (15 mg) (Tylenol No. 3) (n = 110), both given orally every 4 hours as necessary. Pain ratings were recorded before the first dose and at 1, 2, 3, 4, 12 and 24 hours after the first dose on a 10-cm visual analogue scale. Side effects and overall opinion were assessed at 24 hours.
Ibuprofen and acetaminophen with codeine had similar analgesic properties in the first 24 hours post partum (mean pain rating 3.4 and 3.3, mean number of doses in 24 hours 3.4 and 3.3, and proportion of treatment failures 13.8% [16/116] and 16.0% [16/100] respectively). Significantly fewer subjects in the ibuprofen group than in the acetaminophen with codeine group experienced side effects (52.4% v. 71.7%) (p = 0.006). There were no significant differences in overall patient satisfaction between the 2 groups. The major determinant of pain intensity was forceps-assisted delivery. Overall, 78% of the treatment failures were in women with forceps-assisted deliveries.
Since the 2 analgesics were rated similarly, ibuprofen may be the preferred choice because it is less expensive and requires less nursing time to dispense. Further studies need to address improved analgesia for women with forceps-assisted deliveries.
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Use of ibuprofen and risk of Parkinson disease
Gao, Xiang
Chen, Honglei
Schwarzschild, Michael A.
Ascherio, Alberto
Neuroinflammation may contribute to the pathogenesis of Parkinson disease (PD). Use of nonsteroidal anti-inflammatory drugs (NSAID) in general, and possibly ibuprofen in particular, has been shown to be related to lower PD risk in previous epidemiologic studies.
We prospectively examined whether use of ibuprofen or other NSAIDs is associated with lower PD risk among 136,197 participants in the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS) free of PD at baseline (1998 for NHS and 2000 for HPFS). NSAIDs use was assessed via questionnaire. Results were combined in a meta-analysis with those of published prospective investigations.
We identified 291 incident PD cases during 6 years of follow-up. Users of ibuprofen had a significantly lower PD risk than nonusers (relative risk [RR], adjusted for age, smoking, caffeine, and other covariates = 0.62; 95% confidence interval [CI] 0.42–0.93; p = 0.02). There was a dose–response relationship between tablets of ibuprofen taken per week and PD risk (p trend = 0.01). In contrast, PD risk was not significantly related to use of aspirin (RR = 0.99; 95% CI 0.78–1.26), other NSAIDs (RR = 1.26; 95% CI 0.86–1.84), or acetaminophen (RR = 0.86; 95% CI 0.62–1.18). Similar results were obtained in the meta-analyses: the pooled RR was 0.73 (95% CI 0.63–0.85; p < 0.0001) for ibuprofen use, whereas use of other types of analgesics was not associated with lower PD risk.
The association between use of ibuprofen and lower PD risks, not shared by other NSAIDs or acetaminophen, suggests ibuprofen should be further investigated as a potential neuroprotective agent against PD.
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Comparison of preemptive analgesic effects of a single dose of nonopioid analgesics for pain management after ambulatory surgery: A prospective, randomized, single-blind studyin Turkish patients
Sener, Mesut
Ozgur Pektas, Zafer
Yilmaz, Ismail
Turkoz, Ayda
Uckan, Sina
Donmez, Asli
Arslan, Gulnaz
Current Therapeutic Research, Clinical and Experimental
Preemptive analgesia used for postsurgical pain management has been shown to reduce the requirements of postoperative analgesics.
The aim of this study was to compare the preemptive analgesic effects of diflunisal, naproxen sodium, meloxicam, acetaminophen, and rofecoxin (no longer available in some markets) in patients undergoing ambulatory dental surgery and the need for postoperative pain management in these patients.
This prospective, randomized, single-blind study was conducted at the Departments of Anesthesiology and Reanimation and Oral and Maxillofacial Surgery, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey. Turkish outpatients aged ≥ 16 years with American Society of Anesthesiologists physical status 1 (ie, healthy) and scheduled to undergo surgical extraction of an impacted third molar were enrolled. Patients were randomly assigned to receive diflunisal 500 mg, naproxen sodium 550 mg, meloxicam 7.5 mg, acetaminophen 500 mg, or rofecoxib 12.5 mg. All medications were administered orally 1 hour before surgery as preemptive analgesia and after surgery if needed, up to the maximum recommended dose. Surgery was performed with the patient under local anesthesia (articaine hydrochloride). Pain intensity was assessed using a 100-mm visual analog scale (VAS) (0 = none to 100 = worst possible pain) at 2, 4, 6, and 12 hours after ambulatory surgery. The use of additional analgesics was recorded for 24 hours using patient diaries. Postoperative adverse events were recorded using the diaries.
One hundred fifty patients (108 women, 42 men; mean [SE] age, 26.8 [0.6] years; 30 patients per group) had data available for analysis. Demographic data were similar between the 5 groups. No significant differences in mean VAS scores were found between the 5 groups at any time point. All mean VAS scores indicated minor pain. The rate of additional postoperative analgesics required was significantly lower in the diflunisal group compared with groups receiving naproxen sodium, meloxicam, acetaminophen, and rofecoxib (3 [10%] patients vs 11 [37%], 15 [50%], 15 [50%], and 14 [47%] patients, respectively; all, P < 0.05). Bleeding at the surgical site was reported in 2 patients each in the diflunisal, naproxen sodium, meloxicam, and acetaminophen groups, and in 1 patient in the rofecoxib group; the between-group differences were not significant. No significant differences in the prevalences of other adverse effects (eg, nausea, vomiting, allergy, gastrointestinal symptoms) were found between the 5 treatment groups.
In the present study in patients undergoing third molar extraction, adequate preemptive analgesia, based on VAS scores, was found with all of the nonopioid analgesic agents used. Fewer patients required rescue medication with diflunisal. All 5 study drugs were similarly well tolerated.
preemptive analgesia; ambulatory surgery; NSAIDs
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Efficacy of Low Dose Combination Analgesics: Acetaminophen/Codeine, Aspirin/Butalbital/Caffeine/Codeine, and Placebo in Oral Surgery Pain
Desjardins, Paul J.
Cooper, Stephen A.
Finizio, Tobin
Anesthesia Progress
A double-blind, randomized, single-dose study was performed to compare the efficacy and safety of two commonly prescribed combination analgesic products to placebo. The combinations were acetaminophen 300 mg/codeine 30 mg†, and aspirin 325 mg/butalbital 50 mg/caffeine 40 mg/codeine 30 mg††. One hundred twenty-three (123) oral surgery outpatients took study medications when their pain became moderate to severe and recorded the levels of pain intensity, pain relief, anxiety and relaxation at 30 minutes and hourly for 6 hours after dosing. Remedication was permitted if study medications did not provide adequate pain relief. Time to remedication, and the number of observations with 50% or better relief, were noted as were any side effects. An overall evaluation was obtained from each patient. Results of the study showed that the aspirin/butalbital/caffeine/codeine combination was significantly more effective than placebo for total pain relief, peak relief and global evaluation. While the acetaminophen/codeine combination was numerically superior to placebo, it achieved statistical significance only for global evaluation. The aspirin/butalbital/caffeine/codeine combination was numerically superior to acetaminophen/codeine for every measure of analgesic efficacy but the differences did not achieve statistical significance. Both active treatment groups experienced significantly less total anxiety than did the placebo group. Only 11 patients reported mild, transient adverse effects; the most common was drowsiness. The adverse effects occurred equally among the three treatment groups. In this study, the aspirin/butalbital/caffeine/codeine combination was significantly superior to placebo and somewhat better than acetaminophen/codeine.
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Effects of naloxone and flumazenil on antinociceptive action of acetaminophen in rats
Madenoğlu, Halit
Kaçmaz, Mustafa
Aksu, Recep
Bicer, Cihangir
Yaba, Gülay
Yildiz, Karamehmet
Doğru, Kudret
Boyaci, Adem
Current Therapeutic Research, Clinical and Experimental
Background: Studies of acetaminophen suggest that multiple nociceptive pathways are involved in the drug's analgesic action.
Objective: The purpose of this study was to determine whether naloxone and flumazenil were able to modify or antagonize the antinociceptive effect of acetaminophen in rats.
Methods: Adult albino Wistar rats were used in the study and randomly allocated to 1 of 4 groups. The acetaminophen group (A group) was administered IP saline and then 300 mg/kg IP acetaminophen 5 minutes thereafter. The acetaminophen + naloxone group (AN group) was pretreated with 1 mg/kg IP naloxone, followed by 300 mg/kg IP acetaminophen 5 minutes later. The acetaminophen + flumazenil group (AF group) was pretreated with 1 mg/kg IP flumazenil, followed by 300 mg/kg IP acetaminophen 5 minutes later. The control group received 2.5 mL IP saline, followed by an additional 2.5 mL IP injection of saline 5 minutes later. The paw-withdrawal latency period of the rats was assessed by an investigator blinded to treatment using the hot-plate test at 30, 45, 60, and 90 minutes after administration of acetaminophen.
Results: Thirty-two rats were evenly randomized by envelope method into 4 groups of 8 rats each. Baseline values for the A, AN, AF, and control groups were not significantly different (9.1 [2.3], 10.5 [2.7], 9.8 [3.0], and 8.9 [1.4] sec, respectively). In the AF group, flumazenil appeared to antagonize the analgesic effect exerted by the acetaminophen in the hot-plate test (30 min, 10.3 [3.7] sec; 45 min, 11.7 [5.1] sec; 60 min, 12.1 [5.1] sec; and 90 min, 12.2 [4.9] sec) and values were not significantly different from those obtained in the control group (30 min, 9.8 [2.2] sec; 45 min, 9.0 [1.6] sec; 60 min, 9.2 [1.6] sec; and 90 min, 8.5 [2.0] sec). In the AN group, naloxone did not significantly affect the values observed in the hot-plate test (30 min, 18.0 [4.5] sec; 45 min, 21.5 [7.8] sec; 60 min, 20.5 [5.9] sec; and 90 min, 22.3 [7.4] sec) and values at all time points were not significantly different from those obtained in the A group (30 min, 17.8 [7.6] sec; 45 min, 20.9 [6.9] sec; 60 min, 21.5 [7.3] sec; and 90 min, 23.8 [8.6] sec). All postbaseline values in the A and AN groups were significantly increased versus baseline and versus the control group values (all, P < 0.05). All postbaseline values in the A group were significantly greater than those in the AF group (all, P < 0.05).
Conclusion: Flumazenil antagonized the analgesic effect exerted by acetaminophen, while naloxone had no significant effect on acetaminophen's antinociceptive action in this pain model in rats.
antinociceptive action; acetaminophen (paracetamol); flumazenil; naloxone
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Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial
Poonai, Naveen
Bhullar, Gina
Lin, Kangrui
Papini, Adam
Mainprize, David
Howard, Jocelyn
Teefy, John
Bale, Michelle
Langford, Cindy
Lim, Rodrick
Stitt, Larry
Rieder, Michael J.
Ali, Samina
CMAJ : Canadian Medical Association Journal
Recent warnings from Health Canada regarding codeine for children have led to increased use of nonsteroidal anti-inflammatory drugs and morphine for common injuries such as fractures. Our objective was to determine whether morphine administered orally has superior efficacy to ibuprofen in fracture-related pain.
We used a parallel group, randomized, blinded superiority design. Children who presented to the emergency department with an uncomplicated extremity fracture were randomly assigned to receive either morphine (0.5 mg/kg orally) or ibuprofen (10 mg/kg) for 24 hours after discharge. Our primary outcome was the change in pain score using the Faces Pain Scale — Revised (FPS-R). Participants were asked to record pain scores immediately before and 30 minutes after receiving each dose.
We analyzed data from 66 participants in the morphine group and 68 participants in the ibuprofen group. For both morphine and ibuprofen, we found a reduction in pain scores (mean pre–post difference ± standard deviation for dose 1: morphine 1.5 ± 1.2, ibuprofen 1.3 ± 1.0, between-group difference [δ] 0.2 [95% confidence interval (CI) −0.2 to 0.6]; dose 2: morphine 1.3 ± 1.3, ibuprofen 1.3 ± 0.9, δ 0 [95% CI −0.4 to 0.4]; dose 3: morphine 1.3 ± 1.4, ibuprofen 1.4 ± 1.1, δ −0.1 [95% CI −0.7 to 0.4]; and dose 4: morphine 1.5 ± 1.4, ibuprofen 1.1 ± 1.2, δ 0.4 [95% CI −0.2 to 1.1]). We found no significant differences in the change in pain scores between morphine and ibuprofen between groups at any of the 4 time points (p = 0.6). Participants in the morphine group had significantly more adverse effects than those in the ibuprofen group (56.1% v. 30.9%, p < 0.01).
We found no significant difference in analgesic efficacy between orally administered morphine and ibuprofen. However, morphine was associated with a significantly greater number of adverse effects. Our results suggest that ibuprofen remains safe and effective for outpatient pain management in children with uncomplicated fractures. Trial registration: ClinicalTrials.gov, no. NCT01690780.
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Single dose oral ibuprofen for acute postoperative pain in adults
Derry, Christopher J
Derry, Sheena
Moore, R Andrew
McQuay, Henry J
The Cochrane database of systematic reviews
This review updates a 1999 Cochrane review showing that ibuprofen at various doses was effective in postoperative pain in single dose studies designed to demonstrate analgesic efficacy. New studies have since been published. Ibuprofen is one of the most widely used non-steroidal anti-inflammatory (NSAID) analgesics both by prescription and as an over-the-counter medicine. Ibuprofen is used for acute and chronic painful conditions.
To assess analgesic efficacy of ibuprofen in single oral doses for moderate and severe postoperative pain in adults.
Search methods
We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to May 2009.
Selection criteria
Randomised, double blind, placebo-controlled trials of single dose orally administered ibuprofen (any formulation) in adults with moderate to severe acute postoperative pain.
Data collection and analysis
Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk and number-needed-to-treat-to-benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected.
Main results
Seventy-two studies compared ibuprofen and placebo (9186 participants). Studies were predominantly of high reporting quality, and the bulk of the information concerned ibuprofen 200 mg and 400 mg. For at least 50% pain relief compared with placebo the NNT for ibuprofen 200 mg (2690 participants) was 2.7 (2.5 to 3.0) and for ibuprofen 400 mg (6475 participants) it was 2.5 (2.4 to 2.6). The proportion with at least 50% pain relief was 46% with 200 mg and 54% with 400 mg. Remedication within 6 hours was less frequent with higher doses, with 48% remedicating with 200 mg and 42% with 400 mg. The median time to remedication was 4.7 hours with 200 mg and 5.4 hours with 400 mg. Sensitivity analysis indicated that pain model and ibuprofen formulation may both affect the result, with dental impaction models and soluble ibuprofen salts producing better efficacy estimates. Adverse events were uncommon, and not different from placebo.
Authors' conclusions
The very substantial amount of high quality evidence demonstrates that ibuprofen is an effective analgesic in treating postoperative pain. NNTs for 200 mg and 400 mg ibuprofen did not change significantly from the previous review even when a substantial amount of new information was added. New information is provided on remedication.
Administration, Oral; Analgesics, Non-Narcotic [* administration & dosage; adverse effects]; Ibuprofen [* administration & dosage; adverse effects]; Pain, Postoperative [* drug therapy]; Randomized Controlled Trials as Topic; Adult; Humans
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Combined isosorbide dinitrate and ibuprofen as a novel therapy for muscular dystrophies: evidence from Phase I studies in healthy volunteers
Cossu, Maria Vittoria
Cattaneo, Dario
Fucile, Serena
Pellegrino, Paolo
Baldelli, Sara
Cozzi, Valeria
Capetti, Amedeo
Clementi, Emilio
Drug Design, Development and Therapy
We designed two Phase I studies that assessed healthy volunteers in order to evaluate the safety and to optimize the dosing of the combination of the drugs isosorbide dinitrate, a nitric oxide donor, and ibuprofen, a nonsteroidal antiinflammatory drug. We designed these studies with the aim of designing a Phase II trial to evaluate the drugs' efficacy in patients affected by Duchenne muscular dystrophy. For the first trial, ISOFEN1, a single-dose, randomized-sequence, open-label, active control, three-treatment cross-over study, was aimed at comparing the pharmacokinetics of ibuprofen 200 mg and isosorbide dinitrate 20 mg when given alone and concomitantly. The pharmacokinetics of ibuprofen given alone versus ibuprofen given concomitantly with isosorbide dinitrate were similar, as documented by the lack of statistically significant differences in the main drug's pharmacokinetic parameters (time to maximal concentration [Tmax], maximal concentration [Cmax], area under the curve [AUC]0–t, and AUC0–∞). Similarly, we found that the coadministration of ibuprofen did not significantly affect the pharmacokinetics of isosorbide dinitrate. No issues of safety were detected. The second trial, ISOFEN2, was a single-site, dose titration study that was designed to select the maximum tolerated dose for isosorbide dinitrate when coadministered with ibuprofen. Eighteen out of the 19 enrolled subjects tolerated the treatment well, and they completed the study at the highest dose of isosorbide dinitrate applied (80 mg/day). One subject voluntarily decided to reduce the dose of isosorbide dinitrate from 80 mg to 60 mg. The treatment-related adverse events recorded during the study were, for the large majority, episodes of headache that remitted spontaneously in 0.5–1 hour – a known side effect of isosorbide dinitrate. These studies demonstrate that the combination of isosorbide dinitrate and ibuprofen does not lead to pharmacokinetic interactions between the two drugs; they also demonstrate that the combination of isosorbide dinitrate and ibuprofen has optimal tolerability and safety profiles that are similar to those previously reported for isosorbide dinitrate and ibuprofen given alone.
coadministration; pharmacokinetic profile; adverse events; ibuprofen; isosorbide dinitrate
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Randomized comparative trial of efficacy of paracetamol, ibuprofen and paracetamol-ibuprofen combination for treatment of febrile children
Vyas, Falgun Indravadan
Rana, Devang Ashwinkumar
Patel, Piyush M.
Patel, Varsha Jitendra
Bhavsar, Rekha H.
Perspectives in Clinical Research
Paracetamol and ibuprofen are widely used for fever in children as monotherapy and as combined therapy. None of the treatments is proven clearly superior to others. Hence, the study was planned to compare the efficacy of paracetamol, ibuprofen and paracetamol-ibuprofen combination for treatment of febrile children.
Materials and Methods:
This was an investigator blind, randomized, comparative, parallel clinical trial conducted in 99 febrile children, 6 months to 12 years of age, allocated to three groups. First group received paracetamol 15 mg/kg, second group received ibuprofen 10 mg/kg and third group received both paracetamol and ibuprofen, all as a single dose by the oral route. Patients were followed-up at intervals of 1, 2, 3 and 4 h post dose by tympanic thermometry.
Mean tympanic temperature after 4 h of drug administration was significantly lower in the combination group compared with paracetamol group (P < 0.05); however, the difference was not clinically significant (<1°C). The rate of fall of temperature was highest in the combination group. Number of afebrile children any time post dose until 4 h was highest in the combination group. Difference between combination and paracetamol was significant for the 1st h (P = 0.04). Highest fall of temperature was noted in the 1st h of drug administration in all the groups. No serious adverse events were observed in any of the groups.
Paracetamol and ibuprofen combination caused quicker temperature reduction than either paracetamol or ibuprofen alone. If quicker reduction of body temperature is the desired goal of therapy, the use of combination of paracetamol + ibuprofen may be advocated.
Children; combination therapy; fever; ibuprofen; paracetamol
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Double-Blind Randomized Trials of Single-Tablet Ibuprofen/High-Dose Famotidine vs. Ibuprofen Alone for Reduction of Gastric and Duodenal Ulcers
Laine, Loren
Kivitz, Alan J
Bello, Alfonso E
Grahn, Amy Y
Schiff, Michael H
Taha, Ali S
The American Journal of Gastroenterology
We performed two 24-week double-blind trials (REDUCE-1 and -2 (Registration Endoscopic Studies to Determine Ulcer Formation of HZT-501 Compared with Ibuprofen: Efficacy and Safety Studies)) to assess whether double-dose famotidine given in a single-tablet combination with ibuprofen (HZT-501) significantly reduces gastric and duodenal ulcers as compared with ibuprofen.
Patients (40–80 years) requiring daily non-steroidal anti-inflammatory drugs (NSAIDs) for ≥6 months with no prior ulcer complications, negative H. pylori stool test, and baseline endoscopy showing no ulcers and <5 erosions were randomly assigned in a 2:1 ratio to HZT-501 or identical-appearing ibuprofen 800 mg tablets thrice daily. Study endoscopies were done at 8, 16, and 24 weeks. After unblinding and initial analyses, 12 patients were found to be misclassified as having gastric ulcers based on the adjudication of endoscopy reports, and analyses were re-run.
In REDUCE-1, the primary end point analysis of gastric ulcers at 24 weeks with HZT-501 vs. ibuprofen was 12.7% vs. 22.9% (P=0.0044) in the post-adjudication analysis. In REDUCE-2, the primary end point analysis of upper gastrointestinal (GI) ulcers was 13.0% vs. 20.5% (P=0.0587) in the post-adjudication analysis. Prespecified pooled analyses showed significantly fewer gastric (12.5% vs. 20.7%) and duodenal ulcers (1.1% vs. 5.1%) with HZT-501 vs. ibuprofen. Proportional hazards analysis of multiple potential risk factors showed the risk ratio of upper GI ulcers with HZT-501 vs. ibuprofen was 0.46, 95% confidence interval was 0.34–0.61.
Combined results of the REDUCE studies indicate that double-dose famotidine plus ibuprofen, given as a combination tablet, decreases endoscopic upper GI ulcers as compared with ibuprofen alone.
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PMC Canada
PubMed Central Canada is a service of the
Canadian Institutes of Health Research
(CIHR) working in partnership with the National Research Council's
Canada Institute for Scientific and Technical Information
in cooperation with the
National Center for Biotechnology Information
at the
U.S. National Library of Medicine
(NCBI/NLM). It includes content provided to the
PubMed Central International archive
by participating publishers.


text:
Accepting new patients
Accepting new patients
Pines Lake Commercial Center
10796 Pines Blvd
Ste 203
Pembroke Pines, FL 33026 Phone number & directions
10796 Pines Blvd
Ste 203
Pembroke Pines, FL 33026 Phone number & directions
License & Identifications
A medical license is required for a doctor to practice medicine in a particular state. Requirements vary by state but most require, at a minimum, post-graduate training in the doctor's specific specialty. An NPI number is a national identifier unique to an individual health care provider and is managed by the Center for Medicare & Medicaid Services (CMS).
Learn more about Dr. Jose Perez:
View the full profile to get information on:
- Qualifications
- What's important to you
View full profile
Patient Reviews
Have you visited Dr. Perez? Share your experience.
Write a Review
Write a Review
Specialties & Research
- He has special expertise in 1 area:
- Dental Implants
Education & Awards
Dr. Perez graduated from Boston University .
- Spanish
Home > Find a Dentist > FL > Pembroke Pines Dentists > Dr. Jose Perez, DDS, DMD, MSD
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- Additional Information
- Dr. Jose Ricardo Perez DDS, DMD, and MSD is a male dentist and practices in Periodontics.
- Where does Dr. Jose R. Perez practice?
- Dr. Jose Perez has 12 office locations.
Dr. Jose Perez practices Periodontics near Pembroke Pines, FL.
Additional practice locations include: Coral Springs, FL and Sunrise, FL.
See Pembroke Pines Dentists.

subset: commoncrawl


text:
Interactive Seating Charts
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a seating chart for Highmark Stadium.
Highmark Stadium510 West Station Square Drive
Pittsburgh, PA 15219
Upcoming Events
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text:
Oregon ahead of federal law
|| Print |
|High Five
|Tuesday, March 23, 2010
Sen. Laurie Monnes Anderson says Oregon had a head start on the recently passed federal bill, thanks to the state's health-care efforts that were already under way.
Oregon had already begun expanding health care to 80,000 more children, for example, so the federal health-care reform will continue to build on that.
The same state legislation also ensured that under the Oregon Health Plan, 25,000 low-income adults would continue to get coverage, and as many as 35,000 more will be added by 2011.
The federal legislation will expand eligibility for this coverage even more under Medicaid, the joint federal-state program of health insurance for low-income people.
Read the full story at the Statesman Journal.
{biztweet}Oregon health care{/biztweet}
|100 Best Green Workplaces in Oregon
|The Green Paradox
|Frothy Battle
|Eco Zoned
|Up in the Air
|Credit Unions Perspective
|Queen of Resilience
|Did airlines collude to keep fares high?
|Citigroup analyst thinks Puma should sell
|OSU researchers examine warm-water mass
|Appeals court rules against Apple
|Microsoft to cut division, 1,200 jobs
|Apple suppliers introduce 'Force Touch' to new iPhone
|Uncertainty abound in Greece
Tonkon Torp helps seed sustainability at Gunderson.
Oregon-based Environments helps companies create inspired workspaces. "Simply put, we help companies future-proof their workspaces," says Chris Corrado, president. Since 1988,Environments has witnessed firsthand the changing landscape of business. Native Portlander and Environments founder Corrado says, "We help our clients navigate the complex realities of the workplace today and plan for their future in a very mindful, strategic way. We think of ourselves as their partners in the process."
One hundred years ago, the Willamette River might easily have been mistaken for a sewer. Unchecked industrial activity and decades of pollution made it unrecognizable compared to the clean river that now flows north for 187 miles from Eugene through the center of Portland.
3 Degrees Event Celebrates 5th Year Bringing Nonprofit and Business Professionals Together to Benefit Portland.
Bend energy leader brings passion for efficiency and renewable energy to the nonprofit.
Event in Forest Grove marks recognition of Global Food Safety Initiative Certification.


text:
Please read (link), and continue to report images that break our underage rules.
Anonymous1: Pow! Right in the kisser!
Anonymous2: uh, no the eye not the "kisser"
Anonymous3: santa's eye brows!
Anonymous4: who cares, shes hot
Anonymous5: REALLY HOT!!!!
Anonymous6: What a babe!
Anonymous7: Let me cum all in your eyebrows IT"S MY FETISH :B


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Faculty Senate Overview November 2011
The Faculty Senate is part of UofL's shared governance system, which also includes the Staff Senate and the Student Government Association. Senators are elected by their peers. The full body met in regular session Nov. 2 at the School of Dentistry.
Chair Bob Staat presided. This is what happened:
The senate had its first reading of School of Dentistry bylaw changes. A PDF is at louisville.edu/facultysenate/documents/ulsd%20bylaws%209-7-11.pdf/
Reports to the Senate
Edward Halperin, dean, School of Medicine
Halperin's talk on the proposed hospital merger was a follow-up to a presentation in September from President James Ramsey and David Dunn, executive vice president for health affairs. Halperin was unable to be at that meeting. Here are some of his points:
- If merger doesn't take place, trauma care, the James Graham Brown Cancer Center and indigent care are in jeopardy.
- Merger is a national trend.
- The Catholic Church will have no say on medical school curriculum content – no matter its form or where it is delivered.
- In the issues of reproductive health care and end of life, the only thing that will change is tubal ligations that are scheduled to be performed after a Caesarian section delivery. The way in which those will change is in keeping with established practice. Patients will go to Baptist Hospital rather than University Hospital. UofL doctors have had practicing privileges at Baptist since 2001. That agreement recently was extended.
- Doctors typically have admitting privileges at more than one hospital.
- University Hospital will pay transportation costs to Baptist Hospital for indigent patients who cannot afford to get there on their own.
President James Ramsey
Here are some of his points:
- Budget news from Frankfort is mixed good and bad. There is a surplus this year, but growth isn't projected to continue at its current pace.
- UofL wants to see the Big East conference be successful and is trying to do all it can to keep the Big East strong.
- Charting Our Course campaign first quarter for fiscal year 2011-12 is not quite where he'd like it to be, but that should turn around if possible major gifts come through. Development and the president are looking for ways to maximize gifts through some sort of matching program similar to the Research Challenge Trust Fund (Bucks for Brains).
- The hospital merger is awaiting Gov. Steve Beshear's approval.
Shirley Willihnganz, executive vice president and university provost
Among her points:
- Beth Boehm is moving to the post of vice provost for graduate affairs in light of Bill Pierce's recent appointment to the post of executive vice president for research and innovation. She also is serving as interim dean for the School of Interdisciplinary and Graduate Studies.
- Other changes in her staff will be coming and she hopes to have them in place by the first of the year.
- Students' efforts to work with administration to implement a university-wide grading scale that gives them credit for earning an A+ has stalled because of various unit differences.
- Their work has brought to light larger issues with the way UofL develops university-wide policies.
- The provost is committed to a collegial system of governance in which all voices – faculty, student and administrators – are heard in such efforts.
- She is looking for a system that will allow that to happen without bogging down from the complexity of the process.
The Senate will meet again Wednesday, Dec. 7 in Chao Auditorium, Ekstrom Library.
Prepared for the Faculty Senate by Janene Zaccone, internal communications manager.


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Original recipe yields 8 servings
Amount per serving ({{servings}} total)
Based on a 2,000 calorie diet
Ready In
This recipe was a good starting point, but I had to make several major adjustments to achieve something that was suitably "borscht-like" for my tastes. I used two beets rather than one (and nex...
I've never had borscht before, so I don't know how authentic this recipe is. I just made this to use up some beets--which, frankly, I don't even like much. This recipe, though, is INCREDIBLY ...
Great recipe, but thicker than authentic borscht I've had in Ukraine and Russia. Things I did just a bit differently... I used two beets with the stock (peeled) and when I removed them, I di...


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- The Big Picture: What's AAP
- A year later, the tweak: Desh to Dilli
- Bus from Burari laden with volunteers and hope
- Rare day out for AAP families
- Riot of support for AAP in communal hot spots
- Hunt on for CM house, will not accept Z-plus security
- No word from high command, Delhi Congress in a paralysis
- Latest News
- Second time at Ramlila Maidan: Hope overrides their doubts
- Kejriwal has no portfolio, will keep an eye on others
- In sea of white caps, BJP troika plans to be 'forceful opposition'
- MP, MLA see Punjab as the next AAP stop
- A year later, the tweak: Desh to Dilli
- Arvind Kejriwal repeats his advice to sting the corrupt, asks police to act against 'goondagardi'
- Proud that one of our volunteers has become Delhi CM: Anna Hazare
- Arvind Kejriwal not to keep any portfolio
- Now an Aam Aadmi Party Cola by beverage-maker inspired by Arvind Kejriwal's party
- New chief minister Arvind Kejriwal holds meetings at Delhi Secretariat
- Cong's Ajay Maken blames Sheila Dikshit for Delhi polls debacle
- Left, right, AAP
Political volunteers stream in ahead of high-profile battle in Varanasi
As political temperature hots up in this ancient temple town for the blockbuster fight, large number of volunteers of all three major players –Congress, BJP and Aam Aadmi Party– have streamed into the city from across the country to add muscle to the campaign of their candidates.
Scores of AAP volunteers have been running an aggressive door-to-door campaign for last one month but now a sizeable number of Congress and BJP workers from various states have joined their local counterparts in the battle of ideologies.
BJP's Prime Ministerial candidate Narendra Modi is facing challenges from AAP's Arvind Kejriwal and Congress' Ajay Rai, a Varanasi local and the MLA from nearby Pindra assembly seat.
With just two days left for campaigning to end, Congress and BJP workers have been arriving here in hordes by train and bus to ensure victory of their respective candidates. Polling here will take place on Monday.
"I have come here to campaign for Modiji as the country needs his leadership. I came on my own and have been campaigning here for last four days," said Ramesh Srivastava, a BJP worker from Bhopal.
Wearing a T-shirt bearing Modi's image, Srivastava said he has taken 15-days leave from his employer to campaign for the BJP's Prime Ministerial candidate. He said scores of BJP supporters from Madhya Pradesh have been campaigning here for Modi. As Congress campaign witnessed a fresh enthusiasm in the last few days, a large number of party supporters have arrived here to canvass for Rai, who has termed the fight as being one between a "son of soil and outsiders".
"We have been Congress supporters for last so many decades. I know Congress has not been able to live up to expectations. But still the party has never tried to divide the country on religious lines. I have come here on my own to campaign for Ajay Rai," said 60-year-old Imam Chayani, a native of Rajkot in Gujarat.
Draped with the Congress flag around his body and holding the national flag, Chayani has been visiting various Muslim dominated areas on the outskirts of Varanasi, asking people to vote for Rai. Varanasi has around three lakh Muslim voters who may play a vital role in the election.
His campaign colleague Atshe Lal, hailing from Jhanshi, said he was very agitated against Modi after hearing the campaign punch-line 'Har har Modi, Ghar Ghar Modi' and decided to come to Varanasi on his own to garner support for Congress. "I came here five days back and have been campaigning for the Congress. I go out in the morning and come back in the evening to party office here where I spend the nights. This is a fight between contrasting ideologies and that inspired me to come here," said Lal.
A large number of Congress workers, including Youth Congress …continued »


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Results 1 to 11 of 11
Thread: Pikpiak's ashcan
May 28th, 2012 #1
Pikpiak's ashcan
Hi, thanks for checking me out.
I'll use this sketchbook thread to motivate myself to do more digital paintings, and hopefully, see some improvement as I go. It's always awesome seeing the big jump in skills, when you see the first page and the last page of everyone's sketchbook.
Been looking at books like Gurney's Color and Light to learn more, regretted not taking my fundamental years seriously back in school haha.
Please feel free to critique ( or scold me if I haven't been updating the thread, I'd set a daily notification. )
- Similar Threads
- Art: graphic novel ashcan (large dl)
Hide this ad by registering as a memberMay 28th, 2012 #2
Great start to a sketchbook. Bring on more!
*New Sketchbook* Come stop by :3
I am currently looking for a mentor to help me improve my sketch book. Either that or lots of crits and suggestions to help me improve my skills.
The Following User Says Thank You to Newman101 For This Useful Post:
May 29th, 2012 #3
Thanks newman, I'll try to keep 1 up everyday
Here's yesterday's.
June 17th, 2012 #4
CHOW flame guardian attempt
A hecatonchire conjured by the smokes of the flame, guarding the flame by asphyxiating any intruders.
July 9th, 2012 #5
Old lady sketch
Trying out a pencil brush in photoshop, along with some tones for practice.
Been in a whirl between coding games/illustrations recently...
July 9th, 2012 #6
I like that onion.
The Following User Says Thank You to catukas For This Useful Post:
July 15th, 2012 #7
Another short practice
@catukas, thanks. Im quite happy of that onion too haha.
Short reference practice with a piece from Rockwell's. Couldn't really nail the neutrals and the mixing : (
July 20th, 2012 #8
Oh wait, there's Batman this weekend!
August 21st, 2012 #9
August Stash
Some quick practices from August ( even though it's not ended yet ).
August 21st, 2012 #10Registered User
- Join Date
- Aug 2012
- Posts
- 5
- Thanks
- 0
- Thanked 0 Times in 0 Posts
Been in a whirl between coding games/illustrations recently...
August 30th, 2012 #11
Force Practice
Some quick silhouettes on form and function from the book, Force.


text:
349 South Euclid Avenue
Commute to Downtown Pasadena
Most errands can be accomplished on foot.
Flat as a pancake, excellent bike lanes.
Score Details
349 South Euclid Avenue has a Walk Score of 86 out of 100. This location is Very Walkable so most errands can be accomplished on foot.
This location is in the South neighborhood in Pasadena. Nearby parks include Central Park, Old Pasadena Historic District and Pasadena Memorial Park.
Explore how far you can travel by car, bus, bike and foot from 349 South Euclid Avenue.
Rail lines:
Metro Gold Line (804)
0.3 mi
Bus lines:
267/264 Metro Local Line
0.1 mi
177 Metro Local Line
0.3 mi
256 Metro Local Line
0.3 mi
687/686 Metro Local Line
0.3 mi
180/181 Metro Local Line
0.4 mi
780 Metro Rapid Line
0.4 mi
Car shares:
Bike shares:
View all South apartments on a map.
Popular apartment searches include pool, hardwood floor and fireplace.
Find a Pasadena real estate agent who knows walkable neighborhoods. Links will open on our partner site Redfin.com.
349 South Euclid Avenue is in the South neighborhood. South is the 2nd most walkable neighborhood in Pasadena with a neighborhood Walk Score of 76.


text:
The supply of housing inventory exceeds demand. Buyers have the advantage over sellers due to the abundance of homes on the market, with homes often selling at reduced prices. Price drops are common as sellers compete to find buyers.
Rental property is in high demand and availability is low. Rent prices have decreased by 2% over the past 3 months. This is 165% lower than the state average of $4,482 and 41% lower than the country average of $2,388.
Trend data coming soon.
|For Sale: 370
|New: 73
|Recently Sold: 487
|Reduced: 123
|Average Home Price
|Average Sold Price
|Property Records: 19,917
|Foreclosed: 5
The average home price in 93536 is $227,129, which is 16.3% lower than the average sold price in 93536 ($271,284) . The average home price per square foot in 93536 is $99 and about 2% of all homes in 93536 sold in the last 6 months. For 93536 home values, real estate prices, and city market trends, research the 19,917 property records or search our 487 recently sold or 370 homes for sale listings. The listings and properties in 93536 are only a part of the 9,092,375 properties and 153,970 homes for sale in California. Because of this, the average home price and average home value of 93536 also influence the average home price $361,123 and average sale price $581,732 of California. Listing counts, 93536 home prices and home values in 93536 are sourced daily from listing and property data on realtor.com®, which is the most up-to-date and accurate aggregation of real estate listings in the industry and includes approximately 800 regional MLSs and is the official website of the National Association of Realtors®.
|Median Age
|Median Household Income


text:
System requirements
You can use Volgistics from any computer, anywhere, as long as it has an Internet connection and any popular web browser, including Internet Explorer, FireFox, Safari, and Chrome.
Any of these popular web browsers
Internet connection
You can use Volgistics from computers with any kind of Internet connection, including dial-up connections, wireless connections, and America Online. If you plan to use Volgistics regularly from a particular location (such as your office), a 'broadband' or high-speed connection such as DSL, cable modem, or T1 is recommended for that computer.
Browser settings
If you plan to use the VicTouch option, read about the VicTouch system requirements.


text:
New User:
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Stock Market & Financial Investment News
News Breaks
July 30, 2014
Exterran Partners increases cash dividend 0.5c to 54.25c
Exterran Partners announced a cash distribution of 54.25 per limited partner unit, or $2.17 per limited partner unit on an annualized basis, payable on August 14 to unitholders of record at the close of business on August 11. The distribution to be paid in August is 0.5c higher than the Q1 distribution of 53.75c per limited partner unit and 2c higher than the 2Q13 distribution of 52.25c per limited partner unit.
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June 24, 2015
Credit Suisse to hold a conference
2015 MLP & Energy Logistics Conference is being held in New York on June 23-24 with webcasted company presentations to begin on June 24 at 8 am; not all company presentations may be webcasted.
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text:
Candia voters to deliberate on $2.4M plan
CANDIA — The town's deliberative session will be held at 9 a.m. Saturday at the Henry W. Moore School where town officials will present proposed warrant articles including the town's roughly $2.4 million budget proposal for next year.
Unlike many towns also holding deliberative sessions this weekend, including Auburn and Allenstown, Candia officials say they have not yet prepared what the tax impacts of the warrant articles would be and that they may not have the impacts ready in time for the deliberative session.
"I am still working on the information that I have to get to the selectmen, so I am not sure if the tax impacts will be ready," said administrative assistant Donna Becker.
Candia does not have a town administrator. Becker said she performs accounting work for the town.
During the deliberative session, residents will be presented with the proposed $2,377,975 town budget for next year. If residents don't pass the budget in March, the default budget of $2,369,061 would kick in.
Other big-ticket items being presented include a warrant article submitted by the road agent asking for $150,000 to resurface portions of Lane, Green and Depot roads. Both the selectmen and the Budget Committee recommended the money be allocated.
The Smyth Public Library Trustees have put forward a warrant article asking for $133,880 for operating expenses.
The town seeks $75,000 for excess winter road maintenance with the stipulation that the funds won't be used unless the winter budget is depleted, and $50,000 for the Apparatus Capital Reserve fund, which is used for the purchase of fire apparatus and equipment. To help pay for future property reevaluations, $20,000 is being asked for the Revaluation Capital Reserve Fund.
There are also two citizens petitions asking for $17,500 for the Candia Youth Athletic Association, which is recommended by the Budget Committee but not by the Board of Selectmen, and $37,000 for implementing a mosquito control program. The Budget Committee opposed the allocation.
Contact Information
The Hooksett Banner
100 William Loeb Drive
Manchester, NH 03109
Neighborhood News publications can be found at a newsstand near you here.
Ph: 603-206-7800
Fax: 603-206-7801
News, Obituaries, Sports & Social Announcements
Thomas Caldwell, Editor
Ph: 603-206-7817
Email ads to email@example.com
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Display advertising: 603-668-4321
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Calendar Listings
Please use our online form at www.nh365.org
Press Releases
NH Conservation K9 Sig Up for 'Top Dog' Award - Vote Today
Nickelback Cancels North American Dates for 2015 "No Fixed Address Tour
Loeb School offers Writing Newsletters Workshop July 24
Tommy Castro and the Painkillers to perform in Londonderry
Loeb School Seeks 1st Amendment Award Nominees
Most Read
Roadside history Uncle Sam's House, Mason
New Boston July 4th parade full of tradition
Rainbow girls: Empowering others to be great


text:
Play Video
Cheaters Caught - Damage Proficiency Glitch - MW3
Posted by DmagnusV on Jan. 19, 2012
Break celebrates 4th of July the American Way: by laying the smack down on ...
With the 4th of July around the corner, we celebrate the most kick-ass USA ...
Dude, are you drunk AND high? Or are you just being PRANKED?!
Posted by DmagnusV on Jan. 19, 2012


text: What happened in this book will change what you think of the criminal justice system in this country. Each of [the authors] tells an extraordinary story about crime . . . but it's their shared spiritual journey toward reconciliation and forgiveness that is even more compelling and profound.--Barry C. Scheck.Edition/Copyright: 10


text:
Catalogue Number: 480-8502
- LCD screen recognises 30 learning tokens
- Robot's body spins around & sound sensor reacts to clapping
- Includes 26 letters/object tokens & 4 funny tokens
Buy on Tesco Direct from:
Earn 34 Clubcard points
3 more buying option(s) from:
3 more buying option(s) available.
Do you want us to email you when this product is back in stock?
Product Details
Meet the VTech® Interactive robot who can help your little one develop all-important skills in identifying letters, numbers and objects, along with developing musical skills and more. His LCD screen recognises 30 learning tokens and he has a sound sensor that reacts to clapping.
This fun robot's body spins around and his ears, eyes, arms and eyebrows move. He comes with 26 letters/object tokens and 4 funny tokens. Batteries included.
Product specifications
Product specifications
Key Information
|Appropriate Age Warning
|Not suitable for children under 36 months
|Age Range
|3 years to 5 years
|Batteries Included
|Battery Type
|Number Of Batteries Required
|4 4
|Power Source
|Electronic Features
Additional Information
|What"s in the Box
|1 x Gadget the Robot,1 x Backpack,26 x Letter chips,4 x Special chips,1 x User manual
|Product Height
|308.0 Centimetre
|Product Width
|226.0 Centimetre
|Product Depth
|135.0 Centimetre
|Product Weight
|1057.0 Kilogram
|Assembled Height
|381.0 Centimetre
|Assembled Width
|381.0 Centimetre
|Assembled Depth
|150.0 Centimetre
|Assembled Weight
|2.13 Kilogram


text:
Best Tamala Jones Movies
List Criteria: Vote for your favorite
List of the best Tamala Jones movies, ranked best to worst with movie trailers when available. Tamala Jones's highest grossing movies have received a lot of accolades over the years, earning millions upon millions around the world. The order of these top Tamala Jones movies is decided by how many votes they receive, so only highly rated Tamala Jones movies will be at the top of the list. Tamala Jones has been in a lot of films, so people often debate each other over what the greatest Tamala Jones movie of all time is. If you and a friend are arguing about this then use this list of the most entertaining Tamala Jones films to end the squabble once and for all.
If you think the best Tamala Jones role isn't at the top, then upvote it so it has the chance to become number one. The greatest Tamala Jones performances didn't necessarily come from the best movies, but in most cases they go hand in hand.
List features films like Who's Your Caddy? and Show Stoppers.
"This list answers the questions, "What are the best Tamala Jones movies?" and "What are the greatest Tamala Jones roles of all time?"
If you're a fan of Tamala Jones, then check out our lists of the best Molly C. Quinn and Stana Katic movies as well.
- 1+ 6- 0
Up in the Air George Clooney, Anna Kendrick, Jason Bateman
- 2+ 7- 1
Next Friday Ice Cube, Chris Tucker, Michael Rapaport
- 3+ 4- 0
The Brothers Gabrielle Union, Julie Benz, Shemar Moore
- 4+ 4- 0
Head of State Chris Rock, Bernie Mac, Tracy Morgan
- 5+ 5- 1
The Wood Christina Milian, Taye Diggs, Sanaa Lathan
- 6+ 3- 0
Booty Call Jamie Foxx, Vivica A. Fox, Bernie Mac
- 7+ 3- 0
Daddy Day Camp Cuba Gooding, Jr., Tamala Jones, Brian Doyle-Murray
- 8+ 4- 1
Two Can Play That Game Gabrielle Union, Vivica A. Fox, Bobby Brown
- 9+ 3- 1
Blue Streak Martin Lawrence, Dave Chappelle, Octavia Spencer
- 10+ 3- 1
Kingdom Come Whoopi Goldberg, LL Cool J, Jada Pinkett Smith
- 11+ 3- 1
Urban Legends: Bloody Mary Kate Mara, Rooney Mara, Tamala Jones
- 12+ 1- 0
Turn It Up Jason Statham, Ja Rule, Patricia Velásquez
- 13+ 1- 0
The Ladies Man Julianne Moore, Will Ferrell, Tiffani Thiessen
- 14+ 1- 0
Nora's Hair Salon Lil' Kim, Bobby Brown, Tatyana Ali
- 15+ 2- 1
Who's Your Caddy? Lil Wayne, Jeffrey Jones, Sherri Shepherd
- 16+ 2- 1
Janky Promoters Ice Cube, Young Jeezy, Mike Epps
- 17+ 0- 0
Little Richard Tamala Jones, Garrett Morris, Jenifer Lewis
- 18+ 0- 0
Megafault Brittany Murphy, Justin Hartley, Tamala Jones
- 19+ 0- 0
Long Distance Monica Keena, Tamala Jones, Kevin Chapman
- 20+ 0- 0
The American Dream Tamala Jones, Clifton Powell, Mike Jones
- 21+ 0- 0
What Love Is Cuba Gooding, Jr., Gina Gershon, Anne Heche
- 22+ 0- 0
Show Stoppers Tamala Jones, Clifton Powell, Bryce Wilson
- 23+ 0- 0
How to Kill Your Neighbor's Dog Robin Wright, Kenneth Branagh, Jared Harris
- 24+ 0- 0
35 and Ticking Meagan Good, Kevin Hart, Mike Epps