Tom P. Barden

Comparative efficacy of ibuprofen and aspirin in episiotomy pain.

Substitutes for aspirin devoid of troublesome effects are needed. A potential candidate, ibuprofen, heretofore marketed outside the United States as an antiarthritic, was compared in single oral doses of 300 and 900 mg with aspirin, 900 mg, and placebo in a parallel balanced randomized double‐blind design in 80 patients with pain due to episiotomy. Over the 6 hours of evaluation, there was pain reduction greater than 50 per cent in 17 of 20 patients treated with either dose of ibuprofen (p < 0.01), in 18 of 20 patients treated with aspirin (p < 0.001), and in only 6 of 20 patients treated with placebo. With the two doses of ibuprofen, pain relief, as measured by pain intensity differences (PID) was similar to that with aspirin with respect to time of onset, degree and duration of analgesia. Reported side effects with ibuprofen were insignificant.

Clinical experience with one hundred seven diabetic pregnancies

Clinical experience with 45 pregnancies in women with Class A diabetes and 62 pregnancies in women with insulin-requiring diabetes is described. The perinatal mortality rates were 0, 16.1, and 9.3, respectively, among the Class A, insulin-requiring, and total diabetic populations. Diabetic mothers experienced significantly higher prevalences of cesarean section and ketoacidosis than did the overall population. There were no other significant differences in maternal complications. Diabetic mothers demonstrated high rates of abnormal estriol levels and relatively low rates of positive contraction stress tests. Positive contraction stress tests were highly correlated with abnormal outcome. Delivery occurred either at or after 37 weeks in 93% of the Class A and in 81% of the insulin-requiring women. In comparison to infants in the general population, those of diabetic mothers experienced significantly elevated rates of being large for gestational age, macrosomia, and hypoglycemia. Congenital abnormalities were significantly higher in the Class A, but not in the insulin-requiring population. Neonatal morbidity could not be related to maternal diabetic control and was only minimally related to gestational age.

Clinical experience with a screening program for gestational diabetes

Screening for abnormal glucose metabolism was carried out in 2,077 pregnant women. Historical or clinical risk factors for gestational diabetes were present in 959 women (group 1). The remaining 1,118 patients composed group 2. A 50 gm oral glucose load and a 1-hour serum glucose determination with a threshold of 150 mg/dl were used as a glucose challenge screening test (GCT). Patients with an abnormal GCT underwent an oral glucose tolerance test (GTT). Group 1 patients underwent screening at the initial clinic visit or when the clinical risk factor was first recognized, with repeat screening at 28 to 32 weeks if the initial testing was normal. Group 2 patients were screened at 28 to 32 weeks. In group 1, 69 patients (7.2%) exhibited an abnormal GCT and 14 (1.5%) demonstrated an abnormal GTT. In group 2, 68 patients (6.1%) exhibited an abnormal GCT and 16 (1.4%) demonstrated an abnormal GTT. These incidences are not statistically different. The estimated costs per patient screened and per case of gestational diabetes detected were

Naproxen, aspirin, and codeine in postpartum uterine pain

4.75 and

Aspirin and codeine in two postpartum pain models

328.96, respectively.

Effect of ritodrine on human uterine motility and cardiovascular responses in term labor and the early postpartum state.

The analgesic efficacy of oral naproxen and its sodium saft was compared with that of aspirin and codeine in two separate trials involving 140 and 90 patients, respectively, with postpartum uterine pain in a single‐dose, parallel, stratified, randomized, placebo‐controlled, double‐blind design. With 300 or 600 mg naproxen and with 275 mg naproxen sodium, significant analgesia, measured subjectively by pain intensity differences (PID), was prolonged at least 7 or 8 hr; onset tended to be delayed 2 hr or more. With 650 mg aspirin analgesia began within 1 hr and continued until the fifth hour, while with 60 mg codeine responses were indistinguishable fram placebo responses throughout the 8‐hr time course. Although time‐effect patterns with naproxen sodium and aspirin were different, summed analgesic effects (SPID) showed equal efficacy and superiority over placebo (p < 0.005). With each of the 2 doses of naproxen, SPID separation from placebo was comparable to that above (p < 0.02 and 0.005, respectively), but analgesic dose response, though measurable, was not significant. Side effects were not significant with any of the treatments. It appears that naproxen and naproxen sodium are analgesics with efficacy equal to aspirin and may prove to be rational substitutes for currently available analgesics in some painful states in which longer pain relief would be desireable.

Newborn brain stem auditory evoked responses and perinatal clinical events

Aspirin and codeine, standard reference analgesics, are frequently used as positive controls in clinical trials of new oral analgesics. In randomized parallel double‐blind studies, single doses of aspirin and codeine were compared with placebo in episiotomy pain (99 patients) and in postpartum uterine pain (130 patients), common models in analgesic trials. With aspirin, 600 and 1,200 mg, in episiotomy pain, analgesia as measured by pain intensity difference (PID) scores began within 1 hr, peaked at the second hour (p < 0.01), and continued to the fifth hour (p < 0.01). In uterine pain, responses with aspirin, 650 mg, were observed to be equally good. With codeine, 60 mg, in episiotomy pain measurable analgesia was present by the second hour and was significant at the fourth hour (p < 0.05); in uterine pain, responses were indistinguishable from placebo throughout an 8‐hr time‐course. Codeine seemed ineffective and therefore unacceptable as a positive control in uterine pain. These data imply that the two postpartum pain models are qualitatively different: episiotomy pain seems sensitive to both aspirin alld codeine, while uterine pain appears sensitive to aspirin but not to codeine.

Nefopam and propoxyphene in episiotomy pain.

Abstract The uterine and cardiovascular responses to ritodrine hydrochloride were studied in 16 patients immediately post partum and in 17 patients during term labor. Data of electronic monitoring of maternal and fetal responses to ritodrine, in contrast to those of the control series of patients, were subjected to statistical analysis. Ritodrine is an effective uterine inhibitor with minimal cardiovascular activity, except for maternal tachycardia, and is a promising compound for treatment of unwanted uterine activity.

Influence of steroids on human myometrial contractility and myometrial response to catecholamines

The technique of brain stem auditory evoked electroencephalographic response testing was applied to 61 newborn infants in an attempt to study the potential influence of perinatal risk factors for hearing impairment and/or asphyxial brain damage. The results, althoug not conclusive, indicate that birth asphyxia and/or low birth weight may be associated with shortened latencies of evoked potentials. An efferent mechanism may account for this phenomenon.

Metkephamid and meperidine analgesia after episiotomy

To evaluate relative efficacy, safety, and time course of analgesia, nefopam (45 and 90 mg), a new centrally acting nonnarcotic analgesic, was compared with propoxyphene (65 mg) and placebo in a single oral dose, parallel, stratified, randomized, double‐blind trial with 100 hospitalized postpartum women with medium or severe episiotomy pain. Using subjective reports as indices of response, patients rated pain intensity and side effects at periodic interviews for 6 hr. After 45 and 90 mg nefopam, 21 of 25 and 20 of 25 patients (p < 0.01) reported more than 50% reduction of pain, whereas after 65 mg propoxyphene 18 of 25 (p < 0.05) and after placebo 11 of 25 reported reduction in pain. Relative efficacy, based on summed pain intensity differences, showed measurable but modest dose‐dependent analgesia with nefopam, suggesting that the effectiveness of 65 mg propoxyphene lay between 45 mg nefopam and placebo. Side effects included mild dizziness and hypothermia after nefopam and mild elevation of diastolic arterial pressure after nefopam and propoxyphene. Our results suggest that 45‐ and 90‐mg doses of nefopam induced more analgesia than 65 mg propoxyphene in the relief of episiotomy pain.