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Rat Diz Ekleminde Kıkırdak ve Sinovyum Üzerine Ketorolak Trometamin'in İntraartiküler Enjeksiyonunun Etkileri

Year 2016, Volume: 6 Issue: 2, 70 - 75, 19.10.2016

Nihal Kılınç Şaban Cem Sezen

https://doi.org/10.16899/ctd.40753

Abstract

Amaç: Bu çalışmada, sıçan diz eklem içine lokal ketorolak tromethamine enjeksiyonunun dizin kıkırdak ve sinovyal dokuları üzerindeki etkilerini histopatolojik olarak araştırdık.
Gereç ve yöntemler: Çalışma 250-300 gr ağırlığında 30 adet Sprague-Dowley dahil edildi. Halotan anestezisi sonrası, tüm sıçanların sağ diz eklem içine toplam 10 mg olmak üzere %0.9 serum fizyolojik ile hazırlanan 0.25 ml ketorolak trometamin enjekte edildi. Tüm sıçanların sol diz eklemleri 0.25 ml %0.9’luk serum fizyolojik enjekte edildi  ve çalışmanın kontrol gruplarını oluşturuldu. Bütün sıçanlar aşağıdaki sırayla fenobarbital ile sakrifiye edildi: Grup I (n = 10) intra-artiküler (ia) enjeksiyondan 24 saat sonra, Grup II (n = 10) enjeksiyondan 48 saat sonra, Grup III (n = 10) enjeksiyondan 5 gün sonra. Örnekler parafine gömüldü sonra histopatolojik olarak incelendi. Enflamatuvar ve dejeneratif değişiklikler için, konjesyon, ödem, fibrin eksüdasyonu, sinovyal hiperplazi, nötrofil artışı, makrofaj artışı, makrofaj benzeri (A tipi hücreler) fibroblast benzeri hücreler (A tipi hücreler)  gibi parametreler çalışıldı.
Sonuçlar: Ketorolak grubunda, 24 ve 48. saatte sakrifiye edilen sıçanlar yüzeysel erozyon ve eklem kapsülü iç yüzeyinin subsynovial tabakasında ve sinovyal epitelinde ki sinoviyositleri azaldı (p = 0.127, p = 0.042). Özellikle 5. gün kurban edilen Grup III’de, eklem kapsülü içinde sinovyal membranın derin bölümlerinde  subsynovial bağ dokusunda konjesyon, ödem, nötrofil ve makrofaj artışı, B tipi hücre artışı ve lenfosit artışı tespit edildi (P = 0.000). Grupların hiçbirinde ciddi iltihab olan fibrin eksüdasyonu ve sinovyal membran hiperplazisi izlenmedi. 
Karar: Uzun vadeli hidrotik ketorolak uygulanmasının kaçınılmalıdır. Diğer taraftan, Saf ketorolak stabilize ketorolaktan daha az inflamasyona neden olduğu bilinmektedir. İnflamasyonu inhibe edecek ajanlar tercih tercih edilmelidir.

Keywords

Ketorolac analjezi intra-artiküler sinoviyum sıçan diz eklemi.

References

  • Shapiro PS, Rohde RS, Froimson MI, Lash RH, Postak P, Greenwald AS. The Effect of Local Corticosteroid or Ketorolac Exposure on Histologic and Biomechanical Properties of Rabbit Tendon and Cartilage. Am Asso Hand Surg. 2007;2:165-172.
  • Convery PN, Milligan KR, Quinn P, Scott K, Clarke RC. Low-dose intra-articular ketorolac for pain relief fol- lowing arthroscopy of the knee joint. Anaesthesia. 1998;53(11):1125-9.
  • Irwin MG, Cheung KM, Nicholls JM, Thompson N. Intra-articular injection of ketorolac in the rat knee joint: effect on articular cartilage and synovium. Br J Anaesth. 1998;80(6):837-9.
  • Dogan N, Erdem AF, Gundogdu C, Kursad H, Kizilkaya M. The effects of ketorolac and morphine on articular cartilage and synovium in the rabbit knee joint. Can J Physio Pharma 2004;502-5.
  • Reuben SS, Connelly NR. Postarthroscopic meniscus repair analgesia with intraarticular ketorolac or mor- phine. Anesth Analg. 1996; 82(5):1036-9.
  • Chow GK, Fabrizio MD, Steer T, Potter SR, Jarrett TW, Gelman S, Kavoussi LR. Prospective double-blind study of effect of ketorolac administration after laparoscop- ic urologic surgery. J Endourol. 2001; 15(2):171-4.
  • Ben-David B, Katz E, Gaitini L, Goldik Z. Comparison of i.m. and local infiltration of ketorolac with and with- out local anaesthetic. Br J Anaesth. 1995; 75(4): 409- 12.
  • Avellaneda C, Gomez A, Martos F, Rubio M, Sarmiento J, de la Cuesta FS. The effect of a single intravenous dose of metamizol 2 g, ketorolac 30 mg and propa- cetamol 1 g on haemodynamic parameters and post- operative pain after heart surgery. Eur J Anaesthesiol. 2000;17(2):85-90.
  • Brocks DR, Jamali F. Clinical pharmacokinetics of ketorolac tromethamine. Clin Pharmacokinet. 1992;23(6):415-27.
  • Gupta A, Axelsson K, Allvin R, Liszka-Hackzell J, Rawal N, Althoff B, Augustini BG. Postoperative pain follow- ing knee arthroscopy: the effects of intra-articular ketorolac and/or morphine. Reg Anesth Pain Med. 1999;24(3):225-30.
  • Reuben SS, Connelly NR. Postoperative analgesia for outpatient arthroscopic knee sugery with in- traarticular bupivacaine and ketorolac. Anesth An- alg.1995;80(6):1154-7.
  • Wilkinson DJ. Intraarticular ketorolac (letter). Anesth Analg. 1996; 82(2): 426-39.
  • Cook TM, Nolan JP, Tuckey JP. Postarthroscopic me- niscus repair analgesia with intraarticular ketorolac or morphine. Anesth Analg.1997;84(2):466-7.
  • De Andres J, Valia JC, Barrera L, Colomina R. Intra- articular analgesia after arthroscopic knee surgery: comparison of three different regimens. Eur J Anaes- thesiol. 1998;15(1):10-5.
  • McInnes LB, Leung BP, Liew FY. Cell-cell interactions in synovitis, interactions between T lymphocytes and synovial cells (review). Arthritis Res.2000 2:374-8.
  • Granados-Soto V, Flores-Murrieta FJ, Castaneda-Her- nandez G, Lopez-Munoz FJ. Evidence for the involve- ment of nitric oxide in the antinociceptive effect of ketorolac. Eur J Pharmacol. 1995;277(2-3):281-4.

THE EFFECTS OF INTRAARTICULAR INJECTION OF KETOROLAC TROMETHAMINE ON CARTILAGE AND SYNOVIUM IN RAT KNEE JOINT

Year 2016, Volume: 6 Issue: 2, 70 - 75, 19.10.2016

Nihal Kılınç Şaban Cem Sezen

https://doi.org/10.16899/ctd.40753

Abstract

ml into their right knee joints, comprising the study (ketorolac) groups. The left knee joints of all the rats were injected 0.25 ml 0.9 % serum physiologic and formed the control groups of the study. All the rats were sacrificed by phenobarbital in the following order- Group I (n=10) 24 hours after intra-articular (i.a.) injection, Group II (n=10) 48 hours after the injection, Group III (n=10) rats 5 days after the injection. The samples were then paraffin embedded and histopathologically examined. For inflammatory and degenerative changes, the parameters such as congestion, edema, fibrin exudation, synovial hyperplasia, neutrophil increase, macrophage increase, macrophage like cells (type A cells) and fibroblast like cells (type A cells) were studied. Results- In Ketorolac group, the rats which were sacrificed at the 24th and 48th hour had superficial erosion and decreased synoviocytes in the subsynovial layer of the inner surface of the joint capsule and synovial epithelium (P=0.127, P=0.042). Particularly, in Group III, which was sacrificed on the 5th day, congestion, edema, neutrophile and macrophage increase in the subsynovial connective tissue, type B cell increase, and lymphocyte increase in the deeper sections of synovial membrane were detected in the joint capsules (P=0.000). None of the groups presented synovial membrane hyperplasia and fibrin exudation that could suggest severe inflammation. Conclusion- The long-term i.a. application of ketorolac should be avoided. On the other hand, since pure ketorolac is known to cause less inflammation than stabilized ketorolac, agents which will inhibit inflammation should be the choice of preference-

Keywords

Ketorolac Analgesic Intra-articular Synovium Rat knee joint.

References

  • Shapiro PS, Rohde RS, Froimson MI, Lash RH, Postak P, Greenwald AS. The Effect of Local Corticosteroid or Ketorolac Exposure on Histologic and Biomechanical Properties of Rabbit Tendon and Cartilage. Am Asso Hand Surg. 2007;2:165-172.
  • Convery PN, Milligan KR, Quinn P, Scott K, Clarke RC. Low-dose intra-articular ketorolac for pain relief fol- lowing arthroscopy of the knee joint. Anaesthesia. 1998;53(11):1125-9.
  • Irwin MG, Cheung KM, Nicholls JM, Thompson N. Intra-articular injection of ketorolac in the rat knee joint: effect on articular cartilage and synovium. Br J Anaesth. 1998;80(6):837-9.
  • Dogan N, Erdem AF, Gundogdu C, Kursad H, Kizilkaya M. The effects of ketorolac and morphine on articular cartilage and synovium in the rabbit knee joint. Can J Physio Pharma 2004;502-5.
  • Reuben SS, Connelly NR. Postarthroscopic meniscus repair analgesia with intraarticular ketorolac or mor- phine. Anesth Analg. 1996; 82(5):1036-9.
  • Chow GK, Fabrizio MD, Steer T, Potter SR, Jarrett TW, Gelman S, Kavoussi LR. Prospective double-blind study of effect of ketorolac administration after laparoscop- ic urologic surgery. J Endourol. 2001; 15(2):171-4.
  • Ben-David B, Katz E, Gaitini L, Goldik Z. Comparison of i.m. and local infiltration of ketorolac with and with- out local anaesthetic. Br J Anaesth. 1995; 75(4): 409- 12.
  • Avellaneda C, Gomez A, Martos F, Rubio M, Sarmiento J, de la Cuesta FS. The effect of a single intravenous dose of metamizol 2 g, ketorolac 30 mg and propa- cetamol 1 g on haemodynamic parameters and post- operative pain after heart surgery. Eur J Anaesthesiol. 2000;17(2):85-90.
  • Brocks DR, Jamali F. Clinical pharmacokinetics of ketorolac tromethamine. Clin Pharmacokinet. 1992;23(6):415-27.
  • Gupta A, Axelsson K, Allvin R, Liszka-Hackzell J, Rawal N, Althoff B, Augustini BG. Postoperative pain follow- ing knee arthroscopy: the effects of intra-articular ketorolac and/or morphine. Reg Anesth Pain Med. 1999;24(3):225-30.
  • Reuben SS, Connelly NR. Postoperative analgesia for outpatient arthroscopic knee sugery with in- traarticular bupivacaine and ketorolac. Anesth An- alg.1995;80(6):1154-7.
  • Wilkinson DJ. Intraarticular ketorolac (letter). Anesth Analg. 1996; 82(2): 426-39.
  • Cook TM, Nolan JP, Tuckey JP. Postarthroscopic me- niscus repair analgesia with intraarticular ketorolac or morphine. Anesth Analg.1997;84(2):466-7.
  • De Andres J, Valia JC, Barrera L, Colomina R. Intra- articular analgesia after arthroscopic knee surgery: comparison of three different regimens. Eur J Anaes- thesiol. 1998;15(1):10-5.
  • McInnes LB, Leung BP, Liew FY. Cell-cell interactions in synovitis, interactions between T lymphocytes and synovial cells (review). Arthritis Res.2000 2:374-8.
  • Granados-Soto V, Flores-Murrieta FJ, Castaneda-Her- nandez G, Lopez-Munoz FJ. Evidence for the involve- ment of nitric oxide in the antinociceptive effect of ketorolac. Eur J Pharmacol. 1995;277(2-3):281-4.
There are 16 citations in total.

Details

Subjects Health Care Administration
Journal Section Original Research
Authors

Nihal Kılınç

Şaban Cem Sezen

Publication Date October 19, 2016
Published in Issue Year 2016 Volume: 6 Issue: 2

Cite

APA Kılınç, N., & Sezen, Ş. C. (2016). Rat Diz Ekleminde Kıkırdak ve Sinovyum Üzerine Ketorolak Trometamin’in İntraartiküler Enjeksiyonunun Etkileri. Çağdaş Tıp Dergisi, 6(2), 70-75. https://doi.org/10.16899/ctd.40753
AMA Kılınç N, Sezen ŞC. Rat Diz Ekleminde Kıkırdak ve Sinovyum Üzerine Ketorolak Trometamin’in İntraartiküler Enjeksiyonunun Etkileri. J Contemp Med. April 2016;6(2):70-75. doi:10.16899/ctd.40753
Chicago Kılınç, Nihal, and Şaban Cem Sezen. “Rat Diz Ekleminde Kıkırdak Ve Sinovyum Üzerine Ketorolak Trometamin’in İntraartiküler Enjeksiyonunun Etkileri”. Çağdaş Tıp Dergisi 6, no. 2 (April 2016): 70-75. https://doi.org/10.16899/ctd.40753.
EndNote Kılınç N, Sezen ŞC (April 1, 2016) Rat Diz Ekleminde Kıkırdak ve Sinovyum Üzerine Ketorolak Trometamin’in İntraartiküler Enjeksiyonunun Etkileri. Çağdaş Tıp Dergisi 6 2 70–75.
IEEE N. Kılınç and Ş. C. Sezen, “Rat Diz Ekleminde Kıkırdak ve Sinovyum Üzerine Ketorolak Trometamin’in İntraartiküler Enjeksiyonunun Etkileri”, J Contemp Med, vol. 6, no. 2, pp. 70–75, 2016, doi: 10.16899/ctd.40753.
ISNAD Kılınç, Nihal - Sezen, Şaban Cem. “Rat Diz Ekleminde Kıkırdak Ve Sinovyum Üzerine Ketorolak Trometamin’in İntraartiküler Enjeksiyonunun Etkileri”. Çağdaş Tıp Dergisi 6/2 (April 2016), 70-75. https://doi.org/10.16899/ctd.40753.
JAMA Kılınç N, Sezen ŞC. Rat Diz Ekleminde Kıkırdak ve Sinovyum Üzerine Ketorolak Trometamin’in İntraartiküler Enjeksiyonunun Etkileri. J Contemp Med. 2016;6:70–75.
MLA Kılınç, Nihal and Şaban Cem Sezen. “Rat Diz Ekleminde Kıkırdak Ve Sinovyum Üzerine Ketorolak Trometamin’in İntraartiküler Enjeksiyonunun Etkileri”. Çağdaş Tıp Dergisi, vol. 6, no. 2, 2016, pp. 70-75, doi:10.16899/ctd.40753.
Vancouver Kılınç N, Sezen ŞC. Rat Diz Ekleminde Kıkırdak ve Sinovyum Üzerine Ketorolak Trometamin’in İntraartiküler Enjeksiyonunun Etkileri. J Contemp Med. 2016;6(2):70-5.