Epinastine HCl It is interesting to note

It is interesting to note that continuous intra-operative ketamine-remifentanil combined infusions (G2) and (G3), when compared with continuous remifentanil infusion alone (G1), resulted in less postoperative pain scores and total morphine consumption in G2 and G3. These results were similar to Hadi et al. (2010). On the other hand, intra and post-operative ketamine–morphine infusions (G3), when compared with continuous morphine infusion alone (G2), resulted in lower postoperative pain scores and total morphine consumption in G3. Similar results were previously reported by Zakine et al. (2008), who carried out an investigation by using the same method of drug administration in another type of surgery.
We used the visual analog scale score (VAS) for the assessment of pain as Kundra et al. (1997) evaluated this Epinastine HCl method, and recommended using it. Consequently this technique of recording pain scores for this type of surgery proved to be useful and discriminatory. Two other studies have demonstrated that ketamine in combination with morphine provides superior postsurgical pain relief at a lower morphine dose, with a lower (VAS) score, and fewer side effects than morphine alone (Javery et al., 1996; Chia et al., 1998). These results were similar to ours as our results showed that lowering morphine consumption is associated with reducing its side effects such as nausea and vomiting, and the use of the low dose (1μg/kg/min) of ketamine was not associated with any transient psychotic effects. These results were also confirmed in a previously reported study (Snijdelaar et al., 2004; Webb et al., 2007).
This is not the first study in which ketamine has been used at a low concentration post surgery as Frederic Adame and his colleagues (Adam et al., 2005) evaluated the effect of low dose ketamine on post-operative pain relief and the total morphine consumption after total knee artheroplasty. Their results confirmed that low dose ketamine was a useful analgesic adjuvant in perioperative multimodal analgesia with a positive impact on early knee mobilization. Their patients required significantly less morphine than the control group. These results were similar to ours. In a further meta-analysis study by Bell et al. (2005) it was observed that in the first 24h after surgery, ketamine reduced postoperative nausea and vomiting which could have been due to a morphine-sparing effect. The problem with this study is that it could not be translated into any specific administration regimen with ketamine and so the present study establishes a safe and effective concentration to use. The present study, by establishing a statistically significant difference between the three groups (G1, G2, and G3) for morphine induced nausea and vomiting side effects clearly showed the effectiveness of ketamine to counter such effects.
In this study we have examined different parameters concerning adding low dose ketamine intra and post-operatively, other studies have tested further positive impacts of ketamine, on narcotic tolerance patients (Urban et al., 2008), the achievements of haemodynamic stability (Hadi et al., 2010) and its prevention of post-operative hyperalgesia effect (Gu et al., 2009), all these parameters give ketamine a superior impact over other analgesics.



5-Fluorouracil(5-FU) has been widely used as an effective chemotherapeutic agent and drug of choice in oropharyngeal caner, colorectal cancer, stomach cancer and cervical cancer (Calavresi and Chabner, 1996). Chemically, 5-FU is a diprotic acid with pka values of 8.0 and 13.0 and is highly polar in nature (Rudy and Senkowski, 1973; Williams and Barry, 1991). After oral administration, 5-FU is poorly absorbed with erratic variation in bioavailability ranging between 0% and 80%. 5-FU after parenteral administration is rapidly eliminated with apparent terminal half life of approximately 8–20min (Dollery, 1999; Singh et al., 2005). On intravenous administration 5-FU produces severe systemic toxic effects including gastrointestinal, hematological, neural, cardiac and dermatological origin (Diasio and Harris, 1989). In such cases, local administration of 5-FU would be very advantageous instead of oral or parenteral drug delivery.