Myoclonic movements and pain on injection are common problems during induction of anesthesia with etomidate (Amidate^®, Bedford Labs). Researchers from Turkey, investigating ways to pre-treat the pain, randomly assigned 100 patients to four groups: ketamine 0.2 mg/kg, ketamine 0.5 mg/kg, magnesium sulfate 2.48 mmol, and normal saline.

Pre-treatment with magnesium sulfate reduced the incidence and intensity of myoclonic movements; 19 patients (76%) had none. By contrast, 18 patients (72%) in the 0.5-mg ketamine group, 16 (64%) in the 0.2-mg ketamine group, and 18 (72%) in the control group had myoclonic movements.

After magnesium treatment, 64% of patients experienced mild-to-moderate pain associated with the etomidate injection. However, both doses of ketamine provided better pain relief; at the lower dose, 44% of the patients experi­enced pain, and at the higher dose, only 28% of patients had pain.

Despite the better analgesia, however, ketamine did not effectively reduce myo-clonus. At the higher dose, it caused mild-to-severe sedation in all patients and respiratory depression in 80% of patients.

The researchers say that this is the first reported clinical study showing that pre-treatment with magnesium reduces myoclonic muscle movements without any adverse effects.

Caraco Pharmaceutical Laboratories Ltd. has announced the FDA’s final approval of an ANDA for Generic Tramadol HCl with acetaminophen tablets. This is the generic equivalent of Ortho-McNeil’s brand product, Ultracet, which is indi­cated for the short-term management of acute pain over a period of five days or less.

The FDA is requiring revised labeling to help reduce the risk of an overdose in patients using pain medications such as Darvon (propoxyphene napsylate) and Darvocet (propoxyphene napsylate plus acetaminophen) because of data linking propoxyphene to fatal overdoses. A widely prescribed opioid, propoxyphene has been sold since 1957 as a therapy for mild-to-moderate pain.

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