<p class="abstract"><strong>Background:</strong> Various orthopaedic conditions end up being painful, chronic and progressive, and are associated with persistent inflammation. The present study aimed to evaluate the efficacy and safety of an enzyme-bioflavonoid combination of trypsin-bromelain-rutoside in managing the chronic pain and swelling in out-patients with various orthopaedic conditions.</p><p class="abstract"><strong>Methods:</strong> The study was a prospective, observational study, conducted in 100 patients attending the orthopaedics department at a multi-speciality hospital located in Nashik, Maharashtra, India.  Verbal rating scales were used for grading the pain intensity and extent of swelling at baseline and on days 3 and 8, after being prescribed oral tablets of trypsin-bromelain-rutoside combination. Scores were analysed using paired t test. A 5-point Likert scale was used to evaluate patient- and investigator-reported global assessment of improvement in pain and swelling at days 3 and 8.<strong></strong></p><p class="abstract"><strong>Results:</strong> At baseline, 68 patients reported moderate-severe pain, while 74 patients had moderate swelling. The mean scores for pain and swelling showed statistically significant reduction at both day 3 (p&lt;0.0001) and day 8 (p&lt;0001). By day 8, 98 patients reported good-excellent improvement and the investigator reported good-excellent improvement in 97 patients. No adverse event was reported by any patient.</p><p class="abstract"><strong>Conclusions:</strong> The results indicate that this therapy led to significant improvement in the pain and swelling as early as day 3 and further improvement with continued therapy, and can, thus, provide a safe alternative in patients with various orthopaedic conditions and reduce the need for other analgesic and anti-inflammatory drugs.</p>

Inflammation involves various interlinked pathways and processes. In its uncontrolled form, inflammation results in variety of diseased sates. Current therapy for inflammatory diseases is limited to steroidal and non-steroidal anti-inflammatory drugs (NSAIDs). But these are associated with safety concerns and have a deleterious effect on wound healing. Proteolytic enzymes, also called proteases, which are naturally occurring substances derived from animal or plant sources, are believed to be effective and safer alternatives to the conventional medications. Combined with the bioflavonoid rutoside, the proteases trypsin and bromelain have been extensively investigated as alternatives to conventional therapies for pain and swelling associated with diverse conditions. Their individual mechanisms of action and the advantages of combining bromelain and rutoside with trypsin has been discussed. The combination not only covers a wider range of processes involved in inflammation, but they also complement each other’s actions and provide a more well-rounded control of the inflammatory processes.

Background: Appropriate surgical wound management is required to prevent post-operative complications, including delayed wound-healing which may result in increased hospital stay. The present study aimed to evaluate the efficacy and safety of oral administration of a fixed dose combination of trypsin-bromelain-rutoside in the post-operative management after dental surgeries.Methods: The study was a prospective, observational data collection exercise. Hundred subjects undergoing dental surgeries, who were administered trypsin-bromelain-rutoside combination, were observed over a period of 8 days post-surgery. Verbal rating scales were used for grading the pain intensity and extent of swelling, while a 5-point Likert scale was used to evaluate patient- and investigator-reported global assessment of improvement in pain and swelling. Scores at day 3 and day 8 were analysed using paired t test.Results: At day 3 and day 8, the mean scores of pain and swelling were significantly reduced from baseline (all p<0.0001). By day 8, 100% of the patients achieved complete resolution of pain, while mild swelling was reported in only 2 patients. At day 3, 95% patients reported good/ very good global improvement in pain and swelling; while at day 8, 100% reported good/ very good improvement. No adverse event was reported in any of the patients.Conclusions: The study results demonstrate that treatment with trypsin-bromelain-rutoside combination led to significant improvement in the post-operative pain and swelling. The use of this combination is useful for wound recovery and reducing the need for other analgesic and anti-inflammatory drugs.

<p>Inflammation, which manifests as pain and swelling, forms the basis of various dental pathologies like dental caries and pulpitis. Inflammation is also associated with tissue injury in cases of surgical processes like tooth extraction, root canal treatment or third molar extraction. Various drugs which help reducing inflammation are used in the treatment of dental pathologies. In this article, the mechanism of action of trypsin, bromelain and rutoside is mapped to show the clinical benefit. To demonstrate comparative benefit of trypsin, bromelain, and rutoside combination, a literature search was carried out for real-world investigator-initiated studies. A qualitative analysis of these studies was carried out. All 7 studies, identified in literature, controlled clinical studies comparing efficacy and safety of combination of trypsin, bromelain, and rutoside with that of non-steroidal anti-inflammatory drugs like diclofenac, versus other anti-inflammatory enzymes like trypsin-chymotrypsin combination or serratiopeptidase. All studies have demonstrated efficacy benefit of combination of trypsin, bromelain and rutoside. Importance and place of trypsin-bromelain-rutoside combination in therapy of dental pathologies, is further emphasized based on the results of this review.</p>

<p><strong>Background:</strong> Post-operative management of inflammation plays an important role in orthopaedic surgeries, as delay in wound healing may lead to extended hospital stay. Proteases like trypsin and bromelain combined with the bioflavonoid rutoside are often used to reduce post-operative pain and swelling. The present study aimed to evaluate the efficacy and safety of oral administration of a fixed dose combination of trypsin-bromelain-rutoside in the post-operative management after orthopaedic surgeries.</p><p><strong>Methods:</strong> The study was a prospective, observational data collection exercise. Hundred subjects undergoing orthopaedic surgeries, who were administered trypsin-bromelain-rutoside combination, were observed over a period of 8 days post-surgery. Verbal rating scales were used for grading the pain intensity and extent of swelling, while a 5-point Likert scale was used to evaluate patient- and investigator-reported global assessment of improvement in pain and swelling. Scores at day 3 and day 8 were analysed using paired t test.</p><p><strong>Results:</strong> At day 3 and day 8, the mean scores of pain and swelling were significantly reduced from baseline (all p&lt;0.0001). By day 8, 74% of the patients achieved complete resolution of pain, while 50% reported complete resolution of swelling. By day 8, 54% patients reported excellent/ very good global improvement in pain and swelling, while the investigator reported excellent/ very good global improvement in 81% of the patients. No adverse event was reported in any of the patients.</p><p><strong>Conclusions:</strong> The combination of trypsin-bromelain-rutoside was safe and effective in reducing the post-operative pain and swelling after orthopaedic surgeries. An 8-day treatment led to complete resolution of pain in three-fourths of the patients and complete resolution of swelling in half the patients. The use of this combination has the potential to reduce hospital stay and pill burden.</p>