We studied 100 ASA I-II females undergoing general anaesthesia for major gynaecological surgery, in a prospective, double-blind, placebo-controlled, randomized study. Patients received one of four regimens for the prevention of postoperative nausea and vomiting (PONV): ondansetron 4 mg (n = 25), dexamethasone 8 mg (n = 25), ondansetron with dexamethasone (4 mg and 8 mg, respectively, n = 25) or placebo (saline, n = 25) There were no differences in background factors or factors related to operation and anaesthesia, morphine consumption, pain or side effects between groups. The incidence of nausea and emetic episodes in the ondansetron with dexamethasone group was lower than in the placebo (P < 0.01), ondansetron (P < 0.05) and dexamethasone (P = 0.057) groups. There were no differences between ondansetron and dexamethasone, and both were more effective than placebo (P < 0.05 and P < 0.01, respectively). Dexamethasone appeared to be preferable in preventing nausea than emetic episodes. Fewer patients in the ondansetron with dexamethasone group needed antimetic rescue (P < 0.01 vs placebo and P < 0.05 vs ondansetron). We conclude that prophylactic administration of combined ondansetron and dexamethasone is effective in preventing PONV.

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Background Biosimilars are used at the same dose as the reference product to treat the same disease and may offer cost savings in clinical practice. Epoetin zeta is an epoetin biosimilar that is licensed for use in Europe for the treatment of chemotherapy-induced anaemia. Purpose To evaluate the efficacy of epoetin zeta and to analyse the economic effect of biosimilar incorporation. Materials and methods Retrospective, observational study of epoetin zeta, administered subcutaneously, in patients with cancer who had anaemia and were undergoing chemotherapy in the Ribera Health Department. The patients had previously been treated with epoetin alfa or darbepoetin alfa. The number of patients who presented all these requirements was 28. The study comprised two periods: 12 months in treatment with epoetin alfa/darbepoetin and 12 months in treatment with epoetin zeta. Haemoglobin (Hb) concentration and dose of epoetin were compared. The doses were adjusted to obtain an optimal target level of 10–12 g/dL. To describe statistically significant changes, the two sided Student`s t-test was applied using paired observations. Results When comparing the mean Hb concentration for each patient in each of the periods of study treatment before and after switching to epoetin zeta, there were no statistically significant differences in 71% of patients (p > 0.05). It was observed that 46% of patients needed an increase in the dose of epoetin, during treatment with epoetin zeta to maintain the concentration of haemoglobin within the target level. The mean (±SD) Hb concentration during epoetin alfa treatment was 10.78 ± 1.73 g/dL and during epoetin zeta treatment was 11.06 ± 2.06 g/dL. Significant statistical differences in the comparison of two means were not observed (p = 0.49). The mean (±SD) Hb concentration during darbepoetin treatment was 9.87 ± 1.39 g/dL and during epoetin zeta treatment was 10.94 ± 1.71 g/dL. Significant statistical differences in the comparison of two means were observed (p = 0.01). No statistically significant differences were observed in the comparison of the Hb values within the optimal target level between epoetin alfa (or darbepoetin alfa) and epoetin zeta. Cost per patient was reduced from 1190 ± 571 €/month to 826 ± 394 €/month. This means a saving of 364 € per patient per month during the treatment with epoetin zeta, representing an annual saving of 4370€ per patient. Conclusions Despite the limited number of patients, it has been demonstrated that epoetin zeta was effective in the treatment of anaemia in patients with cancer receiving chemotherapy. In addition, epoetin zeta improved the efficiency of treatment, significantly reducing costs. No conflict of interest.

Clinical experience with cannabis derivatives in patients with multiple sclerosis is accumulating steadily, but there is no current literature about its efficacy for SPS. Because MS and SPS share some neurological symptoms such as spasticity and rigidity, it is thought that THC-CBC can be an option for SPS patient. Our case report suggests that THC-CBD oromucosal spray is an alternative treatment for patients with refractory SPS, and further validation is appropriate.

RESUMENSe presenta una revisión sobre el dolor en la edad pediátrica, que se puede considerar de máxima actualidad dada la novedosa aplicación de analgesia u otros procedimientos para evitar y controlar los diferentes tipos de dolor en la práctica habitual en la edad infantil.Después de una breve introducción sobre la historia del dolor y la poca atención que se le dio hasta fechas recientes, se exponen conceptos y diferentes actuaciones ante el dolor, dependiendo de la etiología y localización: dolor en oncología, dolor postoperatorio, dolor en enfermedades crónicas o agudas, dolor en cuidados intensivos, etc.Se presentan tablas con las dosis habitualmente utilizadas en estas edades en las diferentes situaciones requeridas por el niño y ante las que el profesional puede encontrarse.Se expone la actitud no farmacológica que puede ser de gran utilidad en estadios iniciales de control del dolor en estas edades, y se explican las diferentes modalidades de sedación y analgesia en la edad pediátrica en cuanto a los fármacos empleados, su forma de administración y la importancia del equipo multidisciplinar: pediatras, anestesistas infantiles, personal de enfermería así como soporte técnico preciso para la actuación correspondiente.Palabras clave. Niño. Dolor. Analgesia. Sedación. Farmacología. ABSTRACTThe paper presents a review of pain at the paediatric age, which can be considered a question of maximum interest given the novel application of analgesia or other procedures for avoiding and controlling the different types of pain in the course of normal practice during childhood.After a brief introduction on the history of pain and the scarce attention that it has received until recently, the concepts and different actions for dealing with pain are set out, which depend on its aetiology and localisation: pain in oncology, post-operational pain, pain in chronic or acute diseases, pain in intensive care, etc.Tables are presented with the normal doses used at these ages in the different situations required by the child and which the professional might find himself facing.The non-pharmacological attitude is set out as this can be of great use in the initial stages of controlling pain at these ages, and the different forms of sedation and analgesia at the paediatric age are explained, with regard to the medicines employed, the form of administering them and the importance of a multidisciplinary team: paediatricians, child anaesthetists, nursing personnel as well as the necessary technical support for taking the corresponding action.