In the present study a statistically significant effect of ginger extract could only be demonstrated by explorative statistical methods in the first period of treatment before cross-over, while a significant difference was not observed in the study as a whole.

Patients receiving an opioid-sparing postsurgical pain management protocol with liposomal bupivacaine 266 mg experienced a statistically significant reduction of postsurgical pain and clinically relevant reduction in opioid consumption. The overall incidence of treatment-emergent adverse events was comparable in patients receiving an opioid-sparing postsurgical pain management protocol with or without liposomal bupivacaine.

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IN a previous study the present authors1 confirmed the numerous reports of a high frequency of subnormal serum folates (SF) in patients with epilepsy treated with diphenylhydantoin, phenobarbital, and primidone.The clinical importance of these drug-induced subnormal SF levels is unknown. Reynolds2 and Strachan and Henderson3 have put forward the hypothesis, that folate deficiency may lead to neuropsychiatric disorders. Reynolds2 observed an improvement in the mental state and a corresponding increase in fit frequency in patients during folic acid administration, whereas Hawkins and Meynell4 found folic acid treatment to cause a decrease in fit frequency. Horwitz et al,5 in a controlled study, did not observe any effect of folic acid administration in respect to peripheral neuropathy in patients with subnormal SF levels due to anticonvulsant drugs.The aim of the present study has been to investigate in patients suffering from epiledsy and with drug-induced subnormal SF, the effect of folic acid administration on fit fre¬ quency, mental state, peripheral blood ex¬ aminations, and serum levels of diphenylhydantoin and phénobarbital. Materials and MethodsA group of 24 patients with an equal sex distribution and an age average of 34 years was studied. They all suffered from epilepsy and had been hospitalized for many years and, through a long period, treated with either diphenylhydantoin, phénobarbital, primidone, or combinations of these drugs. All of the patients had subnormal SF levels (less than 0.2 m/ig/100 cc), normal whole blood folates (above 2.0 m/ig/100 cc), normal serum B12, normal periph¬ eral blood examinations, and they all had a very low formiminoglutamic acid (FIGLU) ex¬ cretion after histidine load.All the patients were more or less mentally deteriorated, and six of the patients in addition suffered from an intermittent or chronic pro¬ ductive psychotic condition with hallucinations and delusions in general admixed with an out¬ spoken affective air.The study was carried out with the doubleblind crossover technique. The period of inves¬ tigation was five months. Folie acid was admin¬ istered in tablets in an amount of 20 mg daily.The clinical observations were results from a combination of the daily registrations of the ward staff personnel in regard to fit frequency and mental state and a neurological and psychi¬ atric examination of the patients by a physician every fortnight. Likewise, the blood samples for determination of serum diphenylhydantoin and phénobarbital were drawn every fortnight. The peripheral blood examinations were carried out before the start of the study, at the time of the crossover, and at the end of the study.The determinations of SF, whole blood folate, B12, diphenylhydantoin and phénobarbital, FIGLU, and peripheral blood examinations were performed in the same way as previously de¬ scribed.1 ResultsDuring the period of investigation no changes, that could be ascribed to the folie acid administration, were observed in the fit frequency and the mental state of the pa¬ tients. It...