Corticosteroids combination therapy with NSAID

Effect of corticosteroids and combination therapy with NSAIDs... 

Risk factors for NSAID-induced peptic ulcers and complications are presented in Table 15-2. Several important principles should be considered when estimating the risk for developing PUD in a patient taking an NSAID (1) risk factors are generally additive (2) some risk factors (e.g., corticosteroid therapy) are not by themselves a risk factor for ulceration but increase PUD risk substantially when combined with NSAID therapy and (3) many of the risk factors postulated to increase PUD... 

Studies conducted in our laboratories examined the effects of such conjoint therapy with antibiotics on eicosanoid levels and survival in septic shock. In the rat faecal peritonitis model, improved survival time was observed with early treatment with steroids. However, this protection appears to be independent of inhibition of arachidonic acid metabolism. Corticosteroid pretreatment effected no more than a 30 and 40% inhibition of plasma levels of iTxB2 and i6-keto-PGFi3( respectively, compared with 100% inhibition with the cyclo-oxygenase inhibitors. Conjoint steroid and NSAID treatment improved survival time compared with each drug employed individually. The combination of steroid, NSAID and gentamicin produced the most significant effect on survival. 

Postoperative analgesia from morphine has been shown to be the most effective if administered at the completion of the procedure (Brandsson et al 2000, Reuben et al 2001, Tetzlaff et al 2000). In these cases, it appears that the postoperative use of morphine allows the clinician to reduce both the level and the duration of other analgesics. This is not to say that the only potential benefit of morphine is in the postoperative patient. Morphine has also been shown to be of equivalent effect to corticosteroid administration in other forms of chronic arthritides (Keates et al 1999, Stein et al 1999). The reductions in inflammatory cell influx, reduced edema formation and analgesia provided with minimal systemic effects make intraarticular morphine a very attractive postoperative therapy. I most commonly use a combination of 5-15 mg morphine with 6 mg lidocaine for postoperative analgesia and have seen no untoward effects. The beneficial effects with respect to improved analgesia and ability to reduce the usage of NSAIDs remains to be proven. 

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