Journal of Pharmacy Technology

To provide an overview of the indications, actions, efficacy, and safety of various sclerosants for medical treatment of hydroceles.

Pertinent English-language literature dealing with human studies was retrieved from a MEDLINE search (1966–1994); search terms were sclerosant and hydrocele.

All English-language clinical trials of sclerotherapy in males with hydroceles were selected. Studies included open, noncomparative study designs because of limitations of published literature. Case reports also were included if they addressed use or safety of sclerosants. Both authors reviewed all cited literature.

Data were extracted and analyzed if the information was relevant and consistent. Independent extraction was performed by both authors.

Tetracycline, ethanolamine oleate, sodium tetradecyl sulfate, phenol, antazoline, polidocanol, and bismuth phosphate all have been used as sclerosants for hydroceles. All appear to have comparable efficacy; however, they differ in adverse effects. Severe pain upon injection into the scrotum has been reported with bismuth phosphate; pain is least common with phenol, antazoline, and polidocanol. Allergic reactions have occurred with phenol and tetracycline. Sodium tetradecyl sulfate may impair fertility.

The most experience over the longest period of time is with tetracycline; however, the parenteral formulation was removed from the commercial market in 1992. Alternative agents with comparable efficacy that are available in the US include ethanolamine oleate, sodium tetradecyl sulfate, and phenol.

To determine analgesic qualities of epidural sufentanil, associated plasma concentrations, and incidence of adverse effects.

Case series.

Postanesthesia care unit of a tertiary care facility.

Thirteen patients undergoing elective intraabdominal surgery.

Postsurgical analgesia was maintained with epidural sufentanil infusion (0.3–0.6 μg/kg/h). Epidural boluses of sufentanil 0.3 μg/kg had been administered prior to sufentanil infusion to achieve adequate analgesia.

Quality of analgesia was measured with a visual analog scale (VAS). Adverse effects measured included nausea, vomiting, and pruritus. Respiratory function was monitored with end-tidal CO₂, pulse oximetry, and respiratory rate. To determine systemic absorption, plasma concentrations of sufentanil were measured.

Analgesia occurred within five minutes after bolus epidural sufentanil injection. Mean ± SEM VAS scores decreased from 6.2 ± 0.7 at time 0 to 2.4 ± 0.6 after five minutes and were less than three over the next eight hours. One of 13 patients became nauseated and one experienced hypotension and respiratory depression during the study period. Mean plasma sufentanil concentrations were <0.1 ng/mL for the first seven hours and at the lower limits of assay detection (0.1 ng/mL) during hour 8. After 24 and 48 hours of epidural sufentanil infusion, the mean plasma sufentanil concentration was 0.4 ± 0.1 (n=8) and 0.4 ± 0.1 ng/mL (n=4), respectively.

These data suggest that epidural sufentanil can provide rapid postoperative analgesia. Plasma sufentanil concentration tends to increase with the duration of infusion, which could increase the risk of respiratory depression.

To report the first case series study of two patients who developed parotid gland swelling while taking clozapine.

Transient, unilateral parotid swelling was noted in two patients who were on clozapine.

Some patients who have hypersalivation develop unilateral parotid swelling. The swelling tends to resolve spontaneously within a few hours.

Clinicians should be aware of this potential spontaneously reversible reaction. J Pharm Technol 1995;11:18–20.

To report a program to reduce the practice of prescribing sublingual nifedipine.

Pharmacy records were used to identify orders for sublingual nifedipine at Georgetown University Medical Center. Initial review showed 30–40 orders/month, or approximately 11 % of all nifedipine orders. A newsletter was published outlining Pharmacy and Therapeutics Committee guidelines for the use of nifedipine when rapid onset of action is desired. Further educational efforts involved correspondence with each attending physician responsible for the sublingual nifedipine orders. A reduction in orders for sublingual nifedipine to approximately 10 orders/month (3.9% of total nifedipine orders) was observed after using this educational approach. The reduction in orders has been maintained by frequent contact with the attending physicians.

Repeated educational measures have resulted in a reduction in the inappropriate prescribing of sublingual nifedipine.