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Pediatric Testicular Torsion Medication

  • Author: Krishna Kumar Govindarajan, MBBS, MS, DNB, MRCS, MCh; Chief Editor: Marc Cendron, MD  more...
 
Updated: Mar 30, 2015
 

Medication Summary

Analgesic and antianxiety medications are valuable adjuncts in the treatment of testicular torsion. Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and enables physical therapy regimens. Antiemetics can be used to counter the nausea and vomiting that may accompany testicular torsion.

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Analgesics

Class Summary

Most analgesics have sedating properties, which are beneficial for patients who have sustained painful trauma.

Morphine sulfate (Duramorph, Astramorph, MS Contin)

 

Morphine is the drug of choice for narcotic analgesia due to reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

Various IV doses are used; the dose is commonly titrated until the desired effect is obtained.

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Antiemetics

Class Summary

These agents are used to prevent nausea and vomiting.

Prochlorperazine (Compro)

 

Prochlorperazine may relieve nausea and vomiting by blocking postsynaptic mesolimbic dopamine receptors through its anticholinergic effects and depressing the reticular activating system. In addition to its antiemetic effects, it has the advantage of augmenting hypoxic ventilatory response, acting as a respiratory stimulant at high altitude.

Metoclopramide (Reglan, Metozolv)

 

Metoclopramide blocks dopamine receptors in the chemoreceptor trigger zone of the central nervous system.

Ondansetron (Zofran)

 

Odansetron is a selective 5-HT3-receptor antagonist that blocks serotonin both peripherally and centrally. It prevents nausea and vomiting, including that associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin), and complete body radiotherapy.

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Antianxiety Agents

Class Summary

These agents are used to reduce anxiety.

Diazepam (Diastat, Valium)

 

Diazepa modulates the postsynaptic effects of gamma-aminobutric acid–A (GABA-A) transmission, resulting in an increase in presynaptic inhibition. It appears to act on part of the limbic system, the thalamus, and hypothalamus, to induce a calming effect. It also has been found to be an effective adjunct for the relief of skeletal muscle spasm caused by upper motor neuron disorders.

Diazepam rapidly distributes to other body fat stores. Twenty minutes after initial IV infusion, the serum concentration drops to 20% of maximum plasma concentration (Cmax).

Individualize dosage and increase cautiously to avoid adverse effects

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Contributor Information and Disclosures
Author

Krishna Kumar Govindarajan, MBBS, MS, DNB, MRCS, MCh MNAMS, FAIS, FICS, FACS, FEBPS, Assistant Professor and Consultant Pediatric Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research, India

Krishna Kumar Govindarajan, MBBS, MS, DNB, MRCS, MCh is a member of the following medical societies: American College of Surgeons, International College of Surgeons, British Association of Paediatric Surgeons, Association of Surgeons of India, Indian Association of Pediatric Surgeons, Association of Colon and Rectal Surgeons of India, Association of Minimal Access Surgeons of India, National Academy of Medical Sciences (India)

Disclosure: Nothing to disclose.

Coauthor(s)

Caleb P Nelson, MD, MPH Assistant Professor of Surgery (Urology), Department of Urology, Harvard Medical School; Consulting Staff, Department of Urology, Children's Hospital Boston

Caleb P Nelson, MD, MPH is a member of the following medical societies: American Urological Association, Endourological Society, Phi Beta Kappa, Society for Pediatric Urology, Society for Fetal Urology

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Marc Cendron, MD Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, New Hampshire Medical Society, Society for Pediatric Urology, Society for Fetal Urology, Johns Hopkins Medical and Surgical Association, European Society for Paediatric Urology

Disclosure: Nothing to disclose.

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Perinatal testicular torsion.
Intravaginal testicular torsion with ischemia in adolescent boy.
Torsion of undescended testis.
Torsion of testis, with cord twist clearly demonstrated.
Torsion of appendix testis.
 
 
 
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