Testicular Torsion Medication

Updated: Aug 31, 2018
  • Author: Oreoluwa I Ogunyemi, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Medication

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.

Studies have looked at anti-inflammatory adjuncts to testicular torsion in the rat model. Phosphodiesterase type-5 inhibitors and statin medications have been shown to decrease inflammatory markers and to increase blood flow to the testicles. These adjuncts are still in the research stage and are not clinically available for this use. [48]

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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, Kadian)

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)

Diazepam 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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