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1.
Life Sci ; 265: 118836, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33259865

RESUMEN

AIMS: Our previous study has demonstrated that porcine diazepam-binding inhibitor (pDBI) and its active fragments, pDBI-16 and pDBI-19, have inhibition effect on morphine analgesia in mice. The present study aimed to investigate the underlying mechanism and potential application of this anti-opioid effect. MATERIALS AND METHODS: Effect of DBI on morphine analgesia was examined by the tail electric stimulation vocalization test. Complementary peptides and antiserum were used to further confirm the effect of DBI in morphine tolerance and dependence. Pharmacological and microinjection methods were used to investigate the underlying mechanism. KEY FINDINGS: Firstly, pDBI administered either intracerebroventricularly or intravenously dose-dependently inhibited morphine analgesia, while blocking DBI-16 or DBI-19 by the complementary peptides for DBI-16 (CP-DBI-16) or DBI-19 (CP-DBI-19) potentiated it in mice. Secondly, explicit immunoexpression of DBI in the lateral habenular (LHb) was observed in naive rats, and intra-LHb injection of pDBI dose-dependently abolished analgesic effect produced by intra-periaqueductal gray (PAG) injection of morphine in rats. Thirdly, pretreatment with N-Methyl-d-Aspartate receptor (NMDAR) antagonist MK-801 or nitric oxide (NO) synthase inhibitor L-NAME abolished the inhibition effect of pDBI, pDBI-16 or pDBI-19 on morphine analgesia in mice. Finally, antiserum against DBI dose-dependently reversed analgesic tolerance induced by increasing doses of morphine twice daily for 13 days in mice, while CP-DBI-16 or CP-DBI-19 significantly inhibited naloxone-precipitated morphine withdrawal jumping in mice. SIGNIFICANCE: Taken together, our results demonstrated that NMDAR/NO signaling and LHb-PAG pathway are crucially involved in the anti-opioid effect of DBI, which could provide a potential biological target for opioid tolerance and dependence.


Asunto(s)
Analgésicos Opioides/farmacología , Inhibidor de la Unión a Diazepam/farmacología , Morfina/farmacología , Antagonistas de Narcóticos/farmacología , Analgésicos Opioides/administración & dosificación , Animales , Inhibidor de la Unión a Diazepam/administración & dosificación , Relación Dosis-Respuesta a Droga , Tolerancia a Medicamentos , Estimulación Eléctrica , Masculino , Ratones , Morfina/administración & dosificación , Naloxona/farmacología , Antagonistas de Narcóticos/administración & dosificación , Óxido Nítrico/metabolismo , Trastornos Relacionados con Opioides/tratamiento farmacológico , Ratas , Ratas Wistar , Receptores de N-Metil-D-Aspartato/metabolismo , Porcinos , Cola (estructura animal) , Vocalización Animal/efectos de los fármacos
2.
J Surg Oncol ; 123(1): 352-356, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33125747

RESUMEN

BACKGROUND AND OBJECTIVES: Surgical oncology patients are vulnerable to persistent opioid use. As such, we aim to compare opioid prescribing to opioid consumption for common surgical oncology procedures. METHODS: We prospectively identified patients undergoing common surgical oncology procedures at a single academic institution (August 2017-March 2018). Patients were contacted by telephone within 6 months of surgery and asked to report their opioid consumption and describe their discharge instructions and opioid handling practices. RESULTS: Of the 439 patients who were approached via telephone, 270 completed at least one survey portion. The median quantity of opioid prescribed was significantly larger than consumed following breast biopsy (5 vs. 2 tablets of 5 mg oxycodone, p < .001), lumpectomy (10 vs. 2 tablets of 5 mg oxycodone, p < .001), and mastectomy or wide local excision (20 tablets vs. 2 tablets of 5 mg oxycodone, p < .001). The majority of patients reported receiving education on taking opioids, but only 27% received instructions on proper disposal; 82% of prescriptions filled resulted in unused opioids, and only 11% of these patients safely disposed of them. CONCLUSIONS: This study demonstrates that opioid prescribing exceeds consumption following common surgical oncology procedures, indicating the potential for reductions in prescribing.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Neoplasias de la Mama/cirugía , Prescripciones de Medicamentos/estadística & datos numéricos , Mastectomía/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Oncología Quirúrgica/normas , Neoplasias de la Mama/patología , Femenino , Estudios de Seguimiento , Humanos , Dolor Postoperatorio/etiología , Dolor Postoperatorio/patología , Pronóstico , Estudios Prospectivos , Encuestas y Cuestionarios
3.
J Intensive Care Med ; 36(2): 157-174, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32844730

RESUMEN

The rapid spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to a global pandemic. The 2019 coronavirus disease (COVID-19) presents with a spectrum of symptoms ranging from mild to critical illness requiring intensive care unit (ICU) admission. Acute respiratory distress syndrome is a major complication in patients with severe COVID-19 disease. Currently, there are no recognized pharmacological therapies for COVID-19. However, a large number of COVID-19 patients require respiratory support, with a high percentage requiring invasive ventilation. The rapid spread of the infection has led to a surge in the rate of hospitalizations and ICU admissions, which created a challenge to public health, research, and medical communities. The high demand for several therapies, including sedatives, analgesics, and paralytics, that are often utilized in the care of COVID-19 patients requiring mechanical ventilation, has created pressure on the supply chain resulting in shortages in these critical medications. This has led clinicians to develop conservation strategies and explore alternative therapies for sedation, analgesia, and paralysis in COVID-19 patients. Several of these alternative approaches have demonstrated acceptable levels of sedation, analgesia, and paralysis in different settings but they are not commonly used in the ICU. Additionally, they have unique pharmaceutical properties, limitations, and adverse effects. This narrative review summarizes the literature on alternative drug therapies for the management of sedation, analgesia, and paralysis in COVID-19 patients. Also, this document serves as a resource for clinicians in current and future respiratory illness pandemics in the setting of drug shortages.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Bloqueantes Neuromusculares/administración & dosificación , Respiración Artificial , /virología , Enfermedad Crítica , Humanos , Unidades de Cuidados Intensivos , Pandemias
4.
Anaesthesia ; 76(2): 189-198, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32564365

RESUMEN

Peri-operative lidocaine infusion warrants investigation in bariatric surgery because obese patients present different physiological and pharmacological risks. This single-centre, prospective, randomised double-blind placebo-controlled study enrolled obese patients scheduled for laparoscopic bariatric surgery using an enhanced recovery protocol. Patients received either lidocaine (bolus of 1.5 mg.kg-1 , then a continuous infusion of 2 mg.kg-1 .h-1 until the end of the surgery, then 1 mg.kg-1 .h-1 for 1 h in the recovery area) or identical volumes and rates of 0.9% saline. The primary outcome was the consumption of the equivalent of oxycodone consumption over the first 3 postoperative days. Secondary outcomes were: postoperative pain; incidence of nausea and vomiting; bowel function recovery; and lengths of stay in the recovery area and in hospital. Plasma concentrations of lidocaine were measured. On the 178 patients recruited, data were analysed from 176. The median (IQR [range]) equivalent intravenous oxycodone consumption was 3.3 mg (0.0-6.0 [0.0-14.5]) and 5.0 mg (3.3-7.0 [3.3-20.0]) in the lidocaine and saline groups, respectively (difference between medians (95%CI): 1.7 (0.6-3.4) mg; p = 0.004). Length of stay in the recovery area, postoperative pain, nausea and vomiting, day of recovery of bowel function, and length of stay in hospital were not different between groups. Mean (SD) lidocaine plasma concentrations were 2.44 (0.70) µg.ml-1 and 1.77 (0.51) µg.ml-1 at the end of surgery and 1 hour after the end of infusion, respectively. Lidocaine infusion during bariatric surgery resulted in a clinically non-relevant difference in postoperative oxycodone consumption.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Anestésicos Locales/uso terapéutico , Cirugía Bariátrica , Lidocaína/uso terapéutico , Dolor Postoperatorio/prevención & control , Adulto , Analgesia Controlada por el Paciente , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Laparoscopía , Tiempo de Internación , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Obesidad/cirugía , Oxicodona/administración & dosificación , Oxicodona/uso terapéutico , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Náusea y Vómito Posoperatorios/epidemiología , Estudios Prospectivos , Recuperación de la Función
5.
Res Social Adm Pharm ; 17(1): 2005-2008, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33317769

RESUMEN

BACKGROUND: Healthcare access has changed drastically during the COVID-19 pandemic. Elective medical procedures, including routine office visits, were restricted raising concerns regarding opioid and benzodiazepine provider and prescription availability. OBJECTIVE: To examine how the cancelation of elective medical procedures due to COVID-19 impacted the dispensing of opioid and benzodiazepine prescriptions in Texas. METHODS: Interrupted time series analyses were preformed to examine changes in prescription trends for opioids and benzodiazepines before and after the restriction on elective medical procedures. Samples of patients who filled an opioid or benzodiazepine prescription from January 5, 2020 to May 12, 2020 were identified from the Texas Prescription Monitoring Program. Elective medical procedures were restricted starting March 23, 2020 indicating the beginning of the intervention period. RESULTS: Restricting elective procedures was associated with a significant decrease in the number of patients (ß = -6029, 95%CI = -8810.40, -3246.72) and prescribers (ß = -2784, 95%CI = -3671.09, -1896.19) filling and writing opioid prescriptions, respectively. Also, the number of patients filling benzodiazepine prescriptions decreased significantly (ß = -1982, 95%CI = -3712.43, -252.14) as did the number of prescribers (ß = -708.62, 95%CI = -1190.54, -226.71). CONCLUSION: Restricting elective procedures resulted in a large care gap for patients taking opioid or benzodiazepine prescriptions.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Benzodiazepinas/administración & dosificación , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prescripciones de Medicamentos , Política de Salud , Accesibilidad a los Servicios de Salud , Humanos , Análisis de Series de Tiempo Interrumpido , Programas de Monitoreo de Medicamentos Recetados , Texas
6.
Medicine (Baltimore) ; 99(50): e23667, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327355

RESUMEN

BACKGROUND: The goal of this study was to comprehensively evaluate the analgesic and antiemetic effects of adjuvant dexmedetomidine (DEX) for breast cancer surgery using a meta-analysis. METHODS: Electronic databases were searched to collect the studies that performed randomized controlled trials. The effect size was estimated by odd ratio (OR) or standardized mean difference (SMD). Statistical analysis was performed using the STATA 13.0 software. RESULTS: Twelve published studies involving 396 DEX treatment patients and 395 patients with control treatment were included. Pooled analysis showed that the use of DEX significantly prolonged the time to first request of analgesia (SMD = 1.67), decreased the postoperative requirement for tramadol (SMD = -0.65) and morphine (total: SMD = -2.23; patient-controlled analgesia: SMD = -1.45) as well as intraoperative requirement for fentanyl (SMD = -1.60), and lower the pain score at 1 (SMD = -0.30), 2 (SMD = -1.45), 4 (SMD = -2.36), 6 (SMD = -0.63), 8 (SMD = -2.47), 12 (SMD = -0.81), 24 (SMD = -1.78), 36 (SMD = -0.92), and 48 (SMD = -0.80) hours postoperatively compared with the control group. Furthermore, the risks to develop postoperative nausea/vomiting (PONV) (OR = 0.38) and vomiting (OR = 0.54) were significantly decreased in the DEX group compared with the control group. The pain relief at early time point (2, 6, 12, 24 hours postoperatively) and the decrease in the incidence of PONV were especially obvious for the general anesthesia subgroup (P < .05) relative to local anesthesia subgroup (P >.05). CONCLUSION: DEX may be a favorable anesthetic adjuvant in breast cancer surgery, which could lower postoperative pain and the risk to develop PONV. DEX should be combined especially for the patients undergoing general anesthesia.


Asunto(s)
Neoplasias de la Mama/cirugía , Dexmedetomidina/uso terapéutico , Mastectomía/métodos , Dolor Postoperatorio/prevención & control , Náusea y Vómito Posoperatorios/prevención & control , Analgésicos Opioides/administración & dosificación , Dexmedetomidina/administración & dosificación , Dexmedetomidina/efectos adversos , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Oportunidad Relativa , Dimensión del Dolor , Ensayos Clínicos Controlados Aleatorios como Asunto
7.
Medicine (Baltimore) ; 99(47): e23214, 2020 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-33217833

RESUMEN

BACKGROUND: The serratus anterior plane block (SAPB) is a novel method that provides lateral chest wall analgesia. There are 2 methods of SAPB; deep and superficial SAPB. Each of these methods has been demonstrated to provide effective perioperative analgesia in thoracic surgery. The aim of this study was to compare the intraoperative hemodynamic and analgesic benefits of deep versus superficial SAPB during video-assisted thoracic surgery (VATS) lobectomy. METHODS: We performed a prospective, randomized, patient/assessor-blinded trial. We included patients who were 20 to 75 years of age and scheduled to undergo VATS lobectomy with American Society of Anesthesiologists physical status 1 or 2. Patients were randomly allocated to receive either ultrasound-guided deep SAPB (Group D) or superficial SAPB (Group S). The primary outcome was intraoperative remifentanil consumption. We also recorded intraoperative systolic blood pressure (SBP), heart rate (HR), emergence time, and doses of rescue drugs used to manage hemodynamic instability. RESULTS: Data for 50 patients undergoing 3-port VATS lobectomy were analyzed. Intraoperative remifentanil consumption did not differ significantly between Group D (n = 25, 715.62 ±â€Š320.36 µg) and group S (n = 25, 721.08 ±â€Š294.48 µg) (P = .97). Additionally, there were no significant differences between the 2 groups in SBP and HR at any time point, emergence time, or amount of rescue drugs used. CONCLUSION: Our study suggests that the intraoperative analgesic efficacy is similar for deep and superficial SAPB during VATS lobectomy.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Bloqueo Nervioso/métodos , Neumonectomía , Remifentanilo/administración & dosificación , Cirugía Torácica Asistida por Video , Anciano , Periodo de Recuperación de la Anestesia , Presión Sanguínea , Método Doble Ciego , Femenino , Frecuencia Cardíaca , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ultrasonografía Intervencional
8.
JAMA Netw Open ; 3(11): e2023677, 2020 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-33146732

RESUMEN

Importance: The US opioid epidemic is complex and dynamic, yet relatively little is known regarding its likely future impact and the potential mitigating impact of interventions to address it. Objective: To estimate the future burden of the opioid epidemic and the potential of interventions to address the burden. Design, Setting, and Participants: A decision analytic dynamic Markov model was calibrated using 2010-2018 data from the National Survey on Drug Use and Health, Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey, the US Census, and National Epidemiologic Survey on Alcohol and Related Conditions-III. Data on individuals 12 years or older from the US general population or with prescription opioid medical use; prescription opioid nonmedical use; heroin use; prescription, heroin, or combined prescription and heroin opioid use disorder (OUD); 1 of 7 treatment categories; or nonfatal or fatal overdose were examined. The model was designed to project fatal opioid overdoses between 2020 and 2029. Exposures: The model projected prescribing reductions (5% annually), naloxone distribution (assumed 5% reduction in case-fatality), and treatment expansion (assumed 35% increase in uptake annually for 4 years and 50% relapse reduction), with each compared vs status quo. Main Outcomes and Measures: Projected 10-year overdose deaths and prevalence of OUD. Results: Under status quo, 484 429 (95% confidence band, 390 543-576 631) individuals were projected to experience fatal opioid overdose between 2020 and 2029. Projected decreases in deaths were 0.3% with prescribing reductions, 15.4% with naloxone distribution, and 25.3% with treatment expansion; when combined, these interventions were associated with 179 151 fewer overdose deaths (37.0%) over 10 years. Interventions had a smaller association with the prevalence of OUD; for example, the combined intervention was estimated to reduce OUD prevalence by 27.5%, from 2.47 million in 2019 to 1.79 million in 2029. Model projections were most sensitive to assumptions regarding future rates of fatal and nonfatal overdose. Conclusions and Relevance: The findings of this study suggest that the opioid epidemic is likely to continue to cause tens of thousands of deaths annually over the next decade. Aggressive deployment of evidence-based interventions may reduce deaths by at least a third but will likely have less impact for the number of people with OUD.


Asunto(s)
Sobredosis de Droga/mortalidad , Epidemia de Opioides/tendencias , Trastornos Relacionados con Opioides/mortalidad , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/envenenamiento , Costo de Enfermedad , Sobredosis de Droga/tratamiento farmacológico , Sobredosis de Droga/prevención & control , Femenino , Humanos , Masculino , Cadenas de Markov , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/terapia , Pautas de la Práctica en Medicina/tendencias , Estados Unidos
9.
Pan Afr Med J ; 36: 343, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33224409

RESUMEN

Introduction: sickle cell disease (SCD) has significant pediatric morbidity and mortality in sub-Saharan Africa, where access to therapies such as hydroxyurea and opioids is often limited. Poor disease control and Pain management adversely affects the well-being and mental health of affected children. Questionnaires have been utilized in other regions to report the quality of life (QOL) in children with SCD, but assessments from Africa are lacking. Methods: children age 2-14 years with SCD presenting for routine outpatient consultations at Hospital Central de Maputo from June-August 2017 were offered participation. After informed consent, the Pediatric QOL Inventory (PedsQL) SCD Module was administered to all caregivers and children > 5 years. Responses were scored from 0-100, with higher scores representing better QOL. Results: a total of 14 children were included, with six (43%), four (29%), two (14%), and two (14%) from the age groups of 2-4, 5-7, 8-12, and 13-14 years, respectively. Mean overall patient QOL was 65.3 and 56.0 in child and caregiver respondents. In patients > 5 years, the difference in mean overall QOL for those on/not on hydroxyurea was 0.6 (66.5-64.9) in child respondents and 15.8 (68.4-52.6) in caregiver respondents. Domains related to worry/emotions and communication scored lower in QOL than Pain-related domains for both patient and caregiver respondents. Conclusion: SCD has a negative impact on QOL as reported by this cohort of Mozambican pediatric patients and caregivers, with Pain being less of a concern than emotional and interpersonal issues. A comprehensive, child-focused care approach with robust psychosocial support is needed.


Asunto(s)
Anemia de Células Falciformes/fisiopatología , Accesibilidad a los Servicios de Salud , Manejo del Dolor/métodos , Calidad de Vida , Adolescente , Analgésicos Opioides/administración & dosificación , Anemia de Células Falciformes/tratamiento farmacológico , Anemia de Células Falciformes/psicología , Cuidadores/estadística & datos numéricos , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Hidroxiurea/administración & dosificación , Masculino , Mozambique , Dolor/etiología , Apoyo Social , Encuestas y Cuestionarios
10.
Pan Afr Med J ; 36: 356, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33224422

RESUMEN

The object of this study is to determine which local wound analgesic option is superior, local anaesthetic infiltration or intercostal nerve block, by combined local anaesthetic agents (0.5% bupivacaine + 2% lidocaine) and to detect which option can best alleviate the post-operative pain management and significantly prolong the time to the first rescue analgesic requirement and the total consumption of opioids in the first post-operative 72 hrs. The medical records of 1458 patients who underwent flank incision procedures by two different surgeons in our institute were retrospectively reviewed. Each surgeon used a different type of local incisional pain management; the first one used infiltration of flank incision routinely, the second surgeon used an intercostal block with all his patients. These elective procedures were carried out in our Urology Centre between June 2007 and June 2019. The duration of follow-up was from the recovery transfer until the end of the third post-operative day. Patients were divided into two groups: group 1 (729 patients-infiltration of flank incision) and group 2 (729 patients-intercostal nerve block). Patients were aged between 19-78 years. No significant differences were seen regarding the demographic data between both groups, P > 0.05. On the other hand, there were significant differences between group 1 and group 2 according to the mean visual analogue scale score (lower in group 1, P < 0.05), the total mean analgesic requirements during the first post-operative 72 hrs (lower in group 1, P < 0.05) and the time to the first analgesic demand (higher in group 1, P < 0.05). There were no statistically significant differences in post-operative complications between both groups, P > 0.05. The infiltration of flank incision with combined local anaesthetic agents (0.5% Bupivacaine + 2% lidocaine) is more effective in alleviating post-operative pain, decreasing total analgesic consumption during the first post-operative 72 hrs and prolonging the time required for the first rescue opioid.


Asunto(s)
Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Lidocaína/administración & dosificación , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Adulto , Anciano , Analgésicos Opioides/administración & dosificación , Femenino , Humanos , Nervios Intercostales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Adulto Joven
11.
PLoS One ; 15(11): e0241828, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33152029

RESUMEN

Anesthesia with desflurane and remifentanil can be maintained with either fixed or titrated desflurane concentration. We hypothesized that the fixed-gas concentration (FG) method would reduce the number of anesthetic titrations without hypnotic and hemodynamic instability compared to the bispectral index (BIS)-guided (BG) method. Forty-eight patients were randomly allocated to the FG or BG groups. In the FG group, desflurane vaporizer setting was fixed at 1 age-corrected minimum alveolar concentration (MAC). In the BG group, desflurane was titrated to target a BIS level at 50. Remifentanil was titrated to maintain a systolic arterial pressure (SAP) of 120 mmHg in both groups. Our primary endpoint was the hypnotic stability measured by the wobble of BIS in performance analysis, and the secondary endpoints included the wobble of SAP, mean BIS value during surgery, and the number of anesthetic titrations. The BIS in the FG group showed significantly less wobble (3.9 ± 1.1% vs 5.5 ± 1.5%, P <0.001) but lower value (33 ± 6 vs 46 ± 7, P <0.001) than BG group. The wobble of SAP showed no difference between groups [median (inter-quartile range), 5.0 (4.1-7.5)% vs 5.2 (4.2-8.3)%, P = 0.557]. The numbers of anesthetic titrations in the FG group were significantly lower than the BG group (0 ± 0 vs 8 ± 5, P<0.001 for desflurane, 13 ± 13 vs 22 ± 17, P = 0.047 for remifentanil). Less wobble in BIS and reduced anesthetic titration without hemodynamic instability during the FG technique may be practical in balanced anesthesia using desflurane and remifentanil anesthesia. Clinical trial: This study was registered at ClinicalTrials.gov (NCT02283866).


Asunto(s)
Analgésicos Opioides/administración & dosificación , Anestésicos por Inhalación/administración & dosificación , Desflurano/administración & dosificación , Remifentanilo/administración & dosificación , Estómago/cirugía , Anciano , Periodo de Recuperación de la Anestesia , Presión Arterial/efectos de los fármacos , Cálculo de Dosificación de Drogas , Procedimientos Quirúrgicos Electivos , Electroencefalografía , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/métodos
12.
J Subst Abuse Treat ; 119: 108139, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33138924

RESUMEN

The COVID-19 pandemic led government regulators to relax prescribing rules for buprenorphine and methadone, the agonist medications that effectively treat opioid use disorder, allowing for take home supplies of up to 28 days. These changes prioritized the availability of these medications over concerns about their misuse and diversion, and they provided a means for overdose prophylaxis during the highly uncertain conditions of the pandemic. In considering how to capitalize on this shift, research should determine the extent to which increased diversion has occurred as a result, and what the consequences may have been. The shifts also set the stage to consider if methadone can be safely prescribed in primary care settings, and if the monthly injectable formulation of buprenorphine is a suitable alternative to increased supplies of sublingual strips if concerns about diversion persist. The disruptions of the pandemic have caused a surge in overdose deaths, so carefully considering the prophylactic potential of agonist medications, in addition to their role as a treatment, may help us address this mortality crisis.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Infecciones por Coronavirus , Trastornos Relacionados con Opioides/rehabilitación , Pandemias , Neumonía Viral , Pautas de la Práctica en Medicina/estadística & datos numéricos , Desvío de Medicamentos bajo Prescripción/estadística & datos numéricos , Analgésicos Opioides/efectos adversos , Buprenorfina/administración & dosificación , Sobredosis de Droga/epidemiología , Humanos , Metadona/administración & dosificación , Tratamiento de Sustitución de Opiáceos/métodos
13.
Medicine (Baltimore) ; 99(48): e23332, 2020 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-33235097

RESUMEN

BACKGROUND: Perioperative intravenous lidocaine has been reported to have analgesic and opioid-sparing effects in many kinds of surgery. Several studies have evaluated its use in the settings of spine surgery. The aim of the study is to examine the effect of intravenous lidocaine in patients undergoing spine surgery. METHODS: We performed a quantitative systematic review. Databases of PubMed, Medline, Embase database and Cochrane library were investigated for eligible literatures from their establishments to June, 2019. Articles of randomized controlled trials that compared intravenous lidocaine to a control group in patients undergoing spine surgery were included. The primary outcome was postoperative pain intensity. Secondary outcomes included postoperative opioid consumption and the length of hospital stay. RESULT: Four randomized controlled trials with 275 patients were included in the study. postoperative pain compared with control was reduced at 6 hours after surgery (WMD -0.50, 95%CI, -0.76 to -0.25, P < .001), at 24 hours after surgery (WMD -0.50, 95%CI, -0.70 to -0.29, P < .001) and at 48 hours after surgery (WMD -0.57, 95%CI, -0.96 to -0.17, P = .005). The effect of intravenous lidocaine on postoperative opioid consumption compared with control revealed a significant effect (WMD -15.36, 95%CI, -21.40 to -9.33 mg intravenous morphine equivalents, P < .001). CONCLUSION: This quantitative analysis of randomized controlled trials demonstrated that the perioperative intravenous lidocaine was effective for reducing postoperative opioid consumption and pain in patients undergoing spine surgery. The intravenous lidocaine should be considered as an effective adjunct to improve analgesic outcomes in patients undergoing spine surgery. However, the quantity of the studies was very low, more research is needed.


Asunto(s)
Anestésicos Locales/uso terapéutico , Lidocaína/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Columna Vertebral/cirugía , Administración Intravenosa , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Humanos , Tiempo de Internación , Lidocaína/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como Asunto
14.
J Opioid Manag ; 16(5): 357-373, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33226093

RESUMEN

OBJECTIVE: The Centers for Disease Control and Prevention (CDC) recommend that clinicians prescribing opioids for chronic pain should consider at least annual urine drug testing (UDT). We evaluated whether shorter intervals for repeat UDT are associated with decreased rates of drug misuse. DESIGN: Retrospective analysis of deidentified serial UDT and matched prescribing data. SETTING: We analyzed Quest Diagnostics 2016-2017 UDT results from new patients being monitored for prescription drug adherence, in nonsubstance use disorder (SUD) treatment environments. MAIN OUTCOME MEASURES: Drug misuse was defined as the absence of a prescribed substance or the presence of a nonprescribed substance. Patients with ≥3 sets of the UDT results were included. RESULTS: UDT results from 49,601 patients (148,803 specimens) were tested. Declines in misuse between the first and second UDT were highest for those tested at the shortest intervals: approximately weekly, 19 percent; monthly, 15 percent; bimonthly, 12 percent; quarterly, 9 percent; semiannually, 3 percent; misuse rates increased by 1 percent for patients tested annually. Declines in misuse were more pronounced for opioids than other drug groups. Substantial declines in positivity were noted for heroin (32 percent) and nonprescribed fentanyl (10 percent). Declines in misuse between the second and third UDT followed a similar pattern. CONCLUSIONS: UDT intervals of ≤ quarterly were associated with marked declines, but testing annually or semiannually was not associated with consistent decreases. Our findings suggest that clinical strategies that include serial testing conducted quarterly or sooner may be instrumental in decreasing drug misuse. Testing more frequently than "at least once annually" should be considered by clinicians monitoring potential drug misuse.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Abuso de Medicamentos/estadística & datos numéricos , Detección de Abuso de Sustancias/métodos , Adulto , Analgésicos Opioides/administración & dosificación , Abuso de Medicamentos/prevención & control , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores de Tiempo
15.
J Opioid Manag ; 16(5): 391-394, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33226096

RESUMEN

Kratom (Mitragyna speciosa) is a plant extract that exhibits opioid agonistic activity at the µ-opioid receptor. The use of this substance has increased recently due to widespread local availability across the United States, primarily at gas stations. Repeated kratom use has been shown to have major adverse effects leading to physiological dependence and addiction similar to other opioids. We used a novel contingency management (CM) program utilizing nonmonetary reinforcers along with medication-assisted treatment (MAT) using buprenorphine in an office-based setting to treat kratom use disorder in two cases. MAT with buprenorphine in a CM-based setting was found to be an effective strategy for treating kratom use disorder.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Buprenorfina/uso terapéutico , Mitragyna/química , Trastornos Relacionados con Sustancias/tratamiento farmacológico , Analgésicos Opioides/administración & dosificación , Humanos , Tratamiento de Sustitución de Opiáceos/métodos , Estados Unidos
16.
Afr Health Sci ; 20(2): 806-814, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33163047

RESUMEN

Background: Inguinal herniotomy is one of the commonest paediatric surgical procedures at the University of Benin Teaching Hospital. Incisional infiltration with plain bupivacaine has been used to provide postoperative analgesia for this procedure but with a short duration of action, 4-6 hours. Aims/Objectives: The aim of this study therefore was to evaluate the efficacy of subcutaneous ketamine on post-operative analgesia in children undergoing unilateral inguinal herniotomy. Methods: Forty-six (46) ASA I or II patients aged three to seven years scheduled for unilateral inguinal herniotomy were recruited. The patients were randomized to receive surgical wound site infiltration with plain bupivacaine plus subcutaneous injection of ketamine for group I or surgical wound site infiltration plain bupivacaine plus 2ml of saline subcutaneously for group II at the end of surgery. Data obtained were analyzed using SPSS version 20. Continuous data were compared using student t-test while categorical data were compared using Chi-square or Fisher's exact test. P-value <0.05 was considered statistically significant. Results: In group, I, the mean time to first analgesic request was 667.7 minutes (11.12 hours) and in group II, it was 371.3 minutes (6.2 hours) with p<0.001. The pain scores were better and more favourable in group I from the 8th hour and above of the assessment period. The mean post-operative analgesic consumption in 24 hours was less in group I (19.35±5.4mg) than in group II (27.32±5.8 mg) with p-value <0.001. Conclusion: The study showed that subcutaneous ketamine prolonged the analgesic effect of plain bupivacaine surgical wound site infiltration in children undergoing unilateral inguinal herniotomy.


Asunto(s)
Anestésicos Disociativos/administración & dosificación , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Hernia Inguinal/cirugía , Ketamina/administración & dosificación , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Periodo de Recuperación de la Anestesia , Anestésicos Disociativos/efectos adversos , Niño , Preescolar , Femenino , Humanos , Inyecciones Subcutáneas , Ketamina/efectos adversos , Masculino , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Cuidados Posoperatorios , Resultado del Tratamiento
17.
Expert Opin Pharmacother ; 21(17): 2153-2160, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33135514

RESUMEN

INTRODUCTION: Opioids are used for severe forms of acute and cancer pain. Over the last years, their potential use in patients with noncancer pain such as those with rheumatoid arthritis (RA) has been postulated. A recent population-based comparative study showed that chronic opioid use was 12% vs. 4% among RA and non-RA patients, respectively. Another study showed an increase from 7.4% to 16.9% (2002 to 2015). In general, there has been an increasing tendency to use opioids in recent years. AREAS COVERED: The authors have performed an extensive literature search using PubMed for articles including noncancer pain and the use of the mu opioid receptor (MOR) agonists in patients with RA. EXPERT OPINION: Data is not sufficient to support opioid use for the treatment of chronic pain in patients with RA. Data is scarce and inconclusive. Rheumatologists should think and ponder the question: Why is this patient in pain? Differential diagnosis should include a disease flare, degenerative changes of the musculoskeletal system, and fibromyalgia. And while there are new strategies for opioid administration currently being researched, unfortunately, they are far from being applied to human subjects in the everyday clinical setting, and are still being evaluated at an experimental level. CNS: Central nervous system; DORs: delta opioid receptor agonists; GI: Gastrointestinal; GPCRs: G protein-coupled receptors; IL: Interleukin; JAK: Janus kinase; KORs: kappa opioid receptor agonists; MCPs: Metacarpophalangeal joints; MORs: Mu opioid receptor agonists; MTPs: Metatarsophalangeal joints; NSAIDs: Non-steroidal anti-inflammatory drugsOA: Osteoarthritis; ORs: Opioid receptors; PD: Pharmacodynamic; PIPs: Proximal interphalangeal joints; PK: Pharmacokinetic; PNS: Peripheral nervous system; RA: Rheumatoid arthritis; RGS: Regulator of G protein signaling; SSRIs: Selective serotonin reuptake inhibitors; TNF: Tumor necrosis factor.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Dolor Crónico/tratamiento farmacológico , Receptores Opioides mu/agonistas , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Animales , Artritis Reumatoide/metabolismo , Dolor Crónico/metabolismo , Humanos , Trastornos Relacionados con Opioides/prevención & control , Guías de Práctica Clínica como Asunto
18.
Anesth Analg ; 131(6): 1765-1780, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33186163

RESUMEN

Cardioprotection encompasses a variety of strategies protecting the heart against myocardial injury that occurs during and after inadequate blood supply to the heart during myocardial infarction. While restoring reperfusion is crucial for salvaging myocardium from further damage, paradoxically, it itself accounts for additional cell death-a phenomenon named ischemia/reperfusion injury. Therefore, therapeutic strategies are necessary to render the heart protected against myocardial infarction. Ischemic pre- and postconditioning, by short periods of sublethal cardiac ischemia and reperfusion, are still the strongest mechanisms to achieve cardioprotection. However, it is highly impractical and far too invasive for clinical use. Fortunately, it can be mimicked pharmacologically, for example, by volatile anesthetics, noble gases, opioids, propofol, dexmedetomidine, and phosphodiesterase inhibitors. These substances are all routinely used in the clinical setting and seem promising candidates for successful translation of cardioprotection from experimental protocols to clinical trials. This review presents the fundamental mechanisms of conditioning strategies and provides an overview of the most recent and relevant findings on different concepts achieving cardioprotection in the experimental setting, specifically emphasizing pharmacological approaches in the perioperative context.


Asunto(s)
Cardiotónicos/administración & dosificación , Precondicionamiento Isquémico Miocárdico/métodos , Daño por Reperfusión Miocárdica/prevención & control , Atención Perioperativa/métodos , Complicaciones Posoperatorias/prevención & control , Analgésicos Opioides/administración & dosificación , Humanos , Daño por Reperfusión Miocárdica/etiología , Daño por Reperfusión Miocárdica/fisiopatología , Inhibidores de Fosfodiesterasa 3/administración & dosificación , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5971-5975, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33019332

RESUMEN

The purpose of the present study was to investigate the ability of three different normalization methods, namely root mean square (RMS) value, mean value, and maximum which referred to pulse beat interval (PBI), based on photoplethysmographic diastolic interval (DI) in response to laryngeal mask airway (LMA) insertion under various remifentanil concentrations during general anesthesia. Sixty patients were randomly allocated to one of the four groups to receive a possible remifentanil effect-compartment target concentration (Ceremi) of 0, 1, 3, or 5 ng/ml, and an effect-compartment target controlled infusion of propofol to maintain the state entropy (SE) at 40~60. Three normalized measures DIRMS, DIMean, and DIPBI were compared with the DI values without normalization. Before LMA insertion, only DI showed a considerable correlation with remifentanil concentrations. DIRMS and DIMean performed better than DI in discriminating 'insufficient' concentrations (0 and 1 ng/ml) from 'sufficient' concentrations (3 and 5 ng/ml). DIRMS was superior to all other variables in grading analgesic depth after nociceptive event occurred with PK value of 0.836. These results demonstrate that the normalization using RMS value, compared to using mean value and maximum, seems to provide a more effective approach for signal pre-processing.


Asunto(s)
Analgésicos Opioides , Anestesia General , Máscaras Laríngeas , Fotopletismografía , Propofol , Remifentanilo , Analgésicos , Analgésicos Opioides/administración & dosificación , Humanos , Piperidinas , Remifentanilo/administración & dosificación
20.
Medicine (Baltimore) ; 99(43): e22667, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120758

RESUMEN

BACKGROUND: Total knee arthroplasty is accompanied by moderate to severe postoperative pain. Postoperative pain hampers the functional recovery and lowers patient satisfaction with the surgery. Recently, the adductor canal block (ACB) has been widely used in total knee arthroplasty. However, there is no definite answer as to the location of a continuous block within the ACBs. METHOD: Randomized controlled trials about relevant studies were searched in PubMed (1996 to Oct 2019), Embase (1996 to Oct 2019), and Cochrane Library (CENTRAL, Oct 2019). RESULTS: Five studies involving 348 patients met the inclusion criteria. Pooled data indicated that the proximal ACB was as effective as the distal ACB in terms of total opioid consumption (P = .54), average visual analog scale (VAS) score (P = .35), worst VAS score (P = .19), block success rate (P = .86), and time of catheter insertion (P = .54). CONCLUSIONS: Compared with the distal ACB, the proximal ACB showed similar analgesic efficacy for total opioid consumption, average VAS score, worst VAS score, block success rate, and time of catheter insertion. However, because of the limited number of involved studies, more high-quality studies are needed to further identify the optimal location of the ACB.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Bloqueo Nervioso/métodos , Manejo del Dolor/métodos , Dolor Postoperatorio/prevención & control , Anciano , Analgésicos Opioides/administración & dosificación , Femenino , Nervio Femoral , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Ensayos Clínicos Controlados Aleatorios como Asunto
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