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2.
J Spec Oper Med ; 20(1): 31-33, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32203601

RESUMO

Ketamine's favorable hemodynamic and safety profile is motivating increasing use in the prehospital environment. Despite these advantages, certain side effects require advanced planning and training. We present a case of rapid intravenous administration of ketamine causing bradycardia and hypotension. A 46-year-old man presented to the emergency department for an exacerbation of chronic shoulder pain. Given the chronicity of the pain and multiple failed treatment attempts, ketamine at an analgesic dose was used. Despite the local protocol directing administration over several minutes, it was pushed rapidly, resulting in malaise, nausea, pallor, bradycardia, and hypotension. The patient returned to his baseline without intervention. This and other known side effects of ketamine, such as behavioral disturbances, altered sense of reality, and elevated heart rate and blood pressure, are well documented in the literature. With this report, the authors aim to raise awareness of transient bradycardia and hypotension associated with the rapid administration of ketamine at an analgesic dose.


Assuntos
Analgésicos/efeitos adversos , Bradicardia/induzido quimicamente , Hipotensão/induzido quimicamente , Ketamina/efeitos adversos , Analgésicos/administração & dosagem , Serviço Hospitalar de Emergência , Humanos , Infusões Intravenosas , Ketamina/administração & dosagem , Masculino , Pessoa de Meia-Idade
3.
PLoS One ; 15(1): e0227762, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929589

RESUMO

Intranasal ketamine has recently gained interest in human medicine, not only for its sedative, anaesthetic or analgesic properties, but also in the management of treatment resistant depression, where it has been shown to be an effective, fast acting alternative treatment. Since several similarities are reported between human psychiatric disorders and canine anxiety disorders, intranasal ketamine could serve as an alternative treatment for anxiety disordered dogs. However, to the authors knowledge, intranasal administration of ketamine and its pharmacokinetics have never been described in dogs. Therefore, this study aimed to examine the pharmacokinetics, absolute bioavailability and tolerability of intranasal ketamine administration compared with intravenous administration. Seven healthy, adult laboratory Beagle dogs were included in this randomized crossover study. The dogs received 2 mg/kg body weight ketamine intravenously (IV) or intranasally (IN), with a two-week wash-out period. Prior to ketamine administration, dogs were sedated intramuscularly with dexmedetomidine. Venous blood samples were collected at fixed times until 480 min post-administration and ketamine plasma concentrations were determined by liquid chromatography-tandem mass spectrometry. Cardiovascular parameters and sedation scores were recorded at the same time points. Non-compartmental pharmacokinetic analysis revealed a rapid (Tmax = 0.25 ± 0.14 h) and complete IN bioavailability (F = 147.65 ± 49.97%). Elimination half-life was similar between both administration routes (T1/2el IV = 1.47 ± 0.24 h, T1/2el IN = 1.50 ± 0.97 h). Heart rate and sedation scores were significantly higher at 5 and 10 min following IV administration compared to IN administration, but not at the later time-points.


Assuntos
Analgésicos/sangue , Dexmedetomidina/administração & dosagem , Ketamina/sangue , Administração Intranasal , Analgésicos/efeitos adversos , Analgésicos/farmacologia , Animais , Disponibilidade Biológica , Dexmedetomidina/farmacologia , Cães , Feminino , Frequência Cardíaca/efeitos dos fármacos , Ketamina/administração & dosagem , Ketamina/efeitos adversos , Ketamina/farmacologia , Masculino
4.
Expert Rev Clin Pharmacol ; 13(2): 135-146, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31990596

RESUMO

Introduction: The use of ketamine infusions for chronic pain has surged, with utilization exceeding the proliferation of knowledge. A proposed mechanism for the long-term benefit in chronic pain is that ketamine may alter the affective-motivational component of pain.Areas covered: In this review, we discuss the classification and various dimensions of pain, and explore the effects of ketamine on different pain categories and components. The relationship between ketamine's action at the NMDA receptor, the development of chronic pain, and the its possible role in preventing the persistence of pain are examined. We also summarize animal models evaluating the antinociceptive effects of ketamine and risk mitigation strategies of ketamine-associated side effects.Expert opinion: Although ketamine exerts most of its analgesic effects via the NMDA receptor, recent evidence suggests that other receptors such as AMPA, and active metabolites such as nor-ketamine, may also play a role in pain relief and alleviation of depression. Data from clinical studies performed in patients with chronic pain and depression, and the observation that ketamine's analgesic benefits outlast its effects on quantitative sensory testing, suggest that the enduring effects on chronic pain may be predominantly due ketamine's ability to modulate the affective-motivational dimension of pain.


Assuntos
Analgésicos/administração & dosagem , Dor Crônica/tratamento farmacológico , Ketamina/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos/farmacologia , Animais , Dor Crônica/fisiopatologia , Depressão/tratamento farmacológico , Depressão/fisiopatologia , Modelos Animais de Doenças , Antagonistas de Aminoácidos Excitatórios/administração & dosagem , Antagonistas de Aminoácidos Excitatórios/efeitos adversos , Antagonistas de Aminoácidos Excitatórios/farmacologia , Humanos , Infusões Intravenosas , Ketamina/efeitos adversos , Ketamina/farmacologia , Receptores de N-Metil-D-Aspartato/efeitos dos fármacos , Receptores de N-Metil-D-Aspartato/metabolismo
5.
Oncology ; 98(2): 117-122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31715614

RESUMO

BACKGROUND: The treatment of kidney cancer usually involves surgery, and in some cases systemic therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to control postsurgical pain in patients undergoing nephrectomy for renal cancer. Nevertheless, the association between these drugs and adverse postsurgical outcomes, including deterioration of renal function, is not fully established. METHODS: This retrospective cohort study included patients >18 years old with kidney cancer undergoing nephrectomy between January 2006 and January 2018. The primary endpoint was to determine the impact of postsurgical analgesic therapy (NSAIDs vs. acetaminophen) on renal function and postsurgical complications. This study was approved by our scientific and bioethical committee. RESULTS: One hundred patients were included in the final analysis. Clear-cell renal-cell carcinoma was the most frequent histologic subtype. Adequate acute pain control was accomplished in 91% of the patients during hospitalization. Twenty percent of the patients presented postsurgical complications. Bleeding-related complications were the most frequent (9%), followed by surgical-site infection (6%) and acute renal injury (6%). The administration of NSAIDs was not related to any postsurgical complication in comparison with the use of acetaminophen (21.3 vs. 17.9%, respectively). The length of hospital stay did not differ between patients treated with NSAIDs and those treated with acetaminophen (the average stay was 4 days for both groups, p = 0.32). CONCLUSION: The use of NSAIDs was not related to acute kidney injury, postsurgical complications, or prolonged hospital stay in patients with renal cancer undergoing nephrectomy.


Assuntos
Analgésicos/efeitos adversos , Neoplasias Renais/complicações , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Analgésicos/administração & dosagem , Biomarcadores , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/metabolismo , Prognóstico , Resultado do Tratamento
6.
Gastroenterology ; 158(1): 123-136, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470006

RESUMO

BACKGROUND & AIMS: Peppermint oil is frequently used to treat irritable bowel syndrome (IBS), despite a lack of evidence for efficacy from high-quality controlled trials. We studied the efficacy and safety of small-intestinal-release peppermint oil in patients with IBS and explored the effects of targeted ileocolonic-release peppermint oil. METHODS: We performed a double-blind trial of 190 patients with IBS (according to Rome IV criteria) at 4 hospitals in The Netherlands from August 2016 through March 2018; 189 patients were included in the intent-to-treat analysis (mean age, 34.0 years; 77.8% female; 57.7% in primary care), and 178 completed the study. Patients were randomly assigned to groups given 182 mg small-intestinal-release peppermint oil, 182 mg ileocolonic-release peppermint oil, or placebo for 8 weeks. The primary endpoint was abdominal pain response, as defined by the US Food and Drug Administration: at least a 30% decrease in the weekly average of worst daily abdominal pain compared with baseline in at least 4 weeks. The co-primary endpoint was overall relief of IBS symptoms, as defined by the European Medicines Agency. Secondary endpoints included abdominal pain, discomfort, symptom severity, and adverse events. RESULTS: Abdominal pain response did not differ significantly between the peppermint oil and placebo groups: 29 of 62 patients in the small-intestinal-release peppermint oil group had a response (46.8%, P = .170 vs placebo), 26 of 63 patients in the ileocolonic-release peppermint oil group had a response (41.3%, P = .385 vs placebo), and 22 of 64 patients in the placebo group had a response (34.4%). We did not find differences among the groups in overall relief (9.7%, P = .317 and 1.6%, P = .351 vs 4.7% for placebo). The small intestinal peppermint oil did, however, produce greater improvements than placebo in secondary outcomes of abdominal pain (P = .016), discomfort (P = .020), and IBS severity (P = .020). Adverse events, although mild, were more common in both peppermint oil groups (P < .005). CONCLUSIONS: In a randomized trial of patients with IBS, we found that neither small-intestinal-release nor ileocolonic-release peppermint oil (8 weeks) produced statistically significant reductions in abdominal pain response or overall symptom relief, when using US Food and Drug Administration/European Medicines Agency recommended endpoints. The small-intestinal-release peppermint oil did, however, significantly reduce abdominal pain, discomfort, and IBS severity. These findings do not support further development of ileocolonic-release peppermint oil for treatment of IBS. Clinicaltrials.gov, Number: NCT02716285.


Assuntos
Dor Abdominal/tratamento farmacológico , Analgésicos/administração & dosagem , Síndrome do Intestino Irritável/tratamento farmacológico , Óleos Vegetais/administração & dosagem , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Administração Oral , Adolescente , Adulto , Idoso , Analgésicos/efeitos adversos , Cápsulas , Método Duplo-Cego , Feminino , Humanos , Mucosa Intestinal/efeitos dos fármacos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/diagnóstico , Masculino , Pessoa de Meia-Idade , Países Baixos , Medição da Dor , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
7.
BMC Complement Altern Med ; 19(1): 370, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842860

RESUMO

BACKGROUND: Tianshu capsule (TSC), a formula of traditional Chinese medicine, has been widely used in clinical practice for prophylactic treatment of headaches in China. However, former clinical trials of TSC were small, and lack of a standard set of diagnostic criteria to enroll patients. The study was conducted to re-evaluate the efficacy and safety of TSC post-marketing in an extending number of migraineurs who have diagnosed migraine with the International Classification of Headache Disorders, 3rd edition (beta version, ICHD-3ß). METHODS: The study was a double-blind, randomized, placebo-controlled clinical trial that conducted at 20 clinical centers in China. At enrollment, patients between 18 and 65 years of age diagnosed with migraine were assigned to receive either TSC (4.08 g, three times daily) or a matched placebo according to a randomization protocol. The primary endpoint was a relative reduction of 50% or more in the frequency of headache attacks. The secondary outcomes included a reduction in the incidence of headache, the visual analogue scale of headache attacks, days of acute analgesic usage, and percentage of patients with a decrease of 50% or more in headache severity. Accompanying symptoms were also assessed. RESULTS: One thousand migraine patients were initially enrolled in the study, and 919 of them completed the trial. Following the 12-week treatment, significant improvement was observed in the TSC group concerning both primary and secondary outcomes. After therapy discontinuation, the gap between the TSC group and the placebo group in efficacy outcomes continued to increase. There were no severe adverse effects. CONCLUSIONS: TSC is an effective, well-tolerated medicine for prophylactic treatment of migraine, and still have prophylactic effect after medicine discontinuation. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02035111; Data of registration: 2014-01-10.


Assuntos
Analgésicos/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Adulto , Analgésicos/efeitos adversos , Método Duplo-Cego , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Acta Clin Croat ; 58(Suppl 1): 114-117, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741569

RESUMO

Medico-legal responsibility in the management of acute or chronic pain in broad sense implies acting by the rules of good clinical practice and reducing the potential treatment side effects and complications that may entail health impairment and possible legal proceedings. Patients with acute or chronic obstetric or nonobstetric pain should be informed on the mode and method of treatment, possible side effects, and effects of drugs or procedures on fetal growth and development (informed consent). The principles of perinatal pharmacology and toxicology should be respected, choosing the mode of treatment associated with the lowest rate of side effects and a minimally invasive procedure (Accordingly, medico-legal responsibility is a professional and deontological category that should be fostered and implemented in line with professional guidelines and safety for both patients and medical staff.).


Assuntos
Dor Aguda/terapia , Dor Crônica/terapia , Responsabilidade Legal , Manejo da Dor , Complicações na Gravidez/terapia , Analgésicos/efeitos adversos , Feminino , Humanos , Consentimento Livre e Esclarecido , Obstetrícia , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Educação de Pacientes como Assunto , Gravidez
9.
JAMA ; 322(19): 1887-1898, 2019 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-31742631

RESUMO

Importance: Ubrogepant is an oral calcitonin gene-related peptide receptor antagonist under investigation for acute treatment of migraine. Objective: To evaluate the efficacy and tolerability of ubrogepant compared with placebo for acute treatment of a single migraine attack. Design, Setting, and Participants: Phase 3, multicenter, randomized, double-blind, placebo-controlled, single-attack, clinical trial (ACHIEVE II) conducted in the United States (99 primary care and research clinics; August 26, 2016-February 26, 2018). Participants were adults with migraine with or without aura experiencing 2 to 8 migraine attacks per month. Interventions: Ubrogepant 50 mg (n = 562), ubrogepant 25 mg (n = 561), or placebo (n = 563) for a migraine attack of moderate or severe pain intensity. Main Outcomes and Measures: Co-primary efficacy outcomes were pain freedom and absence of the participant-designated most bothersome migraine-associated symptom (among photophobia, phonophobia, and nausea) at 2 hours after taking the medication. Results: Among 1686 randomized participants, 1465 received study treatment (safety population; mean age, 41.5 years; 90% female); 1355 of 1465 (92.5%) were evaluable for efficacy. Pain freedom at 2 hours was reported by 101 of 464 participants (21.8%) in the ubrogepant 50-mg group, 90 of 435 (20.7%) in the ubrogepant 25-mg group, and 65 of 456 (14.3%) in the placebo group (absolute difference for 50 mg vs placebo, 7.5%; 95% CI, 2.6%-12.5%; P = .01; 25 mg vs placebo, 6.4%; 95% CI, 1.5%-11.5%; P = .03). Absence of the most bothersome associated symptom at 2 hours was reported by 180 of 463 participants (38.9%) in the ubrogepant 50-mg group, 148 of 434 (34.1%) in the ubrogepant 25-mg group, and 125 of 456 (27.4%) in the placebo group (absolute difference for 50 mg vs placebo, 11.5%; 95% CI, 5.4%-17.5%; P = .01; 25 mg vs placebo, 6.7%; 95% CI, 0.6%-12.7%; P = .07). The most common adverse events within 48 hours of any dose were nausea (50 mg, 10 of 488 [2.0%]; 25 mg, 12 of 478 [2.5%]; and placebo, 10 of 499 [2.0%]) and dizziness (50 mg, 7 of 488 [1.4%]; 25 mg, 10 of 478 [2.1%]; placebo, 8 of 499 [1.6%]). Conclusions and Relevance: Among adults with migraine, acute treatment with ubrogepant compared with placebo led to significantly greater rates of pain freedom at 2 hours with 50-mg and 25-mg doses, and absence of the most bothersome migraine-associated symptom at 2 hours only with the 50-mg dose. Further research is needed to assess the effectiveness of ubrogepant against other acute treatments for migraine and to evaluate the long-term safety of ubrogepant among unselected patient populations. Trial Registration: ClinicalTrials.gov Identifier: NCT02867709.


Assuntos
Analgésicos/administração & dosagem , Transtornos de Enxaqueca/tratamento farmacológico , Dor/tratamento farmacológico , Piridinas/administração & dosagem , Pirróis/administração & dosagem , Adulto , Idoso , Analgésicos/efeitos adversos , Tontura/induzido quimicamente , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Manejo da Dor , Piridinas/efeitos adversos , Pirróis/efeitos adversos , Adulto Jovem
10.
Medicine (Baltimore) ; 98(44): e17541, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689755

RESUMO

BACKGROUND: Previous clinical trials indicated that duloxetine may be effective in the treatment of osteoarthritis (OA) pain. This meta-analysis is conducted to evaluate short term analgesic effect and safety of duloxetine in the treatment of OA. METHODS: Electronic databases were searched in February 2019, including PUBMED, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science. All eligible studies should be randomized controlled trials (RCTs) comparing duloxetine treatment group to placebo about OA pain relief and safety outcomes. RESULTS: Five RCTs with 2059 patients were involved in this systematic review and meta-analysis. Compared to placebo, duloxetine treatment showed significant better result, with higher reduction pain intensity (mean difference [MD] = -0.77, P < .00001), higher rates of both 30% and 50% reduction in pain severity (risk ratio [RR] = 1.42, P < .00001; RR = 1.62, P < .00001), lower mean Patient Global Improvement-Inventory (PGI-I) score (MD = -0.48, P < .00001). The results of the Western Ontario and McMaster Universities (WOMAC) score change from baseline to endpoint also favored duloxetine treatment group in all four categories, including total (MD = -5.43, P < .00001), pain (MD = -1.63, P = .001), physical function (MD = -4.22, P < .00001), and stiffness score (MD = -0.58, P < .00001). There were higher rates of treatment-emergent adverse events (TEAEs) (RR = 1.32, P < .00001) and discontinuation (RR = 1.88, P < .00001) in duloxetine group. However, there was no significant difference in the incidence of severe adverse events (SAEs) between these 2 groups (RR = 0.84, P = .68). CONCLUSION: Duloxetine was an effective and safe choice to improve pain and functional outcome in OA patients. However, further studies are still needed to find out the optimal dosage for OA and examine its long-term efficacy and safety. TRIAL REGISTRATION NUMBER: CRD42019128862.


Assuntos
Analgésicos/uso terapêutico , Cloridrato de Duloxetina/uso terapêutico , Osteoartrite/tratamento farmacológico , Analgésicos/efeitos adversos , Cloridrato de Duloxetina/efeitos adversos , Humanos , Ontário , Medição da Dor , Gravidade do Paciente , Desempenho Físico Funcional , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Lancet Psychiatry ; 6(11): 935-950, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31588045

RESUMO

BACKGROUND: Antidepressants, opioids for non-cancer pain, gabapentinoids (gabapentin and pregabalin), benzodiazepines, and Z-drugs (zopiclone, zaleplon, and zolpidem) are commonly prescribed medicine classes associated with a risk of dependence or withdrawal. We aimed to review the evidence for these harms and estimate the prevalence of dispensed prescriptions, their geographical distribution, and duration of continuous receipt using all patient-linked prescription data in England. METHODS: This was a mixed-methods public health review, comprising a rapid evidence assessment of articles (Jan 1, 2008, to Oct 3, 2018; with searches of MEDLINE, Embase, and PsycINFO, and the Cochrane and King's Fund libraries), an open call-for-evidence on patient experience and service evaluations, and a retrospective, patient-linked analysis of the National Health Service (NHS) Business Services Authority prescription database (April 1, 2015, to March 30, 2018) for all adults aged 18 years and over. Indirectly (sex and age) standardised rates (ISRs) were computed for all 195 NHS Clinical Commissioning Groups in England, containing 7821 general practices for the geographical analysis. We used publicly available mid-year (June 30) data on the resident adult population and investigated deprivation using the English Indices of Multiple Deprivation (IMD) quintiles (quintile 1 least deprived, quintile 5 most deprived), with each patient assigned to the IMD quintile score of their general practitioner's practice for each year. Statistical modelling (adjusted incident rate ratios [IRRs]) of the number of patients who had a prescription dispensed for each medicine class, and the number of patients in receipt of a prescription for at least 12 months, was done by sex, age group, and IMD quintile. FINDINGS: 77 articles on the five medicine classes were identified from the literature search and call-for-evidence. 17 randomised placebo-controlled trials (6729 participants) reported antidepressant-associated withdrawal symptoms. Almost all studies were rated of very low, low, or moderate quality. The focus of qualitative and other reports was on patients' experiences of long-term antidepressant use, and typically sudden onset, severe, and protracted withdrawal symptoms when medication was stopped. Between April 1, 2017, and March 31, 2018, 11·53 million individuals (26·3% of residents in England) had a prescription dispensed for at least one medicine class: antidepressants (7·26 million [16·6%]), opioids (5·61 million [12·8%]), gabapentinoids (1·46 million [3·3%]), benzodiazepines (1·35 million [3·1%]), and Z-drugs (0·99 million [2·3%]). For three of these medicine classes, more people had a prescription dispensed in areas of higher deprivation, with adjusted IRRs (referenced to quintile 1) ranging from 1·10 to 1·24 for antidepressants, 1·20 to 1·85 for opioids, and 1·21 to 1·85 for gabapentinoids across quintiles, and higher ISRs generally concentrated in the north and east of England. In contrast, the highest ISRs for benzodiazepines and Z-drugs were generally in the southwest, southeast, and east of England, with low ISRs in the north. Z-drugs were associated with increased deprivation, but only at the highest quintile (adjusted IRR 1·11 [95% CI 1·01-1·22]). For benzodiazepines, prescribing was reduced for people in quintiles 4 (0·90 [0·85-0·96]) and 5 (0·89 [0·82-0·97]). In March, 2018, for each of medicine class, about 50% of patients who had a prescription dispensed had done so continuously for at least 12 months, with the highest ISRs in the north and east. Long-term prescribing was associated with a gradient of increased deprivation. INTERPRETATION: In 1 year over a quarter of the adult population in England had a prescription dispensed for antidepressants, opioids (for non-cancer pain), gabapentinoids, benzodiazepines, or Z-drugs. Long-term (>12 months) prescribing is common, despite being either not recommended by clinical guidelines or of doubtful efficacy in many cases. Enhanced national and local monitoring, better guidance for personalised care, and better doctor-patient decision making are needed. FUNDING: Public Health England.


Assuntos
Analgésicos Opioides/efeitos adversos , Analgésicos/efeitos adversos , Antidepressivos/efeitos adversos , Benzodiazepinas/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Acetamidas/efeitos adversos , Adolescente , Adulto , Idoso , Compostos Azabicíclicos/efeitos adversos , Bases de Dados Factuais/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Gabapentina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Piperazinas/efeitos adversos , Pregabalina/efeitos adversos , Saúde Pública , Pirimidinas/efeitos adversos , Síndrome de Abstinência a Substâncias/epidemiologia , Adulto Jovem , Zolpidem/efeitos adversos
12.
Anaesthesia ; 74(12): 1601-1610, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31535721

RESUMO

Cataract surgery is usually of short duration and is associated with minimal pain when employing topical or regional anaesthesia. Patient education regarding the peri-operative process may help alleviate anxiety and avoid the need for sedation. However, sedation may be required, and we discuss the various options. Many consider that pre-operative fasting is necessary due to the risk of aspiration but fasting may not be required if minimal sedation is administered. If the use of sedatives, hypnotics or analgesics is required, then their associated adverse events should be considered.


Assuntos
Analgesia , Extração de Catarata/métodos , Sedação Consciente , Analgésicos/efeitos adversos , Sedação Consciente/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Cuidados Intraoperatórios
13.
Medicine (Baltimore) ; 98(37): e17065, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517828

RESUMO

BACKGROUND: In this study, we will assess the efficacy and safety of metoclopramide for the treatment of acute migraine (AM). METHODS: We will comprehensively search Cochrane Library, PUMBED, EMBASE, Google Scholar, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the inception to July 1, 2019 to identify any eligible studies. Only randomized controlled trials will be considered for inclusion. The study selection, data collection, and management will be completed by two authors independently. The risk of bias will be assessed using Cochrane risk of bias tool. RevMan 5.3 software will be used for statistical analysis. RESULTS: The primary outcome includes pain intensity, as measured by visual analogue scale or others. The secondary outcomes are success rate, requirement of rescue medicine, quality of life, relapse, and adverse events. CONCLUSIONS: This study will summarize the latest evidence for the clinical efficacy and safety of metoclopramide for the treatment of AM. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019142795.


Assuntos
Analgésicos/uso terapêutico , Metoclopramida/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Revisões Sistemáticas como Assunto , Analgésicos/efeitos adversos , Humanos , Metanálise como Assunto , Metoclopramida/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Complement Ther Med ; 46: 123-130, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31519268

RESUMO

The prior medical literature offers little guidance as to how pain relief and side effect manifestation may vary across commonly used and commercially available cannabis product types. We used the largest dataset in the United States of real-time responses to and side effect reporting from patient-directed cannabis consumption sessions for the treatment of pain under naturalistic conditions in order to identify how cannabis affects momentary pain intensity levels and which product characteristics are the best predictors of therapeutic pain relief. Between 06/06/2016 and 10/24/2018, 2987 people used the ReleafApp to record 20,513 cannabis administration measuring cannabis' effects on momentary pain intensity levels across five pain categories: musculoskeletal, gastrointestinal, nerve, headache-related, or non-specified pain. The average pain reduction was -3.10 points on a 0-10 visual analogue scale (SD = 2.16, d = 1.55, p < .001). Whole Cannabis flower was associated with greater pain relief than were other types of products, and higher tetrahydrocannabinol (THC) levels were the strongest predictors of analgesia and side effects prevalence across the five pain categories. In contrast, cannabidiol (CBD) levels generally were not associated with pain relief except for a negative association between CBD and relief from gastrointestinal and non-specified pain. These findings suggest benefits from patient-directed, cannabis therapy as a mid-level analgesic treatment; however, effectiveness and side effect manifestation vary with the characteristics of the product used.


Assuntos
Cannabis/química , Maconha Medicinal/uso terapêutico , Dor/tratamento farmacológico , Analgésicos/efeitos adversos , Analgésicos/uso terapêutico , Canabidiol/efeitos adversos , Canabidiol/uso terapêutico , Cannabis/efeitos adversos , Dronabinol/efeitos adversos , Dronabinol/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Flores/química , Humanos , Maconha Medicinal/efeitos adversos
15.
J Clin Neurosci ; 70: 33-36, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31540858

RESUMO

Medication overuse headache (MOH) has a high relapse rate and disease heterogeneity. This study aimed to determine the predictors of MOH relapse in patients through a 6-month follow-up in Shanghai. In this retrospective study, patients diagnosed with MOH from June 2016 to June 2017 were recruited and followed up for 6 months after withdrawal treatment in Renji Hospital in Shanghai. Patients' information was obtained using headache questionnaires. Follow-up was conducted via telephone interview. Patients were divided into relapse group and no-relapse group according to the outcomes after 6 months. This study enrolled 124 outpatients with MOH at baseline. 102 patients completed the follow up and were analysis finally. Demographics and clinical characteristics were compared between the relapse (n = 39, 38.24%) and no-relapse (n = 63, 61.76%) group. Binary logistic regression analysis was performed, and two variables emerged as significant predictors of relapse before withdrawal; the headache frequency (day/month) was higher in the relapse group than in the no-relapse group [odds ratio (OR) 1.107, p = 0.008]. Furthermore, patients administered analgesics of ≥ 2 units per headache day had a higher risk of relapse [odds ratio (OR) 2.791, p = 0.038]. Headache frequency and analgesics units per headache day before withdrawal may be independent predictors of MOH relapse. Therefore, early identification of high-risk groups and enhancing patients' management could contribute to improving the prognosis of MOH.


Assuntos
Transtornos da Cefaleia Secundários , Adulto , Analgésicos/efeitos adversos , China , Feminino , Seguimentos , Transtornos da Cefaleia Secundários/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários
16.
Tidsskr Nor Laegeforen ; 139(12)2019 Sep 10.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31502800

RESUMO

BACKGROUND: In July 2013, the Department of Paediatric and Adolescent Medicine at Østfold Hospital Trust introduced nitrous oxide as an option for procedural sedation of children and adolescents. MATERIAL AND METHOD: During the period 13 July 2013-25 August 2017, 311 procedures were performed with nitrous oxide in 238 patients aged 4-17 years. Age, sex, type and duration of procedure, any supplementary medications, complications and whether the procedure would previously have required general anaesthesia, were recorded in a form. The child rated the effectiveness of nitrous oxide using a graded age-appropriate 10-point pain scale, and the nurse rated it as good, moderate or none. RESULTS: The children reported a median pain score of 2/10 (interquartile range 0-4), and nurses rated effectiveness as good in 247 of 304 (81 %) cases. For 43 % of procedures, the nurse felt that general anaesthesia would have been necessary had the department not had access to nitrous oxide. Adverse effects, most often dizziness, were reported in 110 of 311 procedures (35 %). In 7 of 311 procedures (2 %), the patient experienced adverse effects that resulted in stoppage of the procedure. The procedure was completed in 286 (92 %) children. INTERPRETATION: Nitrous oxide is a useful option for children who require procedural sedation, and means that more procedures can be performed without general anaesthesia.


Assuntos
Anestésicos Inalatórios , Óxido Nitroso , Utilização de Procedimentos e Técnicas , Adolescente , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos/farmacologia , Anestesia Geral/estatística & dados numéricos , Anestesia Local , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/farmacologia , Criança , Pré-Escolar , Contraindicações de Medicamentos , Feminino , Humanos , Masculino , Óxido Nitroso/administração & dosagem , Óxido Nitroso/efeitos adversos , Óxido Nitroso/farmacologia , Noruega , Enfermeiras e Enfermeiros , Medição da Dor , Utilização de Procedimentos e Técnicas/normas , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Resultado do Tratamento
17.
Regul Toxicol Pharmacol ; 108: 104478, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31539568

RESUMO

Worldwide, drug-induced liver injury (DILI) is a major cause of hepatic failure. It is also the leading cause of withdrawal, cautionary labeling, and restricted usage of licensed drugs; therefore, European Medicines Agency (EMA) and United States Food and Drug Administration (FDA) warn that the existing methods of assessing DILI are insufficient and that some of the translational biomarkers of hepatotoxicity must be relooked. Magnetic resonance imaging (MRI) seems to be a proper tool in elucidating the effects of DILI in both preclinical and clinical studies, providing excellent visualization of the morphology of the liver parenchyma. Therefore, herein, we propose preclinical MRI assessment of liver injury in experimental paracetamol-treated rats. Quantitative MRI clearly provides evidence of adverse effects in the liver tissue caused by a single overdose of paracetamol (1 g kg-1 and 1.5 g kg-1 b.w.). The results of the MRI were confirmed by the histopathological examination (H&E) of the rat liver specimen, however the adverse effects were not disclosed due to standard aminotransferase assays (ALT/AST) in rat blood serum. The results of our analysis demonstrate the successful application of MRI in the examination of paracetamol-induced hepatotoxicity in rats; it has a potential to serve as the early diagnostic tool for the prediction of DILI in preclinical evaluation.


Assuntos
Acetaminofen/efeitos adversos , Analgésicos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico por imagem , Imagem por Ressonância Magnética , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Doença Hepática Induzida por Substâncias e Drogas/sangue , Doença Hepática Induzida por Substâncias e Drogas/patologia , Avaliação Pré-Clínica de Medicamentos , Feminino , Fígado/diagnóstico por imagem , Fígado/efeitos dos fármacos , Fígado/patologia , Ratos Wistar
18.
Minerva Med ; 110(5): 455-463, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31368292

RESUMO

Peripheral neuropathies are frequently encountered in clinical practice and are associated with a major impairment in quality of life. However, their management remains poor, and current therapies are often burdened with major side effects and can present poor efficacy on pain and functionality. Therefore, it has been suggested that the combination of two or more different drugs may improve analgesic efficacy and reduce side effects. Tricortin® 1000 is formulated with 12 mg of Brain cortex phospholipid liposomes + 1000 µg of Cyanocobalamin injectable solution (PL+CNCbl) for intramuscular use and is indicated in the treatment of poly-algo-neuropathic syndromes. This combination exerts a marked neurotrophic action by promoting the synthesis of endogenous phospholipids; moreover, the peculiar formulation optimizes the delivery of CNCbl which has analgesic and neurotrophic action. This paper discusses the pharmacotherapy of peripheral neuropathies, including low-back pain, neck pain, postherpetic neuropathy (PHN) and focuses on the fixed dose combination PL+CNCbl clinical efficacy in association with other treatments or in monotherapy.


Assuntos
Analgésicos/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Fosfolipídeos/uso terapêutico , Vitamina B 12/uso terapêutico , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Córtex Cerebral/química , Ensaios Clínicos como Assunto , Combinação de Medicamentos , Humanos , Injeções Intramusculares , Lipossomos , Fármacos Neuroprotetores/administração & dosagem , Fármacos Neuroprotetores/efeitos adversos , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Fosfolipídeos/administração & dosagem , Fosfolipídeos/efeitos adversos , Vitamina B 12/administração & dosagem , Vitamina B 12/efeitos adversos
19.
J Clin Psychopharmacol ; 39(5): 446-454, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31433347

RESUMO

PURPOSE/BACKGROUND: As a sole agent, ketamine acutely compromises driving ability; however, performance after coadministration with the adjuvant sedating agents dexmedetomidine or fentanyl is unclear. METHODS/PROCEDURES: Using a randomized within-subject design, 39 participants (mean ± SD age, 28.4 ± 5.8 years) received 0.3 mg/kg bolus followed by 0.15 mg kg h infusion of ketamine (3-hour duration), in addition to either (i) 0.7 µg kg h infusion of dexmedetomidine for 1.5 hours (n = 19; KET/DEX) or (ii) three 25 µg fentanyl injections for 1.5 hours (n = 20; KET/FENT). Whole blood drug concentrations were determined during ketamine only, at coadministration (KET/DEX or KET/FENT) and at 2 hours after treatment. Subjective effects were determined using a standardized visual analog scale. Driving performance was assessed at baseline and at posttreatment using a validated computerized driving simulator. Primary outcomes included SD of lateral position (SDLP) and steering variability (SV). FINDINGS/RESULTS: Administration of ketamine with dexmedetomidine but not fentanyl significantly increased SDLP (F1,18 = 22.60, P < 0.001) and reduced SV (F1,18 = 164.42, P < 0.001) 2 hours after treatment. These deficits were comparatively greater for the KET/DEX group than for the KET/FENT group (t37 = -5.21 [P < 0.001] and t37 = 5.22 [P < 0.001], (respectively). For the KET/DEX group, vehicle control (SV) and self-rated performance (visual analog scale), but not SDLP, was inversely associated with ketamine and norketamine blood concentrations (in nanograms per milliliter). Greater subjective effects were moderately associated with driving deficits. IMPLICATIONS/CONCLUSIONS: Driving simulator performance is significantly compromised after coadministration of analgesic range doses of ketamine with dexmedetomidine but not fentanyl. An extended period of supervised driver abstinence is recommended after treatment, with completion of additional assessments to evaluate home readiness.


Assuntos
Condução de Veículo , Dexmedetomidina/administração & dosagem , Fentanila/administração & dosagem , Ketamina/administração & dosagem , Adulto , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Simulação por Computador , Dexmedetomidina/efeitos adversos , Quimioterapia Combinada , Feminino , Fentanila/efeitos adversos , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Ketamina/efeitos adversos , Ketamina/análogos & derivados , Ketamina/farmacocinética , Masculino , Adulto Jovem
20.
Expert Rev Clin Pharmacol ; 12(10): 1003-1007, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31437412

RESUMO

Introduction: The choice of the proper intrathecal drug to treat neuropathic pain has been subject to much debate in recent years. Areas Covered: Currently, the United States Food and Drug Administration (USFDA) has approved two drugs for chronic intrathecal use for the treatment of pain; however, there has been substantial growth in the development of other intrathecal drugs that can be used for neuropathic pain. We performed a PubMed literature search looking at intrathecal drug research for neuropathic pain between January 2005 to May 2019 and discuss current practices and mechanisms in treating these complex patients. Expert Opinion: On-label intrathecal drugs are recommended if efficacious with acceptable side effects. In those suffering from neuropathic pain, clinical evidence suggests additional drug algorithms for treating these patients are necessary. There is ample room for growth in the development and approval of novel drugs for intrathecal delivery to manage neuropathic pain.


Assuntos
Analgésicos/administração & dosagem , Desenvolvimento de Medicamentos/métodos , Neuralgia/tratamento farmacológico , Analgésicos/efeitos adversos , Animais , Aprovação de Drogas , Rotulagem de Medicamentos , Humanos , Injeções Espinhais , Estados Unidos , United States Food and Drug Administration
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