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1.
R I Med J (2013) ; 102(6): 35-40, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31398967

RESUMO

OBJECTIVE: Our objective was to identify patterns of opioid use among pregnant women enrolled in RI Medicaid. METHODS: This study used linked RI Medicaid and RI Birth Certificate data from 01/01/2006 to 12/31/2016. We examined temporal trends of prescription opioid dispensings and identified risk factors associated with opioids use during pregnancy. RESULTS: Among 25,500 RI Medicaid enrolled pregnant women who delivered a live baby from 2008 to 2016, 1,914 (7.5%) received at least one prescription for an opioid medication during pregnancy, 810 (3.2%) were during the first trimester, 633 (2.5%) during the second trimester, and 866 (3.4%) during the third trimester. Of these, 213 (0.8%) women received 3 or more opioids during pregnancy. The prevalence of prescription opioids dispensed in pregnant women increased from 4.9% in 2008 to 9.6% in 2015 (ß±SD: 0.66±0.28, P=0.05). CONCLUSIONS: Prescription opioid use during pregnancy has increased among women enrolled in RI Medicaid.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Gravidez , Adolescente , Adulto , Feminino , Humanos , Hidrocodona/uso terapêutico , Modelos Logísticos , Análise Multivariada , Oxicodona/uso terapêutico , Dor/tratamento farmacológico , Trimestres da Gravidez , Estudos Retrospectivos , Rhode Island , Estados Unidos , Adulto Jovem
2.
Medicine (Baltimore) ; 98(34): e16810, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441852

RESUMO

BACKGROUD: The aim of this study was to compare the analgesic and adverse effects of oxycodone with 3 different infusion modes on postoperative pain after laparoscopic radical surgery of cervical cancer. METHODS: Ninety patients undergoing laparoscopic radical surgery of cervical cancer were randomly divided into 3 groups: Group A (continuous infusion with 0.01 mg/kg/h and a bolus dose with 0.03 mg/kg), Group B (a bolus dose with 0.03 mg/kg) and Group C (PCA was administered as a time-scheduled decremental continuous infusion based on lean body mass). A blinded observer recorded Visual Analogue Scale (VAS), Ramsay sedation score (RSS), infused cumulative dose of oxycodone and side effects at 1, 6, 12, 24, and 48 hours postoperatively, and satisfaction during the postoperative 48 hours. RESULTS: There were significant differences in the VAS pain score when resting or coughing among 3 groups at 1, 6 and 48 hours postoperatively (P <.05). VAS was significantly higher in Group B than in Group A and C until postoperative 1, 6, and 48 hours (P <.05). There were significant differences in cumulative PCA dose among the 3 groups at 1 and 48 hours postoperatively (P <.05). Group C showed significantly less amount of cumulative PCA dose compared to other 2 groups at 1 hour, whereas cumulative PCA dose of Group A at 48 hours was significantly more than other 2 groups (P <.05). There were no significant differences in postoperative nausea and vomiting, FAS, muscle chilling score and RSS among 3 groups at 1, 6, 12, 24 and 48 hours postoperatively. In addition, there was no difference in overall satisfaction during 48 hours postoperatively among 3 groups. CONCLUSIONS: Oxycodone provides significant analgesic effect in 3 different infusion modes over 48 hours after laparoscopic radical surgery of cervical cancer, and a time-scheduled decremental continuous infusion of oxycodone can become a better choice for patients after surgery of cervical cancer.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/uso terapêutico , Oxicodona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Neoplasias do Colo do Útero/cirurgia , Adulto , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Laparoscopia , Masculino , Pessoa de Meia-Idade , Oxicodona/administração & dosagem , Oxicodona/efeitos adversos , Medição da Dor , Estudos Prospectivos
4.
J Trauma Acute Care Surg ; 87(1): 100-103, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31259870

RESUMO

BACKGROUND: Postoperative outpatient narcotic overprescription plays a significant role in the opioid epidemic. Outpatient opioid prescription ranges from 150 to 350 oral morphine equivalent (OME) for a laparoscopic cholecystectomy or appendectomy, with 75 OME (10 pills of 5 mg of oxycodone) being the lowest recommendation (National Institute on Drug Abuse, 2018). We hypothesized that the addition of nonopioid medications to the outpatient pain control regimen would decrease the need for narcotics. METHODS: In this prospective, observational pilot study, we prescribed a 3-day regimen of ibuprofen and acetaminophen to patients after uncomplicated laparoscopic cholecystectomies and appendectomies. An additional opioid prescription for 5 pills of 5 mg of oxycodone (37.5 OME) was written for breakthrough pain. During their postoperative visit, we evaluated patients' adherence to the pain control regime, their postdischarge opioid use, and the adequacy of their pain control. RESULTS: Sixty-five patients were included in the study (52% male). The majority (80%) of surgeries were performed urgently or emergently. The visual analog scale pain score at home was significantly better than upon discharge (3.7 vs. 5.5, p = 0.001). The average number of oxycodone pills taken postdischarge was 1.8 pills. Half (51%) of the patients did not take any opioids. All but four patients reported that their pain was adequately controlled. No patient required additional opioid prescriptions or visited the emergency department. CONCLUSION: This study demonstrated that opioids can be eliminated in at least half of the patients and that five pills of 5 mg of oxycodone (37.5 OME) is sufficient for outpatient pain control when a 3-day course of ibuprofen and acetaminophen is prescribed. LEVEL OF EVIDENCE: Therapeutic study, level V.


Assuntos
Acetaminofen/uso terapêutico , Analgésicos não Entorpecentes/uso terapêutico , Ibuprofeno/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Analgésicos Opioides/uso terapêutico , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxicodona/uso terapêutico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Projetos Piloto , Estudos Prospectivos
5.
Medicine (Baltimore) ; 98(24): e15505, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192908

RESUMO

BACKGROUND: The study aims to investigate the effect and safety of sustained-release oxycodone hydrochloride as background dose on pain titration in patients with moderate-to-severe cancer pain. MATERIAL AND METHODS: Adult patients scheduled with a regular strong opioid for cancer-related pain were recruited and randomly assigned to sustained-release oxycodone group (tablets, 12 hourly) and immediate-release morphine group (5 mg initially, hourly). All patients were hourly reassessed for efficacy and dose titration. RESULTS: The primary end point was the number of titration cycles required to achieve adequate pain relief (numerical rating scale, NRS ≤ 3). Secondary end points included the proportion of patients achieving adequate pain relief during each cycle, potential predictive factors for titration performance, and side effects. Ninety (94.7%) patients in oxycodone group and 78 (86.7%) patients in morphine group achieved adequate pain control during 1 to 4 cycles of titration. Patients in oxycodone group reached adequate pain control within the first 2 cycles of titration, which was significantly shorter than morphine group wherein the number of titration cycles ranged from 1 to 4 (P = .034). Oxycodone prescription significantly increased the response rate of patients to morphine titration during the first cycle of titration (P = .010). The initial NRS score and oxycodone administration were significantly associated with titration performance. The mild or moderate adverse effects were similar in 2 groups, while severe adverse effects were only identified in morphine group (P = .001). CONCLUSION: Use of background sustained-release oxycodone is more efficient and better tolerated on dose titration than immediate-release morphine.


Assuntos
Dor do Câncer/tratamento farmacológico , Morfina/administração & dosagem , Oxicodona/administração & dosagem , Idoso , Preparações de Ação Retardada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Oxicodona/uso terapêutico , Medição da Dor , Resultado do Tratamento
6.
Acta Med Port ; 32(5): 388-399, 2019 May 31.
Artigo em Português | MEDLINE | ID: mdl-31166900

RESUMO

INTRODUCTION: All health professionals should be aware of the importance of evaluating pain - fifth vital sign- in cancer patients. Peripheral and central acting analgesics are widely used to treat moderate to severe pain, particularly cancer pain. Many guidelines have addressed this issue. However, real life patients' have other problems and comorbidities that may raise doubts when prescribing. MATERIAL AND METHODS: Authors made a literature search, trying to clarify same specific situations: loss of oral route, renal impairment (hemodialysis), hepatic impairment, frequent opiod interactions and the availability of short-acting formulations. RESULTS: The following medicines were included in this analysis: the natural opiates (morphine and codeine), their synthetic and semisynthetic derivatives (hydromorphone, oxycodone, and fentanyl), the partial agonist buprenorphine and finally tramadol and tapentadol. Transdermal systems are only available for buprenorphine and fentanyl. In hepatic impairment, fentanyl is safe, but with the exception of codeine and tramadol; other opioids should be used with caution. In renal failure: fentanyl, hydromorphone, and tapentadol are safe. Morphine should be avoided; other opioids should be used with caution. In hemodialysis, buprenorphine, fentanyl, hydromorphone and tramadol (at doses up to 200 mg/day) may be used. DISCUSSION: Failure to recognize the impact of various situations described throughout this work, including the bioavailability due to loss of oral route, due to pharmacokinetics and pharmacodynamics of the various drugs, either in the context of the impaired metabolism or excretion, or in due to pharmacological interactions, conditions a serious risk of subtreatment of pain and consequent impact in terms of quality of life. CONCLUSION: Opioid prescription is safe and effective, even in moderate to severe comorbidities such as renal and hepatic impairment and in patients with no oral route available. In this case, as when considering pharmacological interactions, an individualized therapeutic plan is the best solution and the patient should be assessed regularly. Unadjusted doses may relate to bad pain control and a higher prevalence of adverse events.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor do Câncer/tratamento farmacológico , Administração Oral , Analgésicos Opioides/metabolismo , Buprenorfina/uso terapêutico , Codeína/uso terapêutico , Transtornos de Deglutição/complicações , Fentanila/administração & dosagem , Fentanila/uso terapêutico , Humanos , Hidromorfona/uso terapêutico , Falência Hepática/metabolismo , Morfina/uso terapêutico , Oxicodona/uso terapêutico , Diálise Renal , Insuficiência Renal/terapia , Tapentadol/uso terapêutico , Tramadol/uso terapêutico
7.
Knee ; 26(4): 881-888, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31171426

RESUMO

BACKGROUND: Peripheral nerve blocks reduce postoperative pain and opioid consumption after total knee arthroplasty (TKA). The aim of this study was to evaluate the effects of single-shot femoral nerve and sciatic nerve blocks on postoperative pain management and opioid consumption after TKA. METHODS: This study included 100 patients who underwent TKA between July 2015 and September 2017. Fifty patients received pre-operative, single-injection, ultrasound-guided femoral and sciatic nerve blocks (Group 1) and 50 did not (Group 2). Multimodal analgesia was otherwise identical, and oxycodone was administered either intravenously or orally if the patients complained of postoperative pain ≥6 on the visual analog scale (VAS). Postoperative VAS scores, opioid consumption, and the fear of future TKA were compared between the groups. RESULTS: The mean VAS in the first 18 postoperative hours was significantly lower in Group 1 (P ≤ 0.002). The mean amount of oxycodone taken in the first three postoperative days was significantly lower in Group 1 (P = 0.001). Patient fear of future TKA at 14 days postoperatively was significantly lower in Group 1 (P = 0.027). CONCLUSIONS: Pre-operative ultrasound-guided, single-shot femoral and sciatic nerve blocks afforded effective pain control in the first 18 h after TKA, and significantly reduced oxycodone consumption in the first three postoperative days.


Assuntos
Artroplastia do Joelho , Nervo Femoral , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Nervo Isquiático , Ultrassonografia de Intervenção , Idoso , Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxicodona/uso terapêutico , Período Pós-Operatório , Estudos Retrospectivos , Escala Visual Analógica
8.
Eur J Pharmacol ; 854: 109-118, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-30978319

RESUMO

Oxycodone and morphine are two opioid drugs commonly used for the treatment of moderate to severe pain. However, their use in the management of noncancer pain remains a controversial issue and, in this respect, the evidence on their effectiveness and safety, particularly in osteoarthritis, is being questioned. In order to analyse their analgesic profile, two different pain models in rats were used: the formalin-induced inflammatory pain and the monosodium iodoacetate (MIA)-induced knee osteoarthritic pain. Drugs were administered systemically (i.p.) and their antinociceptive effect and potency were assessed. In the formalin test, both morphine and oxycodone produced a dose-dependent antinociceptive effect, but oxycodone outdid morphine in terms of effectiveness and potency (nearly two times) in the early (acute nociceptive) as in the late phase (inflammatory). In the osteoarthritis model, both drugs reduced movement-evoked pain (knee-bend test), mechanical allodynia (von Frey test) and heat hyperalgesia (Plantar test). Pretreatment with naloxone and naloxone methiodide reduced morphine and oxycodone effects. Peripheral mu-opioid receptors play a crucial role in the antinociceptive effect of both drugs on movement-evoked pain and heat hyperalgesia, but not on tactile allodynia. The main finding of our study is that oxycodone has a better antinociceptive profile in the inflammatory and osteoarthritic pain, being more effective than morphine at 14 days post-MIA injection (phase with neuropathic pain); it overcame the morphine effect by improving the movement-induced pain, tactile allodynia and heat hyperalgesia. Therefore, oxycodone could be an interesting option to treat patients suffering from knee osteoarthritis when opioids are required.


Assuntos
Analgésicos/farmacologia , Morfina/farmacologia , Osteoartrite do Joelho/complicações , Oxicodona/farmacologia , Dor/complicações , Dor/tratamento farmacológico , Analgésicos/uso terapêutico , Animais , Modelos Animais de Doenças , Hiperalgesia/complicações , Inflamação/complicações , Locomoção/efeitos dos fármacos , Masculino , Morfina/uso terapêutico , Oxicodona/uso terapêutico , Dor/metabolismo , Dor/fisiopatologia , Ratos , Ratos Wistar , Receptores Opioides/metabolismo
11.
J Opioid Manag ; 15(1): 51-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30855723

RESUMO

OBJECTIVE: To investigate efficacy and tolerability of tapentadol immediate release (IR) in the treatment of moderate to severe acute pain in three surgical pain models. DESIGN: Three randomized, double-blind, placebo- and active-controlled, multicenter, phase 3 trials were performed in total hip replacement surgery, abdominal hysterectomy, and bunionectomy with trial medications administered every 4-6 hours as needed for up to 72 hours. Tapentadol IR was included in all trials, oxycodone IR in the total hip replacement trial, and morphine IR in the abdominal hysterectomy and bunionectomy trials; active controls ensured assay sensitivity. MAIN OUTCOME MEASURES: The primary efficacy endpoint was the sum of pain intensity differences over the first 24 hours of treatment (SPID24) in the abdominal hysterectomy trial and SPID48 in the other two trials. Tolerability was assessed by adverse events reporting. RESULTS: A total of 330, 832, and 285 patients with total hip replacement, abdominal hysterectomy, and bunionectomy, respectively, were assessed for efficacy. All three trials demonstrated statistically significant improvements of tapentadol IR on the primary endpoint versus placebo and similar improvements compared to morphine IR or oxycodone IR. These findings were consistent with results of total pain relief assessments and patients' global impressions of change in their overall health status after 72 hours (abdominal hysterectomy, bunionectomy). The tolerability profile of tapentadol IR was as expected for a centrally acting analgesic in the post-surgery setting. CONCLUSIONS: Tapentadol IR has strong analgesic efficacy and is well tolerated in multiple post-surgery conditions of moderate to severe pain.


Assuntos
Analgésicos Opioides , Dor Pós-Operatória/tratamento farmacológico , Tapentadol , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Oxicodona/uso terapêutico , Fenóis , Ensaios Clínicos Controlados Aleatórios como Assunto , Tapentadol/uso terapêutico
12.
Drug Alcohol Depend ; 197: 250-254, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30875645

RESUMO

OBJECTIVE: Despite recent decreases in opioid prescribing rates, evidence suggests there is substantial variation in the way opioids are prescribed by providers. This study aims to identify patterns in high-volume opioid prescribing. METHODS: We conducted partitioning-around-medoids cluster analysis using the IQVIA Prescriber Profile dataset, including the number of opioid prescriptions filled at US retail pharmacies aggregated at the prescriber-level from July 2016 through June 2017. Clustering was used to identify prescription patterns within a sample of 10,000 high-volume opioid prescribers (defined as the top 10% of prescribers by number of opioid prescriptions during the 12-month period). Clustering variables included prescription counts by opioid type, and prescriber specialty, age, and region. RESULTS: Family medicine (32%), internal medicine (23%), and orthopedics (11%) were the most common high-volume prescribing specialties. Across specialties, hydrocodone and oxycodone were the most-frequently prescribed opioid types. Thirty-five clusters of prescribers were obtained, consistently comprised of a single majority specialty and region. All majority high-prescribing specialties were represented in Southern clusters, indicating consistently high volume opioid prescribing across specialties in the region. Prescribing patterns varied by drug type and region - across every Northeastern cluster, oxycodone prescribing was higher than hydrocodone. While clusters of pain medicine specialists had the highest median total prescriptions, emergency medicine specialist clusters had some of the lowest. CONCLUSIONS: These results provide a clearer picture of current patterns among high-volume prescribers, who accounted for almost two-thirds of all opioid prescriptions. In light of the ongoing opioid overdose epidemic, this knowledge is critical for prevention activities.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Análise por Conglomerados , Medicina de Família e Comunidade/estatística & dados numéricos , Feminino , Humanos , Hidrocodona/uso terapêutico , Medicina Interna/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ortopedia/estatística & dados numéricos , Oxicodona/uso terapêutico
13.
BMC Palliat Care ; 18(1): 31, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30922276

RESUMO

BACKGROUND: Opioids are prescribed in over 40% of patients with advanced cancer, but side effects occur frequently. In this study we evaluated the development and treatment of opioid induced constipation (OIC), and OIC resolving effect of methylnaltrexone for different opioid subtypes in daily clinical practice. METHODS: Patients with cancer using opioids were included in a retrospective chart analysis. Baseline characteristics, data on opioid use, laxative use, and OIC were collected. Patients with OIC who were prescribed methylnaltrexone, were included in a prospective observational trial (NCT01955213). RESULTS: Thirty-nine of 327 patients (pts) with cancer who were treated with opioids suffered from OIC (overall prevalence 12%; 95%-CI: 8-15%). The prevalence of OIC was similar in patients treated with oxycodone or fentanyl (12 of 81 pts. vs. 18 of 110 pts., RR 0.9; 95%CI 0.4-2.0). The morphine equivalent daily dose did not significantly differ between opioid subtypes (fentanyl 89 mg (IQR 60-180) vs. oxycodone 40 mg (40-80), P = 0.231). Twenty-two individual patients (7%) were admitted for OIC. Most effective laxatives in admitted patients were enemas, methylnaltrexone, or 4-l polyethylene-glycol solution. In the prospective observational study, the effect of methylnaltrexone could be evaluated in 23 patients. Eleven patients achieved the primary endpoint of ≥2 laxation responses out of the first four doses methylnaltrexone, independent of opioid subtype. CONCLUSIONS: OIC is a burdensome clinical problem independent of opioid subtype. Timely intensification of prophylactic laxative treatment, especially when opioid doses increase, may help to prevent OIC. Clinically overt OIC requires a more intensive laxative regimen with for example methylnaltrexone. TRIAL REGISTRATION: NCT01955213 .


Assuntos
Analgésicos Opioides/efeitos adversos , Constipação Intestinal/tratamento farmacológico , Idoso , Analgésicos Opioides/uso terapêutico , Constipação Intestinal/etiologia , Feminino , Fentanila/efeitos adversos , Fentanila/uso terapêutico , Humanos , Laxantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Naltrexona/análogos & derivados , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Oxicodona/efeitos adversos , Oxicodona/uso terapêutico , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Estudos Prospectivos , Compostos de Amônio Quaternário/uso terapêutico , Estudos Retrospectivos , Inquéritos e Questionários
14.
Clin Drug Investig ; 39(5): 455-462, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30852809

RESUMO

BACKGROUND AND OBJECTIVES: In 2014, the Italian Medicines Agency (AIFA) amended the summary of product characteristics of codeine-containing medications limiting their use for maximum three days. This study attempted to clarify the impact of AIFA intervention on prescribing trends and appropriateness of use of codeine-containing medications and other opioids. METHODS: Using the Health Search Database, a quasi-experimental interrupted time series analysis was conducted to evaluate changes in prescribing trends and appropriateness of use of codeine-containing medications and opioids between 2013 and 2015. RESULTS: Prescribing trends of codeine-containing medications significantly decreased (on average, - 352 days of treatment per month of observation), while long-acting opioids (LAOs) had an overall increase. Trends of inappropriate prescriptions significantly increased for two LAOs (i.e. tapentadol, naloxone-oxycodone), both before and after AIFA intervention. CONCLUSION: The use of paracetamol-codeine combination was effectively decreased in Italy because of AIFA intervention. Instead, prescriptions of tapentadol and oxycodone-naloxone stably increased over the study period irrespective of regulatory intervention. Given that the choice of the most appropriate opioid therapy is not straightforward, especially in elderly and/or comorbid patients, general practitioners should consider carefully alternative therapies on the bases of regulatory interventions.


Assuntos
Acetaminofen/uso terapêutico , Analgésicos Opioides/uso terapêutico , Codeína/uso terapêutico , Prescrições de Medicamentos , Análise de Séries Temporais Interrompida/tendências , Atenção Primária à Saúde/tendências , Idoso , Combinação de Medicamentos , Feminino , Humanos , Análise de Séries Temporais Interrompida/métodos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Naloxona/uso terapêutico , Oxicodona/uso terapêutico , Atenção Primária à Saúde/legislação & jurisprudência , Atenção Primária à Saúde/métodos
16.
Neurosci Lett ; 699: 151-159, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-30708128

RESUMO

Treatment of cancer-induced bone pain (CIBP) is challenging in clinics. Oxycodone is used to treat CIBP. However, the lack of understanding of the mechanism of CIBP limits the application of oxycodone. In this study, proteomic profiling of oxycodone-treated spinal dorsal cord of rats with CIBP was performed. Briefly, a total of 3519 proteins were identified in the Sham group; 3505 proteins in the CIBP group; and 3530 proteins in the CIBP-OXY treatment group. The 2-fold cut-off value was used as the differential protein standard for abundance reduction or increase (p < 0.05). Significant differences were found in the abundance of 16 proteins between Sham and CIBP group; 11 proteins in the CIBP group had increased abundance while 5 proteins had reduced abundance. Furthermore, fifteen proteins with differential abundance were identified between the CIBP group and the OXY group. Compared with the CIBP group, there were six increased abundances and nine reduced abundances in the OXY group. In addition, a reduced expression of ADP-ribosylation factor-like 6 binding factor 1 (Arl6ip-1), an endoplasmic reticulum protein that has an important role in cell conduction and material transport, was found in the CIBP group compared with the Sham group. Its expression increased after the administration of OXY. Proteomics results were further verified by Western-blot. Fluorescent staining revealed that Arl6ip-1 co-localized with spinal dorsal horn neurons, but not with astrocytes or microglia. Based on the observed results, we believe that Arl6ip-1 may be a potential drug target for OXY treatment of CIBP rats.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Neoplasias Ósseas/complicações , Dor do Câncer/tratamento farmacológico , Dor do Câncer/metabolismo , Proteínas de Membrana/metabolismo , Oxicodona/farmacologia , Oxicodona/uso terapêutico , Proteômica , Proteínas Adaptadoras de Transdução de Sinal/biossíntese , Proteínas Adaptadoras de Transdução de Sinal/efeitos dos fármacos , Animais , Astrócitos/metabolismo , Dor do Câncer/etiologia , Dor do Câncer/prevenção & controle , Feminino , Proteínas de Membrana/biossíntese , Proteínas de Membrana/efeitos dos fármacos , Microglia/metabolismo , Medição da Dor , Células do Corno Posterior/metabolismo , Ratos
17.
Drug Des Devel Ther ; 13: 365-372, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30705584

RESUMO

Background: Percutaneous radiofrequency ablation (RFA) is a recently introduced alternative technique for the treatment of hepatic cancer. Anesthesia is required for RFA of hepatic cancer to achieve patient comfort and immobilization during this painful procedure. The purpose of this study was to investigate the analgesic efficacy and evaluate the safety of a single intravenous injection of oxycodone hydrochloride for this procedure. Patients and methods: A total of 120 American Society of Anesthesiologists class I-II grade patients for elective ultrasound-guided percutaneous RFA were enrolled in this randomized controlled trial. Patients were randomized (1:1) to receive either a single intravenous injection of oxycodone (group O) or continuous infusion of remifentanil (group R). Both groups received the continuous infusion of dexmedetomidine for sedation. Visual analog scale (VAS), rescue analgesic, and side effects were checked during the periprocedural period. In addition, patient and oncologist satisfaction on a scale of 1-5 were determined. Results: VAS score in group O was significantly lower than in group R at 1, 2, and 3 hours after RFA, and patients in group O required analgesics significantly later and less doses in the first 24 hours after RFA. The occurrence of unwanted body movements was significantly lower in group O. We found no complications including allergic reaction, excessive sedation, and chest wall rigidity in all patients. The patient satisfaction score was significantly higher in group O than that in group R. Conclusion: Ultrasound-guided percutaneous RFA for hepatic cancer can be completed both with continuous infusion of remifentanil or a single intravenous injection of oxycodone. However, oxycodone hydrochloride provides better patient experience with higher satisfactory score and less unwanted body movements, relieves post-procedural pain better, and is not associated with an increase in adverse effects.


Assuntos
Analgésicos Opioides/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Oxicodona/uso terapêutico , Ablação por Radiofrequência , Remifentanil/uso terapêutico , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Oxicodona/administração & dosagem , Remifentanil/administração & dosagem , Ultrassonografia de Intervenção
18.
Support Care Cancer ; 27(10): 3759-3767, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30712098

RESUMO

BACKGROUND: Pain due to oral mucositis (OM) is a major problem during concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients. METHODS: We enrolled 56 NPC patients receiving CCRT and allocated them into two groups: moderate pain group (n = 27) and a severe pain group (n = 29) according to the degree of pain reported (moderate = numerical rating scale (NRS) score 4-6 or severe = NRS score 7-10) at initiation of controlled-release oxycodone (CRO) treatment. RESULTS: Total dose of CRO was significantly higher in severe pain patients than in moderate pain patients (791.60 ± 332.449 mg vs. 587.27 ± 194.940 mg; P = 0.015). Moderate pain patients had significantly better quality of life (P = 0.037), lower weight loss (P = 0.030) and more active CCRT response (90.9% vs. 64.0%; P = 0.041). Although 24-h pain control rate was comparable in the two groups (85.2% vs. 86.2%; P = 0.508), the moderate pain group score eventually stabilized at ~ 2 vs. 3 in the severe pain group (P < 0.001); the titration time to reach bearable pain (NRS ≤ 3) was also significantly shorter in moderate pain patients (2.45 ± 0.60 days vs. 3.60 ± 1.98 days; P = 0.012). Incidence of adverse events was comparable in both groups. CONCLUSIONS: The study findings suggest that early introduction of low-dose CRO at the moderate pain stage could help reduce the total dose required, provide better pain control, improve quality of life, and enhance CCRT response.


Assuntos
Analgésicos Opioides/uso terapêutico , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Dor/tratamento farmacológico , Estomatite/patologia , Adulto , Idoso , Quimiorradioterapia/efeitos adversos , Preparações de Ação Retardada/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/patologia , Neoplasias Nasofaríngeas/patologia , Oxicodona/administração & dosagem , Estudos Prospectivos , Qualidade de Vida , Estomatite/induzido quimicamente , Estomatite/tratamento farmacológico , Perda de Peso
19.
Orthopedics ; 42(2): 110-115, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30810754

RESUMO

The goal of this study was to evaluate 3 common oral analgesics-oxycodone (OXY), ibuprofen (IBU), and acetaminophen (ACE)-for pain management following carpal tunnel release (CTR) and trigger finger release (TFR) surgery. Outcome measures were pain scores, capsule consumption patterns, and satisfaction. Carpal tunnel or trigger finger patients indicated to undergo primary, unilateral release received 10 capsules of either OXY (5 mg), IBU (600 mg), or ACE (500 mg) postoperatively. Medications were distributed in a randomized fashion, with both surgeons and patients blinded to the selected analgesic. Postoperatively, patients recorded pain level each day using a 0 to 10 visual analog scale, the number of capsules taken each day, and any adverse effects experienced. Medication distribution among the 188 patients completing the study was 62 OXY, 64 IBU, and 62 ACE. Surgical distribution was 76 TFR, 61 endoscopic CTR, and 51 open CTR. Overall, the mean total number of capsules consumed from postoperative days 0 through 5 for OXY, IBU, and ACE was 3.2, 4.0, and 3.1, respectively (P>.05). Mean worst daily pain score for the OXY, IBU, and ACE groups was 2.9, 2.5, and 2.5, respectively (P<.05). On subgroup analyses by procedure type, the only difference was found in the open CTR group, with the highest daily pain scores noted in the OXY group (P<.05). Nine of the 11 patients experiencing an adverse reaction also came from the OXY group. There were no reoperations or allergic reactions in any group. In this study, no clinically significant difference in pain experience or capsule consumption based on postoperative opioid vs nonopioid medication was identified. Adverse events were highest in the OXY group. In lieu of opioids, the authors suggest prescribing nonopioids first following TFR and CTR surgery. In addition, they advise prescribing 5 to 10 or fewer pills postoperatively regardless of the analgesic selected. [Orthopedics. 2019; 42(2):110-115.].


Assuntos
Acetaminofen/uso terapêutico , Síndrome do Túnel Carpal/cirurgia , Ibuprofeno/uso terapêutico , Oxicodona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dedo em Gatilho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escala Visual Analógica , Adulto Jovem
20.
Female Pelvic Med Reconstr Surg ; 25(2): e18-e22, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807430

RESUMO

OBJECTIVE: The aim of the study was to evaluate the association of patient factors, amount of in-hospital postoperative narcotics, and pain scores on postdischarge narcotic use (PDNU). METHODS: This is a secondary analysis of a randomized controlled trial comparing a postoperative usual-care regimen with multimodal pain regimen after pelvic reconstructive surgery. This analysis evaluated patients in the multimodal arm. Postdischarge narcotic use (as mg oral morphine equivalents, MME, calculated from narcotic tablets remaining) was assessed postoperative days 7 to 10. Brief Pain Inventory (BPI) surveys were collected preoperatively and at postoperative day 1. Patient factors were evaluated using univariate and multivariate analysis. Correlations examined the relationships between PDNU and postoperative in-hospital narcotic use and BPI scores. RESULTS: Sixty-eight patients randomized to the multimodal pain regimen arm had median (interquartile range) PDNU of 22.5 (0-159.4) MME. After excluding postdischarge narcotic nonusers (34.8%), the median PDNU was 127.5 (22.5-180.0) MME. The median PDNU was 172.5 (150.0-180.0) MME after abdominal reconstructive surgery (n = 7), 82.5 (28.1-180.0) MME after laparoscopic reconstructive surgery (n = 22), and 37.5 (13.1-181.2) MME after vaginal reconstructive surgery (n = 14). A linear correlation was noted between the amount of postoperative narcotics used in-hospital and the amount needed postdischarge after abdominal (r = 0.588, P = 0.057), laparoscopic (r = 0.439, P = 0.019), and vaginal (r = 0.455, P = 0.017) reconstructive surgeries. The BPI scores on postoperative day 1 for "average" pain (r = 0.388, P = 0.002) and "now" pain (r = 0.490, P < 0.001), and on postoperative week 1 for "average" pain (r = 0.383, P = 0.002) and "now" pain (r = 0.389, P = 0.002) correlated with PDNU. CONCLUSIONS: Amount of postoperative in-hospital use of narcotic medications and BPI scores can be valuable predictors of PDNU in patients undergoing pelvic reconstructive surgery.


Assuntos
Analgésicos Opioides/uso terapêutico , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Abdome/cirurgia , Acetaminofen/uso terapêutico , Idoso , Analgésicos não Entorpecentes/uso terapêutico , Feminino , Humanos , Ibuprofeno/uso terapêutico , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Alta do Paciente , Prolapso de Órgão Pélvico/cirurgia , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vagina/cirurgia
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