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2.
Support Care Cancer ; 29(1): 263-269, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32350670

RESUMO

BACKGROUND: Wax microsphere bound oxycodone was developed as an abuse-deterrent opioid and maintains a similar pharmacokinetic profile whether administered with or without an intact capsule. We hypothesized that microsphere oxycodone could be utilized for extended release analgesia in patients undergoing radiation (RT) for head-and-neck cancer (HNC) and would not need to be discontinued due to dysphagia or gastrostomy tube dependence. METHODS AND MATERIALS: We performed a prospective trial that enrolled participants > 18 years with histologically confirmed HNC who were scheduled to receive RT. Analgesia was prescribed in accordance with the WHO pain ladder. Microsphere oxycodone was initiated when total daily opioid dose exceeded 30 mg of morphine sulfate equivalent and was titrated weekly during RT. Pain level and effect on quality of life were assessed using the Brief Pain Inventory. The primary feasibility endpoint was frequency of microsphere oxycodone discontinuation within 3 months of RT for reasons other than pain resolution. RESULTS: Twenty-six eligible patients were enrolled. Microsphere oxycodone was initiated in 16 (61.5%) patients. Six (23.1%) patients utilized a gastrostomy tube to administer microsphere oxycodone during all or part of RT. Microsphere oxycodone was discontinued in 1 (7.6%) patient due to perceived inefficacy. No patients were discontinued due to toxicity or difficulty with administration. Ratings for average pain was 3.1 (± 3.4) at enrollment, 4.0 (± 2.4) at week 6 of RT, and 1.8 (± 2.2) at 3-month follow-up. CONCLUSIONS: These results support the feasibility and safety of microsphere oxycodone for extended release analgesia among patients with HNC undergoing RT.


Assuntos
Analgésicos Opioides/uso terapêutico , Neoplasias de Cabeça e Pescoço/radioterapia , Morfina/uso terapêutico , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Dor/tratamento farmacológico , Analgesia , Transtornos de Deglutição , Preparações de Ação Retardada/uso terapêutico , Feminino , Gastrostomia , Humanos , Masculino , Microesferas , Pessoa de Meia-Idade , Mucosite/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Oxicodona/administração & dosagem , Estudos Prospectivos , Qualidade de Vida/psicologia
3.
Lakartidningen ; 1172020 11 05.
Artigo em Sueco | MEDLINE | ID: mdl-33150576

RESUMO

Patients normally use opioids for less than 3 days after soft tissue and simple bone surgery in the upper extremity [2], but packages of prescribed medications include many pills beyond this need. To address this, we designed a bag of painkillers to optimize pain treatment, primarily for those with long lasting brachial plexus block that may have severe pain debut at home [1]. The bag includes seven oxycodone tablets of 5 mg, and 1 day's worth of ibuprofen and paracetamol in case patients did not buy these preoperatively as instructed. For those with long-lasting ropivacaine brachial plexus block, smart bag treatment was timed to begin 7 hours after ropivacaine initiation. Based on interviews of the first 103 patients, 78% were satisfied. Surgeons and nurses also appreciated the reduced administrative tasks and faster patient discharge.


Assuntos
Analgésicos Opioides , Pacientes Ambulatoriais , Amidas , Analgésicos Opioides/uso terapêutico , Anestésicos Locais , Humanos , Oxicodona/uso terapêutico , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico
4.
Anesth Analg ; 131(5): 1599-1606, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079884

RESUMO

BACKGROUND: Oxycodone has been shown to be an effective analgesic for early postoperative analgesia, especially for abdominal operations associated with severe visceral pain. However, the dose needed varies depending on the operation and application of multimodal analgesia, such as local ropivacaine wound infiltration. Therefore, we conducted this study to estimate the median effective dose (ED50) of oxycodone that provides analgesia for hysterectomy and myomectomy with local ropivacaine wound infiltration. METHODS: In this dose-finding study, the ED50 of oxycodone for postoperative analgesia was estimated separately for laparoscopic hysterectomy, transabdominal hysterectomy, laparoscopic myomectomy, and transabdominal myomectomy. We used the sequential allocation designed by Dixon. Trials were conducted simultaneously in the 4 surgical type groups. A predefined dose of oxycodone was injected 30 minutes before the end of the operation with an initial dose of 0.1 mg/kg. A series of trials were performed following the rule of a relative 10% increase in dose after inadequate analgesia and a relative 10% decrease in dose after adequate analgesia. The study was conducted until the collection of 7 crossover points was achieved. Local ropivacaine wound infiltration was administered during abdominal stitching. The mean blood pressure (MBP) and heart rate (HR) were analyzed to assess the hemodynamic changes associated with oxycodone administration. RESULTS: A total of 113 patients were included in the estimation of ED50: 28 each in the laparoscopic hysterectomy group and transabdominal myomectomy group, 27 in the transabdominal hysterectomy group, and 30 in the laparoscopic myomectomy group. The estimated oxycodone ED50 (95% confidence interval [CI]) after laparoscopic hysterectomy, transabdominal hysterectomy, laparoscopic myomectomy, and transabdominal myomectomy was 0.060 mg/kg (0.053-0.068), 0.079 mg/kg (0.072-0.086), 0.060 mg/kg (0.051-0.071), and 0.092 mg/kg (0.086-0.098), respectively, for postoperative analgesia with local ropivacaine wound infiltration. The ED50 of oxycodone was different between laparoscopic surgeries and transabdominal surgeries (P < .001). The MBP and HR before and after oxycodone injection were different, regardless of surgical type. CONCLUSIONS: The oxycodone ED50 for postoperative analgesia was lower for laparoscopic hysterectomy (0.060 mg/kg) and laparoscopic myomectomy (0.060 mg/kg) than for transabdominal hysterectomy (0.079 mg/kg) and transabdominal myomectomy (0.092 mg/kg) when combined with local ropivacaine wound infiltration. A single intravenous injection of oxycodone is associated with an acceptable decrease in MBP and HR within a short time.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Histerectomia/efeitos adversos , Oxicodona/administração & dosagem , Oxicodona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Ropivacaina/uso terapêutico , Miomectomia Uterina/efeitos adversos , Adulto , Anestesia Local , Anestésicos Locais/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Injeções Intravenosas , Laparoscopia , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Ropivacaina/administração & dosagem
6.
Br J Anaesth ; 125(5): 762-772, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32620260

RESUMO

BACKGROUND: We investigated the effects of spinal and general anaesthesia and surgical tourniquet on acute pain and early recovery after total knee arthroplasty (TKA). METHODS: Patients (n=413) were randomised to four parallel groups: spinal anaesthesia with or without tourniquet, and general anaesthesia with or without tourniquet. The primary outcome was patient-controlled i.v. oxycodone consumption over 24 postoperative hours. RESULTS: Results from 395 subjects were analysed. Median i.v. oxycodone consumption did not differ between the four groups (spinal anaesthesia without [36.6 mg] and with tourniquet [38.0 mg], general anaesthesia without [42.3 mg] and with tourniquet [42.5 mg], P=0.42), between spinal (37.7 mg) and general anaesthesia (42.5 mg) groups (median difference -3.1, 95% confidence interval [CI] -7.4 to 1.2, P=0.15) and between tourniquet and no-tourniquet groups (40.0 vs 40.0 mg, median difference -0.8, CI -5.1 to 3.5, P=0.72). Vomiting incidence was higher with spinal than with general anaesthesia (21% [42/200] vs 13% [25/194], CI 1.05 to 3.1, P=0.034). The mean haemoglobin decrease was greater without than with tourniquet (-3.0 vs -2.5 g dl-1, mean difference -0.48, CI -0.65 to -0.32, P<0.001). No differences were observed in pain, pain management, incidences of blood transfusions, in-hospital complications, or length of hospital stay. CONCLUSIONS: For TKA, spinal and general anaesthesia with or without tourniquet did not differ in 24-h postoperative opioid consumption, pain management, blood transfusions, in-hospital complications, and length of hospital stay. Vomiting incidence was higher in the spinal than in the general anaesthesia group. Tourniquet use caused smaller decreases in haemoglobin levels. CLINICAL TRIAL REGISTRATION: EudraCT 2016-002035-15.


Assuntos
Anestesia/métodos , Artroplastia do Joelho/métodos , Torniquetes , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestesia Geral , Raquianestesia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Oxicodona/administração & dosagem , Oxicodona/uso terapêutico , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Recuperação de Função Fisiológica , Resultado do Tratamento
7.
Zhongguo Zhen Jiu ; 40(6): 601-4, 2020 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-32538009

RESUMO

OBJECTIVE: To evaluate the clinical effect of filiform fire needling on moderate and severe pain in advanced cancer. METHODS: A total of 66 patients with moderate and severe pain in advanced cancer were randomly divided into an observation group (34 cases, 4 cases dropped off) and a control group (32 cases, 2 cases dropped off). The two groups were treated with oral analgesics continuously for 4 weeks. The moderate pain patients was given bucinnazine hydrochloride tablets (starting at 30 mg, once every 6 hours, increasing by 30%-50% until the titration volume was reached), and the severe pain patients were given oxycodone hydrochloride sustained-release tablets (starting at 20 mg every 12 hours and increasing by 25%-50% until the titration volume was reached). The observation group was cooperated with filiform fire needling at ashi point, Zusanli (ST 36), Liangqiu (ST 34), Qihai (CV 6), Guanyuan(CV 4), Quchi (LI 11) and Waiguan (TE 5) once every other day for 4 weeks. The changes of numerical rating scales (NRS) scores were observed in both groups before and after treatment, and the amount of analgesics and the incidence of adverse reactions were recorded. The clinical effects in the two groups were evaluated. RESULTS: The effective rate was 90.0% (27/30) in the observation group, which was higher than 66.7% (20/30) in the control group (P<0.05). After treatment, the NRS scores of both groups were lower than those before treatment (P<0.05), and the reducing degree in the observation group was larger than that in the control group (P<0.05). The average dosage of bunarizine hydrochloride tablets and oxycodone hydrochloride sustained release tablets to titration volume in the observation group was less than that in the control group (P<0.05). The incidence of adverse reactions was 23.3% (28/120) in the observation group, which was lower than 44.2% (53/120) in the control group (P<0.05). CONCLUSION: Filiform fire needling can alleviate pain symptoms of patients with moderate and severe pain in advanced cancer, reduce the amount of analgesics, and decrease the incidence of adverse reactions.


Assuntos
Terapia por Acupuntura , Dor do Câncer/terapia , Neoplasias/terapia , Manejo da Dor , Pontos de Acupuntura , Analgésicos/uso terapêutico , Humanos , Neoplasias/complicações , Oxicodona/uso terapêutico , Piperazinas/uso terapêutico , Resultado do Tratamento
8.
Am J Obstet Gynecol ; 223(2): 262.e1-262.e8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32413429

RESUMO

BACKGROUND: Postoperative opioid prescription patterns play a key role in driving the opioid epidemic. A comprehensive system toward pain management in surgical patients is necessary to minimize overall opioid consumption. OBJECTIVE: This study aimed to evaluate the efficacy of a pain management model in patients undergoing pelvic reconstructive surgery by measuring postdischarge narcotic use in morphine milligram equivalents. STUDY DESIGN: This is a prospective clinical practice study that included women undergoing inpatient pelvic reconstructive surgery from December 2018 to June 2019 with overnight stay after surgery. As a routine protocol, all the patients followed an enhanced recovery after surgery protocol that included a preoperative multimodal pain regimen. Brief Pain Inventory surveys were collected preoperatively and on postoperative day 1. Brief pain inventory and activities assessment scale scores were collected at postoperative week 1 and postoperative weeks 4-6 after surgery. Patients were discharged with 15 tablets of an oral narcotic using an electronic prescription for controlled substances software platform, which is mandated in the state of Connecticut for all controlled substances, prescriptions, and refills. Patients were called at postoperative week 1 and postoperative weeks 4-6 to answer questions regarding their pain, the number of remaining narcotic tablets, and patient satisfaction regarding pain management. Patient electronic medical records and the Connecticut Prescription Monitoring and Reporting System were reviewed to determine whether patients received narcotic refills. Primary outcome was postdischarge narcotic use measured in morphine milligram equivalents. Secondary outcomes evaluated refill rate, brief pain inventory and activities assessment scale scores, and patient satisfaction with pain management. Descriptive statistics were described as mean and standard deviation and median and interquartile range. Bivariate comparisons used Spearman's rho (ρ) with α=0.05. RESULTS: A total 113 patients were enrolled; the median (interquartile range) morphine milligram equivalent prescribed (including refills) was 112.5 (112.5-112.5). The median postdischarge narcotic use was 24.0 (0-82.5) morphine milligram equivalent, which is equivalent to fewer than 4 oxycodone (5 mg) tablets. About 75% of our participants required fewer than 11 oxycodone tablets. The median unused morphine milligram equivalent was 90.0 (45-112.5). 81.4% (92/113), and 83.2% (94/113) of patients at postoperative week 1 and postoperative weeks 4-6, respectively, reported being satisfied or extremely satisfied with their postdischarge pain control. About 88.5% (100/113) of patients felt that the number of opioids they were discharged with was sufficient for their pain needs at the postoperative 1 and postoperative weeks 4-6 time points. At postoperative weeks 4-6, 19.5% of patients said that they filled the narcotic prescription but did not use any of the pills. The overall refill rate was 10.6% (12/113). All patients who needed a refill described the refill process as easy. In-hospital narcotic use was not predictive of postdischarge narcotic use (ρ0.065, P=.495). Patients reported median brief pain inventory scores for "average pain" of 0 (no pain) at postoperative week 1 and postoperative weeks 4-6; however, the scores did not clinically correlate with postdischarge narcotic use. Activities assessment scale scores were not correlated with postdischarge narcotic use. CONCLUSION: Most patients after pelvic reconstructive surgery used fewer than 11 oxycodone (5 mg) tablets, averaging less than 4 tablets, with a third of patients not requiring any opioids. Pain and activities scores did not correlate with narcotic use. A minimal number of opioids can be prescribed because the secure electronic prescribing system allows for convenient electronic refill if required. Our practical and comprehensive pre- and postoperative protocol for pain management minimizes opioid consumption in addition to maximizing patient satisfaction.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Procedimentos Cirúrgicos em Ginecologia , Dor Pós-Operatória/tratamento farmacológico , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Acetaminofen/uso terapêutico , Idoso , Celecoxib/uso terapêutico , Recuperação Pós-Cirúrgica Melhorada , Feminino , Gabapentina/uso terapêutico , Humanos , Ibuprofeno/uso terapêutico , Pessoa de Meia-Idade , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Assistência Perioperatória , Estudos Prospectivos
9.
Medicine (Baltimore) ; 99(20): e20213, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443348

RESUMO

BACKGROUND: Effective postoperative analgesia may enhance early rehabilitation after total knee arthroplasty (TKA). The purpose of this study is to perform a randomized controlled trial to compare the efficiency of adductor canal block (ACB) with periarticular infiltration (PAI) versus PAI alone for early postoperative pain treatment after TKA. METHODS: After institutional review board approval, written informed consent was obtained from patients undergoing elective TKA. Subjects were randomized into 2 groups as follows: adductor canal blockade with 30 mL of 0.5% ropivacaine and 100 mcg of clonidine. All patients received a periarticular infiltration mixture intraoperatively with scheduled and patient requested oral and IV analgesics postoperatively for breakthrough pain. The primary outcome was morphine consumption in the first 24 hours. Secondary outcomes included pain scores, morphine consumption at 48 hours, opioid-related side effects (post-operative nausea/vomiting, sedation scores), functional outcomes, quadriceps strength, and length of hospital stay. CONCLUSIONS: For the present trial, we hypothesized that patients receiving adductor canal block + PAI would have significantly lower morphine consumption and pain scores after surgery. TRIAL REGISTRATION NUMBER: researchregistry5490.


Assuntos
Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/normas , Manejo da Dor/normas , Dor Pós-Operatória/tratamento farmacológico , Idoso , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Artroplastia do Joelho/métodos , Bupivacaína/uso terapêutico , Protocolos Clínicos , Famotidina/uso terapêutico , Feminino , Humanos , Masculino , Meloxicam/uso terapêutico , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Bloqueio Nervoso/estatística & dados numéricos , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/fisiopatologia , Projetos Piloto
10.
PLoS One ; 15(4): e0231763, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32302346

RESUMO

OBJECTIVE: To evaluate the efficacy, safety and cost-effectiveness of Oxycodone Hydrochloride Controlled-release Tablets (CR oxycodone) and Morphine Sulfate Sustained-release Tablets (SR morphine) for moderate to severe cancer pain titration. METHODS: Randomized controlled trials meeting the inclusion criteria were searched through Medline, Cochrane Library, Pubmed, EMbase, CNKI,VIP and WanFang database from the data of their establishment to June 2019. The efficacy and safety data were extracted from the included literature. The pain control rate was calculated to eatimate efficacy. Meta-analysis was conducted by Revman5.1.4. A decision tree model was built to simulate cancer pain titration process. The initial dose of CR oxycodone and SR morphine group were 20mg and 30mg respectively. Oral immediate-release morphine was administered to treat break-out pain. The incremental cost-effectiveness ratio was performed with TreeAge Pro 2019. RESULTS: 19 studies (1680 patients)were included in this study. Meta-analysis showed that the pain control rate of CR oxycodone and SR morphine were 86% and 82.98% respectively. The costs of CR oxycodone and SR morphine were $23.27 and $13.31. The incremental cost-effectiveness ratio per unit was approximate $329.76. At the willingness-to-pay threshold of $8836, CR oxycodone was cost-effective, while the corresponding probability of being cost-effective at the willingness-to-pay threshold of $300 was 31.6%. One-way sensitivity analysis confirmed robustness of results. CONCLUSIONS: CR oxycodone could be a cost-effective option compared with SR morphine for moderate to severe cancer pain titration in China, according to the threshold defined by the WHO.


Assuntos
Dor do Câncer/tratamento farmacológico , Dor do Câncer/economia , Farmacoeconomia , Morfina/economia , Morfina/uso terapêutico , Oxicodona/economia , Oxicodona/uso terapêutico , Análise Custo-Benefício , Árvores de Decisões , Preparações de Ação Retardada/uso terapêutico , Humanos , Viés de Publicação , Risco , Resultado do Tratamento
12.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(1): 91-95, 2020 Feb 28.
Artigo em Chinês | MEDLINE | ID: mdl-32131946

RESUMO

Objective To evaluate the value of oxycodone hydrochloride for postoperative pain management in patients undergoing patient-controlled intravenous analgesia(PCIA). Methods The medical records on postoperative pain management in our department from January 1 to June 30,2018,were retrospectively analyzed.Totally 136 patients were assigned into oxycodone,sufentanil,or morphine groups according to the opioid used in the PCIA.Patients were assessed for postoperative pain severity(scored with NRS)and adverse reactions 24,36,and 48 hours after surgery.The area under curve(AUC)was calculated. Results The score of pain at exercise was significantly lower in the oxycodone group(2.2±2.4)than in the sufentanil group(3.4±2.1)(t=0.305,P=0.0126)or the morphine group(3.4±1.7)(t=0.104,P=0.0277)36 hours after surgery.AUC at rest was significantly lower in the oxycodone and morphine groups than in the sufentanil group(29.00,27.00,and 40.01,respectively);in contrast,AUC at exercise was significantly lower in the oxycodone group(63.17)than in the sufentanil and morphine groups(82.00 and 80.93,respectively).The consumption of opioids was significantly higher in the sufentanil group[(37.2±16.1),(46.1±24.3),(64.4±33.4)mg]than in the oxycodone group[(20.4±14.8)(t=3.571,P=0.001),(24.2±16.1)(t=4.63,P<0.0001),(34.4±25.1)mg(t=6.409,P<0.0001)]or the morphine group[(16.6±11.7)(t=4.233,P<0.0001),(20.5±14.1)(t=5.250,P<0.0001),(28.8±19.0)mg(t=7.354,P<0.0001)]24,36,48 hours after surgery.The oxycodone group experienced less vomiting(χ 2=11.360,P=0.003)and early termination of PCIA(χ 2=7.914,P=0.019)compared with the other two groups. Conclusions Oxycodone can be used for postoperative PCIA.It can alleviate a variety of postoperative pain,with superior analgesic efficiency and safety to sufentanil and morphine.


Assuntos
Analgesia Controlada pelo Paciente , Oxicodona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Operatórios , Humanos , Morfina/uso terapêutico , Estudos Retrospectivos , Sufentanil/uso terapêutico
13.
Surgery ; 167(6): 957-961, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32127178

RESUMO

BACKGROUND: Opioid-based analgesia is the most common method for pain control in the postoperative period. Limited data exist to compare the adequacy of pain control in the post thyroidectomy period with nonopioid-based analgesia. We aimed to evaluate the efficacy of nonopioid-based, postoperative analgesia. METHODS: After institutional review board approval, patients were randomized to 1 of 2 pain control regimens. Sample size was calculated to assess for a pain score difference of 1 based on a visual analog scale. The control group received opioid-based, postoperative analgesia, whereas the study group received nonopioid-based analgesia of acetaminophen and ibuprofen. Pain scores (measured on visual analog scale) and opioid use (converted to morphine equivalent dose) were measured after completion of the operation. RESULTS: The sample sizes for the study and control groups were 49 and 46 patients, respectively. The pain score for the study and control groups 1 hour after the operation (3.3 vs 3.9, P = .35), 6 hours after the operation (2.8 vs 3.0, P = .08), on postoperative day 1 (1.6 vs 2.4, P = .08) and on the first office visit (0.2 vs 0.1, P = .82) did not have a statistically significant difference. Morphine equivalent opioid requirement for pain control in the postoperative period was 0.8 vs 6.9 mg (P < .01), respectively. CONCLUSION: In a randomized control trial, we showed that patients treated with nonopioid analgesia had similar pain scores to those treated with opioids, with the benefit of having lower opioid exposure in the perioperative period.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Tireoidectomia , Acetaminofen/uso terapêutico , Feminino , Humanos , Ibuprofeno/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oxicodona/uso terapêutico , Escala Visual Analógica
14.
Adv Ther ; 37(3): 1188-1202, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32020565

RESUMO

INTRODUCTION: Prolonged-release oxycodone/naloxone (OXN PR), combining an opioid analgesic with selective blockade of enteric µ-opioid receptors, provided effective analgesia and improved bowel function in patients with moderate-to-severe pain and opioid-induced constipation in clinical trials predominantly conducted in Western countries. This double-blind randomized controlled trial investigated OXN PR (N = 116) versus prolonged-release oxycodone (OXY PR, N = 115) for 8 weeks at doses up to 50 mg/day in patients with moderate-to-severe, chronic, non-malignant musculoskeletal pain and opioid-induced constipation recruited in China. METHODS: A total of 234 patients at least 18 years of age with non-malignant musculoskeletal pain for more than 4 weeks that was moderate-to-severe in intensity and required round-the-clock opioid therapy were randomized (1:1) to OXN PR or OXY PR. The primary endpoint was bowel function using the Bowel Function Index (BFI). Secondary endpoints included safety, Brief Pain Inventory-Short Form (BPI-SF), use of analgesic and laxative rescue medication, and health-related quality of life (EQ-5D). RESULTS: While BFI scores were comparable at baseline, at week 8 improvements were greater with OXN PR vs OXY PR (least squares mean [LSM] difference (95% CI) - 9.1 (- 14.0, - 4.2); P < 0.001. From weeks 2 to 8, mean BFI scores were in the range of normal bowel function (≤ 28.8) with OXN PR but were in the range of constipation (> 28.8) at all timepoints with OXY PR. Analgesia with OXN PR was similar and non-inferior to OXY PR on the basis of modified BPI-SF average 24-h pain scores at week 8: LSM difference (95% CI) - 0.3 (- 0.5, - 0.1); P < 0.001. The most frequent treatment-related AEs were nausea (OXN PR 5% vs OXY PR 6%) and dizziness (4% vs 4%). CONCLUSION: OXN PR provided clinically meaningful improvements in bowel function and effective analgesia in Chinese patients with moderate-to-severe musculoskeletal pain and pre-existing opioid-induced constipation. TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT01918098.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Naloxona/uso terapêutico , Constipação Induzida por Opioides/prevenção & controle , Oxicodona/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , China , Preparações de Ação Retardada/administração & dosagem , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Laxantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Naloxona/administração & dosagem , Naloxona/efeitos adversos , Oxicodona/administração & dosagem , Oxicodona/efeitos adversos , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Qualidade de Vida
15.
Medicine (Baltimore) ; 99(6): e19004, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028411

RESUMO

BACKGROUND: Endoscopic tonsillectomy is associated with postoperative pain. Postoperative pain management remains to be improved in children. We aimed to investigate oxycodone preemptive analgesia in children undergoing endoscopic plasma total adenotonsillectomy. METHODS: 166 children with adenotonsillar hypertrophy were recruited at Wuhan Children's Hospital between 08/2016 and 03/2017. They were randomly assigned to receive SPOA (postoperative sufentanil), SPEA+SPOA (preemptive sufentanil and postoperative sufentanil), and OPEA+SPOA (preemptive oxycodone and postoperative sufentanil). The primary endpoint was serum c-fos levels. The secondary endpoints were the response entropy (RE) value, Pediatric Anesthesia Emergence Delirium (PAED) score, FLACC score, and adverse events. RESULTS: c-fos mRNA levels were increased significantly after surgery in the SPOA and SPEA+SPOA groups (P < .05). Postoperatively, c-fos mRNA levels were higher in the SPOA group compared with the OPEA+SPOA group (P = .044). The RE values increased in all groups after surgery (P < .05). At extubation, RE values were higher in the SPOA group compared with the SPEA+SPOA and OPEA+SPOA groups (P < .05). The PAED scores were higher in the SPOA group compared with the OPEA+SPOA group (P = .045). In the SPOA group, the FLACC scores were decreased at 24 h after surgery vs 4 hours (P = .044). Prediction probability (Pk) values indicated that RE and c-fos mRNA levels were quantitative predictors for early postoperative stress reaction after surgery. CONCLUSIONS: The subanalgesic dose of oxycodone (0.1 mg/kg) as preemptive analgesia could improve pain after endoscopic plasma total adenotonsillectomy in children.


Assuntos
Adenoidectomia , Analgésicos Opioides/uso terapêutico , Oxicodona/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Tonsilectomia , Actinas/sangue , Adenoidectomia/efeitos adversos , Adenoidectomia/métodos , Criança , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Masculino , Proteínas Proto-Oncogênicas c-fos/sangue , Reação em Cadeia da Polimerase em Tempo Real , Sufentanil/uso terapêutico , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos
16.
Ann Otol Rhinol Laryngol ; 129(7): 677-683, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32028782

RESUMO

INTRODUCTION: Management of pain following endoscopic sinus surgery (ESS) often involves intermittent use of opioid medications. Given the current opioid crisis, many surgeons aim to minimize opioid prescriptions. However, surgeons often avoid the use of NSAIDs following ESS out of concern for increased bleeding risk. We sought to evaluate the effectiveness and safety of over the counter dosing of ibuprofen on pain and bleeding rates following ESS. METHODS: Prospective cohort pilot study of patients undergoing ESS. Patients self-selected either control arm (acetaminophen and PRN oxycodone) or intervention arm (alternating ibuprofen with acetaminophen, and PRN oxycodone). Outcome measures included pain (10-point visual analog scale [VAS]), bleeding rate (10-point VAS), and number of opiate pills consumed. RESULTS: Thirty-nine patients completed the study (15 control and 24 intervention). Overall, patients in the intervention arm reported decreased pain levels at days 1 (-0.9 [95%CI: -2.2, 0.5], 3 (-0.9 [95%CI: -2.3, 0.5]), and 7 (-0.6 [95%CI: -1.8, 0.6]), as well as decreased postoperative bleeding at those same days -0.9 [95%CI: -2.1, 0.4], -0.9 [95%CI: -2.1, 0.4], and -0.7 [95% CI: -1.2, -0.7], compared to controls. Opiate consumption was similar between groups with patients consuming on average four opiate pills (oxycodone 5 mg). CONCLUSIONS: Over the counter dosing of ibuprofen along with acetaminophen may yield better pain control after sinus surgery compared to acetaminophen alone. Additionally, there was no significant difference in epistaxis in the ibuprofen cohort compared to the cohort who did not take ibuprofen. Furthermore, this study showed very few opioid pills were consumed after routine ESS regardless of pain regimen prescribed. A larger trial is needed to make definitive statements on safety and efficacy. LEVEL OF EVIDENCE: 2b.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Ibuprofeno/administração & dosagem , Procedimentos Cirúrgicos Nasais , Dor Pós-Operatória/tratamento farmacológico , Hemorragia Pós-Operatória/epidemiologia , Rinite/cirurgia , Sinusite/cirurgia , Acetaminofen/uso terapêutico , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Doença Crônica , Estudos de Coortes , Quimioterapia Combinada , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sem Prescrição , Oxicodona/uso terapêutico , Medição da Dor , Projetos Piloto , Estudos Prospectivos
17.
Pain Res Manag ; 2020: 7565962, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32089760

RESUMO

Radiotherapy is commonly used to treat cancer patients. Besides the curable effect, radiotherapy also could relieve the pain of cancer patients. However, cancer pain is gradually alleviated about two weeks after radiotherapy. In addition, cancer patients who receive radiotherapy may also suffer from pain flare or radiotherapy-induced side effects such as radiation esophagitis, enteritis, and mucositis. Pain control is reported to be inadequate during the whole course of radiotherapy (before, during, and after radiotherapy), and quality of life is seriously affected. Hence, radiotherapy is suggested to be combined with analgesic drugs in clinical guidelines. Previous studies have shown that radiotherapy combined with oxycodone hydrochloride can effectively alleviate cancer pain. In this review, we firstly presented the necessity of analgesia during the whole course of radiotherapy. We also sketched the role of oxycodone hydrochloride in radiotherapy of bone metastases and radiotherapy-induced oral mucositis. Finally, we concluded that oxycodone hydrochloride shows good efficacy and tolerance and could be used for pain management before, during, and after radiotherapy.


Assuntos
Analgésicos Opioides/uso terapêutico , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Dor/tratamento farmacológico , Lesões por Radiação/tratamento farmacológico , Feminino , Humanos , Masculino , Dor/etiologia , Qualidade de Vida , Lesões por Radiação/complicações
18.
J Psychosoc Nurs Ment Health Serv ; 58(1): 23-28, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31895967

RESUMO

Benzodiazepines are a class of medications that tend to fly "under the radar" within the general population but nonetheless post a significant risk to older adults when not used appropriately. The current article aims to shine a spotlight on this medication class along with a framework for a team-based approach to successfully de-escalate use when clinically appropriate. [Journal of Psychosocial Nursing and Mental Health Services, 58(1), 23-28.].


Assuntos
Alprazolam/uso terapêutico , Benzodiazepinas , Desprescrições , Hipnóticos e Sedativos/uso terapêutico , Acetaminofen/uso terapêutico , Idoso , Benzodiazepinas/administração & dosagem , Benzodiazepinas/envenenamento , Citalopram/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Oxicodona/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico
19.
Pain Manag Nurs ; 21(1): 65-71, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31501079

RESUMO

BACKGROUND: Previous research suggests that racial disparities in patients' reported analgesic adverse effects are partially mediated by the type of opioid prescribed to African Americans despite the presence of certain comorbidities, such as renal disease. AIMS: We aimed to identify independent predictors of the type of opioid prescribed to cancer outpatients and determine if race and chronic kidney disease independently predict prescription type, adjusting for relevant sociodemographic and clinical confounders. DESIGN: We conducted a secondary analysis of a 3-month observational study. SETTING: Outpatient oncology clinics of an academic medical center. PARTICIPANTS/SUBJECTS: Patients were older than 18 years of age, self-identified as African American or White, and had an analgesic prescription for cancer pain. METHODS: Cancer patients (N = 241) were recruited from outpatient oncology clinics within a large mid-Atlantic healthcare system. RESULTS: Consistent with published literature, most patients (75.5%) were prescribed either morphine or oxycodone preparations as oral opioid therapy for cancer pain. When compared with Whites, African Americans were significantly more likely to be prescribed morphine (33% vs 14%) and less likely to be prescribed oxycodone (38% vs 64%) (p < .001). The estimated odds for African Americans to receive morphine were 2.573 times that for Whites (95% confidence interval 1.077-6.134) after controlling for insurance type, income, and pain levels. In addition, the presence of private health insurance was negatively associated with the prescription of morphine and positively associated with prescription of oxycodone in separate multivariable models. The presence of chronic kidney disease did not predict type of analgesic prescribed. CONCLUSIONS: Both race and insurance type independently predict type of opioid selection for cancer outpatients. Larger clinical studies are needed to fully understand the sources and clinical consequences of racial differences in opioid selection for cancer pain.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor do Câncer/tratamento farmacológico , Grupos de Populações Continentais/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Administração Oral , Adulto , Idoso , Dor do Câncer/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morfina/farmacologia , Morfina/uso terapêutico , Neoplasias/complicações , Neoplasias/psicologia , Pacientes Ambulatoriais/psicologia , Pacientes Ambulatoriais/estatística & dados numéricos , Oxicodona/farmacologia , Oxicodona/uso terapêutico
20.
Intern Med ; 59(2): 293-296, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31534081

RESUMO

Opioid-induced-constipation (OIC) can be treated by naldemedine and other peripherally acting mu-opioid receptor antagonists (PAMORA) via a novel mechanism. We describe the case of a 52-year-old female outpatient who developed OIC while receiving oxycodone for pain due to cancer with multiple bone metastases. Although she did not have brain metastasis, opioid withdrawal syndrome (OWS) developed after taking naldemedine orally. Her Clinical Opiate-Withdrawal Score (COWS) was 19 (moderate symptoms). However, she recovered from OWS on intravenous fentanyl and a continuous infusion of oxycodone. She did not develop OWS thereafter and was discharged two days after recovery.


Assuntos
Naltrexona/análogos & derivados , Antagonistas de Entorpecentes/efeitos adversos , Constipação Induzida por Opioides/tratamento farmacológico , Oxicodona/efeitos adversos , Síndrome de Abstinência a Substâncias/etiologia , Analgésicos Opioides/uso terapêutico , Neoplasias da Mama/patologia , Dor do Câncer/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Naltrexona/efeitos adversos , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Oxicodona/uso terapêutico , Síndrome de Abstinência a Substâncias/tratamento farmacológico
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