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1.
Sci Rep ; 12(1): 17429, 2022 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-36261491

RESUMO

Continuous wound infusion with local anesthesia is an effective method for reducing postoperative pain after laparoscopic colorectal surgery. However, most subcutaneous local anesthesia is delivered through continuous injection, which can be inconvenient for patients. This study compared the effectiveness of postoperative pain relief from the application of a local poloxamer 407-based ropivacaine hydrogel (Gel) to the incision site with continuous infusion-type ropivacaine administration (On-Q) in patients undergoing laparoscopic colorectal surgery. This prospective, randomized, non-inferiority study included 61 patients who underwent laparoscopic colorectal surgery with an incision length of 3-6 cm. All 61 patients were randomly assigned to the Gel group (poloxamer 407-based 0.75% ropivacaine, 22.5 mg) or the On-Q group (0.2% ropivacaine, 4 mg/hour for two days). Postoperative analgesia was induced in all patients with intravenous patient-controlled analgesia (IV-PCA). The outcome measures, which were assessed for 72 h after surgery, included the total amount of fentanyl consumed via IV-PCA (primary endpoint), and the amount of rescue analgesia (pethidine) and postoperative pain intensity assessed using a numeric rating scale (NRS) [secondary endpoints]. The Gel was administered to 31 patients and On-Q was used for 30 patients. There was no significant difference in the total usage of fentanyl between the two groups (Gel group, 1623.98 mcg; On-Q group, 1595.12 mcg; P = 0.806). There was also no significant difference in the frequency of analgesic rescue medication use (P = 0.213) or NRS scores (postoperative 6 h, P = 0.860; 24 h, P = 0.333; 48 h, P = 0.168; and 72 h, P = 0.655) between the two groups. The Gel, which continuously delivers a local anesthetic to operative sites, can thus be considered an effective device for analgesia and pain relief for midline incisions in laparoscopic colorectal surgery.


Assuntos
Anestésicos Locais , Cirurgia Colorretal , Humanos , Anestésicos Locais/uso terapêutico , Ropivacaina , Anestesia Local/métodos , Cirurgia Colorretal/efeitos adversos , Estudos Prospectivos , Poloxâmero/uso terapêutico , Analgésicos Opioides , Analgesia Controlada pelo Paciente/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Fentanila , Analgésicos/uso terapêutico , Meperidina/uso terapêutico , Hidrogéis/uso terapêutico
2.
J Opioid Manag ; 18(5): 467-474, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36226786

RESUMO

This study sought to determine if there were any changes in opioid prescribing habits of providers at a single institution after the implementation of legislation to increase opioid prescribing regulations. Our study demonstrated a 39.5 percent decrease in overall morphine milligram equivalent (MME) prescribed the year after the laws took effect when compared with the year prior. It is clear that these laws have been effective in decreasing the number of opioids prescribed at discharge from Mercy Health Grand Rapids. INTRODUCTION: Opioid use disorder has become an epidemic with approximately 130 people dying every day in the United States due to prescription and illegal opioid overdoses. In December 2017, the Michigan legislature ratified a package of 10 acts to address a variety of problems through several layers of regulations including more restrictive prescribing rules, which took effect in June 2018. OBJECTIVE: To evaluate the impact of legislation on the opioid prescribing habits of providers who discharged patients from a community-based academic teaching hospital. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was performed using data from a community-based academic teaching hospital with 303 beds, a medical ICU, labor and delivery unit, and a 42-room emergency department. All patients discharged from in-patient or observation status in the 12 months before and after June 1, 2018 were included. MAIN OUTCOMES AND MEASURES: The primary outcome was MMEs of opioids prescribed at discharge before (June 1, 2017 to May 31, 2018) and after (June 1, 2018 to May 31, 2019) legislation. Medications included morphine, hydrocodone, oxycodone, fentanyl, methadone, hydromorphone, tramadol, codeine, and meperidine. RESULTS: There were 17,227 patients discharged during the first 12-month period and 15,855 patients discharged in the second 12-month period. There were 14,064 new opioid prescriptions in total during these time periods. Total MME prescribed during the study period showed a 39.5 percent decrease from pre- (2,268,460 MME) to post-legislation (1,372,424 MME), while average MMEs/discharge significantly decreased (135.1 ± 321.2 vs. 87.6 ± 187.4; p < 0.001). Total pill/patch count decreased by almost 40 percent. For patients who were prescribed opioids, average MME/discharge showed significant decline after legislation implementation (309.6 ± 427.1 vs. 212.2 ± 242.1; p < 0.001). Average daily MME/patient prescribed an opioid remained similar between the time periods (52.4 ± 37.0 vs. 51.6 ± 35.0; p = 0.21). Significant reductions (p < 0.05) were seen in MMEs for each individual medication with the exception of acetaminophen-codeine and methadone. CONCLUSIONS AND RELEVANCE: Our results indicate that the legislation implemented in Michigan to regulate opioid prescriptions was associated with a reduction in opioids prescribed to patients discharged from a community-based academic teaching hospital.


Assuntos
Analgésicos Opioides , Tramadol , Acetaminofen/uso terapêutico , Analgésicos Opioides/efeitos adversos , Codeína/uso terapêutico , Endrin/análogos & derivados , Fentanila/uso terapêutico , Humanos , Hidrocodona/uso terapêutico , Hidromorfona/uso terapêutico , Meperidina/uso terapêutico , Metadona/uso terapêutico , Michigan , Oxicodona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Alta do Paciente , Padrões de Prática Médica , Estudos Retrospectivos , Tramadol/uso terapêutico , Estados Unidos
3.
Ulus Travma Acil Cerrahi Derg ; 28(11): 1616-1621, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36282160

RESUMO

BACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Long-term complications of hemophilia such as arthropathy, synovitis, and arthritis can lead to the development of recurrent chronic pain. Pain is therefore a critical aspect of hemophilia. The gold standard treatment for end-stage hemophilic knee arthropathy is total knee arthroplasty (TKA). The hypothesis of this study was that after knee replacement surgeries that cause severe post-operative pain, hemophilia patients with chronic analgesic consumption may experience higher levels of pain than non-hemophilic patients, and use more opioid and non-opioid drugs. METHODS: This retrospective study included 82 patients who were hemophilic and non-hemophilic TKA patients operated under general anesthesia. Seventy-three patients were evaluated and divided into two groups according to the diagnosis of hemophilia: 36 patients were investigated in the hemophilic group and 37 patients in the non-hemophilic group. RESULTS: Post-operative tramadol consumption (p=0.002) and pethidine consumption (p=0.003) were significantly higher in the group hemophilia. The length of stay in the hospital was also significantly longer in the hemophilic group (p=0.0001). CONCLUSION: In the light of these informations, we think that acute post-operative pain management of hemophilia patients should be planned as personalized, multimodal preventive, and pre-emptive analgesia.


Assuntos
Artroplastia do Joelho , Hemofilia A , Artropatias , Tramadol , Humanos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Fator VIII/uso terapêutico , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Hemofilia A/cirurgia , Estudos Retrospectivos , Tramadol/uso terapêutico , Artropatias/complicações , Artropatias/cirurgia , Dor/etiologia , Analgésicos/uso terapêutico , Meperidina/uso terapêutico
4.
J Clin Anesth ; 83: 110978, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36208586

RESUMO

STUDY OBJECTIVE: To determine if acute postpartum pain, psychological distress, socioeconomic factors, and labor analgesia were associated with sub-acute pain after childbirth (SAPC; pain starting after childbirth and lasting between four weeks to three months). DESIGN: Prospective cohort study, from pre-conception to post-partum three months. SETTING: Singapore's major public maternity institution. PATIENTS: We included women planning to conceive within a year. We excluded women who were pregnant, taking chemotherapy or psychotropic medications, had diabetes mellitus, received assisted fertility interventions or contraception, did not conceive after 12 months, with multiple pregnancies, or who developed obstetric complications. INTERVENTIONS: None. MEASUREMENTS: We investigated the relationship between average pain score during the three days after childbirth (primary exposure) and incidence of SAPC at postpartum three months (primary outcome). Secondarily, psychological distress at pre-conception (Beck Depression Inventory (BDI), Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), General Health Questionnaire-12 (GHQ-12), Life Experiences Survey (LES)) and second trimester of pregnancy (BDI, EPDS, STAI, PSS, Pregnancy Experience Scale (PES)) were assessed. Baseline maternal and socioeconomic characteristics, labor analgesia, maternal and neonatal outcomes were also collected accordingly. MAIN RESULTS: Of 317 women who met the study criteria, 30 (9.5%) developed SAPC. Higher average pain score during the three days after childbirth (adjusted odds ratio (aOR) 1.46, 95% CI 1.17 to 1.82, p = 0.001), use of meperidine for labor analgesia (aOR 4.23, 95% CI 1.03 to 17.43, p = 0.046), higher pre-conception GHQ-12 score (aOR 1.14, 95% CI 1.03 to 1.27, p = 0.013), and lack of employment with income during pregnancy (aOR 9.62, 95% CI 3.07 to 30.30, p < 0.001) were independently associated with SAPC, with area under the curve (AUC) of 0.837. CONCLUSIONS: Higher acute postpartum pain scores, use of meperidine for labor analgesia, poorer pre-conception general psychological health, and lack of employment with income during pregnancy are associated with SAPC.


Assuntos
Dor Aguda , Recém-Nascido , Gravidez , Humanos , Feminino , Estudos Prospectivos , Fatores Socioeconômicos , Analgésicos/uso terapêutico , Meperidina
5.
J Clin Anesth ; 83: 110974, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36228453

RESUMO

STUDY OBJECTIVE: We evaluated the perioperative analgesic effects of the inter-semispinal plane (ISP) block in patients undergoing posterior cervical spine surgery. DESIGN: Prospective, randomized, controlled, double-blinded trial. SETTING: Operating room and surgical ward. PATIENTS: 60 patients aged 18-60 years of either gender, ASA I-II, undergoing elective posterior cervical spine surgery. INTERVENTIONS: Patients were randomly assigned into a control group (general anesthesia only), ISP group received bilateral ultrasound guided ISP block at the level of C5 using 20 ml bupivacaine 0.25% on each side. MEASUREMENTS: Visual analog scale (VAS), intraoperative fentanyl and 24 h postoperative pethidine consumptions and time to first rescue analgesic request were documented. MAIN RESULTS: The median (quartiles) of 24 h postoperative rescue pethidine consumption was significantly lower in the ISP group [0 (0-46.25) mg] compared to that of the control group [143 (116.75-169.00) mg]; P < 0.001). VAS was significantly lower in the ISP group at 30 min, 1 h, 2 h,4 h, 6 h, 8 h and 12 h postoperative compared to control group (P < 0.05). At 18 and 24 h, VAS was not significantly different between groups. The median (quartiles) of intraoperative fentanyl consumption in the ISP group [0 (0-40.75) µg] was significantly lower compared to that of the control group [63.5 (39.5-90.25) µg]; P < 0.001]. The time to first rescue analgesic administration was significantly longer in the ISP group compared to the control group (P < 0.001). CONCLUSION: Bilateral ultrasound-guided ISP block can provide decreased 24 h postoperative analgesic consumption as well as lower pain scores in the first 12 postoperative hours in patients undergoing posterior cervical spine surgery.


Assuntos
Analgesia , Bloqueio Nervoso , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Método Duplo-Cego , Fentanila , Meperidina/uso terapêutico , Analgésicos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Ultrassonografia de Intervenção , Analgésicos Opioides
6.
J Clin Pediatr Dent ; 46(4): 311-320, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36099228

RESUMO

PURPOSE: This retrospective study compares the efficacy and safety of variable dosing of Chloral Hydrate - Hydroxyzine with and without Meperidine (Mep)for managing varying levels of anxiety and uncooperative behavior of young pediatric dental patients over a 35-year period. STUDY DESIGN: Reviews of the sedation logs of 2,610 children, 3-7 years were compared in search of what dosing proves safe and effective for differing levels of challenging behavior. Variable dosing of CH with and without Mep were judged using a pragmatic approach which defined sedation success as optimal, adequate, inadequate, or over-dosage using oneway analysis of variance. Descriptive analyses of behavior and physiologic assessment was included with regard to the extent to which physical restraint occurred to control interfering behavior. Arousal levels requiring stimulation, oxygen desaturation, and adverse reactions were included as indications of safety. RESULTS: Where Mep was used, success rates were consistently higher; need for higher-end dosing of CH was not found beneficial when Mep was included. Significantly less need for physical restraint accompanied the addition of Mep. CONCLUSIONS: There appears to be strong basis for the safety and efficacy of the use of CH-H-Mep in combination at lower dosing than historically used. Addition of Mep was observed to enhance sedations, permit lower CH dosing, lessen or eliminate the need for physical restraint and adverse reactions.


Assuntos
Anestesia Dentária , Hidrato de Cloral , Criança , Comportamento Infantil , Hidrato de Cloral/efeitos adversos , Sedação Consciente , Humanos , Hidroxizina/efeitos adversos , Meperidina , Estudos Retrospectivos
7.
Pain Res Manag ; 2022: 5111214, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35899020

RESUMO

Background: Comparing bupivacaine's adjuvants in spinal anesthesia, we assessed the specific blocking characteristics and adverse effects of bupivacaine alone and in combination with dexmedetomidine or meperidine in spinal anesthesia during cesarean section. Methods: In this double-blind randomized clinical trial study, ninety pregnant women were divided into groups to receive 10 mg bupivacaine (group B), 10 mg bupivacaine with 5 µg dexmedetomidine (group BD), or 10 mg bupivacaine with 10 mg meperidine (group BM) intrathecal. Patients were assessed for the quality of analgesia during operations. Durations of sensory and motor blocks and anesthesia-related complications were analyzed using SPSS 21, and p values <0.05 were considered statistically significant. Results: The onset of sensory and motor blocks was essentially the same in all treated groups. Block regression time was significantly prolonged in the BD group compared to the B and BM groups (p < 0.001). The duration of analgesia was significantly longer in the BD and BM groups than in the B group (p < 0.001). The level of sedation in the BD group was higher than in the B group. Shivering occurred in 40% of patients in the B group, which was significantly more than that of the BD (16.6%) and BM (33.3%) groups. Itching happened in 33.3% of women in the BM group which was statistically more than that of the B (3.33%) and BD (0) groups. The incidence of adverse effects was the same in all groups. Conclusion: The combination of bupivacaine with dexmedetomidine significantly prolonged sensory and motor regression time and duration of analgesia.


Assuntos
Raquianestesia , Dexmedetomidina , Analgésicos/uso terapêutico , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Cesárea/efeitos adversos , Dexmedetomidina/farmacologia , Dexmedetomidina/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Injeções Espinhais , Meperidina/uso terapêutico , Dor/tratamento farmacológico , Gravidez
8.
Agri ; 34(3): 174-179, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35792689

RESUMO

OBJECTIVES: Patients suffer notable levels of pain after lumbar spine surgery. The primary objective of this randomized clinical trial is to investigate the efficacy of erector spinae plane block (ESPB) on 24-h post-operative pain score of patients undergoing lumbar spine surgery. Cumulative opioid consumption and intraoperative bleeding were assessed as well. METHODS: Adult patient candidates for elective lumbar spine surgery were randomly assigned to case (ESPB) and control (no ESPB) groups. The block was performed under ultrasound guidance in prone position after induction of general anesthesia. Both groups received the same anesthesia medication and technique. Post-operative pain score, number of patients requiring rescue analgesia (meperidine), total amount of post-operative rescue analgesic demand in the first 24 h, and intraoperative bleeding were recorded. To compare pain score variable in time span, the ANOVA repeated measure test was used. All the statistical tests were two tailed and p<0.05 considered as statistically significant. RESULTS: In all time intervals, pain score in case group was significantly lower than control group. In case group, eight patients demanded rescue analgesic (40%) which was significantly lower than that in control group (15 patients [75%]) (p=0.025). Total amount of meperidine consumption was 57.50±45.95 in control group and 22.50±32.34 in case group (p=0.01) which was higher in control group and statistically significant. CONCLUSION: ESPB reduces post-operative pain score and opioid consumption, while it does not affect intraoperative bleeding in lumbar spine surgery.


Assuntos
Bloqueio Nervoso , Adulto , Analgésicos Opioides/uso terapêutico , Humanos , Meperidina/uso terapêutico , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Ultrassonografia de Intervenção/métodos
9.
Int J Clin Pract ; 2022: 3368077, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35814307

RESUMO

Propofol-based sedation provides faster recovery than midazolam-based regimens with similar safety and comfort during video flexible bronchoscope (VFB) procedures. Pulmonologist-administered propofol "balanced" analgosedation (PAP-BAS) is still debated in Italy. In this real-life study, PAP-BAS safety and comfort during VFB procedures were investigated. We analysed prospectively the subjects undergoing elective VFB procedures in the Pulmonology and RICU of Arezzo Hospital between February and July 2019. PAP-BAS combined low propofol and meperidine doses titrated to achieve an RASS score between 0 and -3. The primary end-point was the complications' rate. Secondary end-points were as follows: the relation between propofol's dose and a subject's comfort assessed with a VAS, recovery time according to a modified Aldrete score ≥9, RASS, and subjects' will of undergoing the procedure again. We collected postprocedure symptoms' intensity too. Our 158 study patients (67 years; SD ± 14; 64% males) incurred in 25% of complication, fully resolved with medical therapy. Neither recourse to ventilator support nor death was reported. Intraprocedural comfort was good (94% of VAS score ≤2). Among postprocedural symptoms, cough was the most frequently reported, in 36% of the cases. Although half of subjects remembered the procedure, 90% of them would have repeated it, if necessary. 85% of them recovered from procedures within 10 minutes. Complications, VAS, and recovery time were not correlated with propofol dose. To our knowledge, this is the first Italian study showing that PAP-BAS to perform a VFB procedure is safe, well tolerated with a quick recovery. Randomised controlled trials are warranted to confirm these preliminary results.


Assuntos
Propofol , Sedação Consciente/métodos , Feminino , Humanos , Hipnóticos e Sedativos , Masculino , Meperidina , Midazolam/efeitos adversos , Propofol/efeitos adversos , Pneumologistas
10.
J Feline Med Surg ; 24(8): e269-e280, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35762271

RESUMO

OBJECTIVES: The aim of this study was to compare the quality of sedation with three different anaesthetic protocols (alfaxalone combined with butorphanol, methadone or pethidine) administered intramuscularly in cats, and to evaluate the influence of the injection site (between supraspinatus and quadriceps muscles) on the onset and quality of sedation. METHODS: A total of 151 cats were selected for this study. Cats were sedated with alfaxalone (3 mg/kg) combined with either butorphanol (0.3 mg/kg; n = 50), methadone (0.3 mg/kg; n = 53) or pethidine (5 mg/kg; n = 48). The combination was injected intramuscularly into the supraspinatus (n = 79) or quadriceps muscle (n = 72). The data included a scoring system for the quality of sedation and physiological parameters, such as heart rate (HR), respiratory rate, body temperature and occurrence of mydriasis, monitored during the first 30 mins of anaesthesia. RESULTS: The opioid associated with alfaxalone influenced the overall sedation score, the degree of myorelaxation, the occurrence of mydriasis and HR. The overall sedation score was poorer with butorphanol than with methadone (P = 0.008), and butorphanol induced a lower degree of myorelaxation than methadone (P = 0.013). The injection into the supraspinatus showed better qualitative results for sedation and a faster onset time (in about 3 mins) than that into the quadriceps (P <0.001). HR decreased from baseline (P <0.001) and over time (P <0.001), mainly in cats of the butorphanol-supraspinatus and pethidine-quadriceps groups (P = 0.004). The occurrence of mydriasis was lower after butorphanol than after methadone and pethidine (P = 0.025), while the incidence of side effects did not differ among groups. CONCLUSIONS AND RELEVANCE: All three protocols provided a good quality of sedation and allowed performing the scheduled procedure. Moreover, the injection into the supraspinatus muscle showed superior results in all the qualitative scores of sedation and quicker onset time than that into the quadriceps muscle.


Assuntos
Anestesia , Doenças do Gato , Midríase , Pregnanodionas , Anestesia/veterinária , Animais , Butorfanol/farmacologia , Butorfanol/uso terapêutico , Gatos , Hipnóticos e Sedativos , Injeções Intramusculares/veterinária , Meperidina , Metadona/uso terapêutico , Midríase/veterinária , Pregnanodionas/farmacologia , Músculo Quadríceps , Manguito Rotador
11.
Acta Med Acad ; 51(1): 14-20, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35695398

RESUMO

OBJECTIVES: Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In this retrospective observational study, we evaluated the effectiveness of 3-in-1 nerve block in patients after total knee arthroplasty compared to standard opioid treatment, and we state the reasons why this approach should still be considered. METHODS: To evaluate the effectiveness of the 3-in-1 nerve block, we assessed the acute pain service archive and compared the values of the visual analog scale, by separating patients into two groups according to the analgesic regimen they received as per local protocols. In group A, patients received 0.25% bupivacaine through a 3 in 1 block catheter and additional meperidine IM if needed, while in group B they received meperidine every six hours. RESULTS: Our analysis showed the statistically significant better effectiveness of 3-in-1 nerve block with bupivacaine administration in postoperative TKR pain control compared to repeated administration of meperidine. CONCLUSION: The results of our study suggest that 3-in-1 nerve block with bupivacaine is an option that must always be considered in order to alleviate post-operative pain after TKR.


Assuntos
Artroplastia do Joelho , Bloqueio Nervoso , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Artroplastia do Joelho/métodos , Bupivacaína/uso terapêutico , Nervo Femoral , Humanos , Meperidina , Bloqueio Nervoso/métodos , Estudos Observacionais como Assunto , Dor Pós-Operatória/tratamento farmacológico
12.
J Food Drug Anal ; 30(1): 104-110, 2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-35647716

RESUMO

Opioids are effective analgesics for pain relief, however, inappropriate use may cause risks. The aims of the study were to evaluate trends of opioid consumption for pain management in Taiwan and compare them among neighboring Asian countries. Opioid consumption data, including fentanyl, morphine, oxycodone, hydromorphone, codeine, and pethidine, were collected from the Controlled Drugs Management Information System of Taiwan Food and Drug Administration from 2008 to 2018. Data of different continents and neighboring Asian countries were retrieved from the WHO website. The major findings include: (1) In Taiwan, the total annual opioid consumption has gradually increased from 2008 to 2018, with fentanyl being the most frequently consumed opioid analgesic, followed by morphine. Codeine and pethidine consumption dropped significantly over the years. (2) In neighboring Asian countries, the opioid consumption in order from highest to lowest consumption were South Korea, Japan, Taiwan, Singapore, Hong Kong (China), and China. We concluded that, from 2008 to 2018, the total opioid consumption trend for pain management in Taiwan has slowly increased, with fentanyl and morphine being the most commonly used opioids. When compared with neighboring Asian countries, level of opioid consumption in Taiwan was between Japan and Singapore. The research results may provide a reference for healthcare professionals worldwide.


Assuntos
Analgésicos Opioides , Dor , Analgésicos Opioides/uso terapêutico , Codeína , Fentanila/uso terapêutico , Humanos , Meperidina , Morfina , Dor/tratamento farmacológico , Taiwan
13.
J Clin Pediatr Dent ; 46(2): 152-159, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35533228

RESUMO

PURPOSE: This retrospective study compares the efficacy and safety of variable dosing of Midazolam (Mid) with and without Meperidine (Mep) combinations for managing varying levels of anxiety and uncooperative behavior of young pediatric dental patients over a thirty-five-year period. STUDY DESIGN: Reviews of the sedation logs of 1,785 sedation visits are compared with emphasis on what dosing proves both safe and effective for differing levels of challenging pediatric behavior. Variable dosing of midazolam with and without meperidine which spanned low-end, mid-range, and upper-end were judged making use of a pragmatic approach which defined sedation success as optimal, adequate, inadequate, or over-dosage. Behavioral and physiologic assessment was included with attention to readily observable analysis of the extent to which need for physical restraint occurred to control interfering behavior. Assessment of arousal levels requiring stimulation along with the frequency of alterations in oxygen de-saturation and adverse reactions were included as indications of safety. RESULTS: Where Mep was used, success rates were consistently higher; working times were significantly prolonged and greater control was provided to avoid adverse reactions by virtue of reversal capability for both agents. CONCLUSIONS: Predictability and working time of Midazolam was enhanced by combination with narcotic for all levels of patient anxiety. Dosages of 0.7-1.0 mg/kg Mid combined with 1.0-1.5 mg/kg Mep offers the most effective and safe results to overcome need for restraint for moderate and severe levels of anxiety, respectively.


Assuntos
Meperidina , Midazolam , Ansiedade , Criança , Sedação Consciente/métodos , Humanos , Hipnóticos e Sedativos , Estudos Retrospectivos
14.
BMC Pregnancy Childbirth ; 22(1): 420, 2022 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-35585620

RESUMO

BACKGROUND: Massage during labour is one form of intrapartum non-pharmacological pain relief but it is not known whether the frequency of practicing these massage techniques among couples during the antenatal period could enhance the effectiveness of intrapartum massage. This study was to evaluate the association between compliance of antenatal massage practice with intrapartum application and their impact on the use of analgesics during labour. METHODS: This was a sub-analysis of a childbirth massage programme which was carried out in two public hospitals with total births of around 8000 per year. Data from women who were randomized to the massage group were further analysed. After attending the pre-birth training class on massage at 36 weeks gestation, couples would be encouraged to practice at home. Their compliance with massage at home was classified as good if they had practiced for at least 15 minutes for three or more days in a week, or as poor if the three-day threshold had not been reached. Application of intrapartum massage was quantified by the duration of practice divided by the total duration of the first stage of labour. Women's application of intrapartum massage were then divided into above and below median levels according to percentage of practice. Logistic regression was used to assess the use of epidural analgesia or pethidine, adjusted for duration of labour and gestational age when attending the massage class. RESULTS: Among the 212 women included, 103 women (48.6%) achieved good home massage compliance. No significant difference in the maternal characteristics or birth outcomes was observed between the good and poor compliance groups. The intrapartum massage application (median 21.1%) was inversely associated with duration of first stage of labour and positively associated with better home massage practice compliance (p = 0.04). Lower use of pethidine or epidural analgesia (OR 0.33 95% CI 0.12, 0.90) was associated with above median intrapartum massage application but not antenatal massage compliance, adjusted for duration of first stage of labour. CONCLUSIONS: More frequent practice of massage techniques among couples during antenatal period could enhance the intrapartum massage application, which may reduce the use of pethidine and epidural analgesia. TRIAL REGISTRATION: (CCRBCTR) Unique Trial Number CUHK_ CCRB00525 .


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Dor do Parto , Trabalho de Parto , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgésicos , Feminino , Humanos , Dor do Parto/terapia , Massagem , Meperidina , Gravidez
15.
BMC Cancer ; 22(1): 539, 2022 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-35549904

RESUMO

BACKGROUND: Bronchoscopy can be a distress for the patient. There have been few studies on the combination of sedatives and opioids. The aim of this study was to demonstrate the usefulness and safety of administration of the combination of midazolam and pethidine during bronchoscopy. METHODS: In this prospective randomized single (patient)-blind study, we randomly assigned 100 patients who were scheduled to undergo bronchoscopy biopsy to receive treatment with either the midazolam/pethidine combination (combination group) or midazolam alone (midazolam group) during examinations. After the end of bronchoscopy, patients completed a questionnaire and the visual analogue scale was measured. The primary outcome was the patients' acceptance of re-examination assessed by visual analogue scale. We also assessed pain levels, vital signs, midazolam use, xylocaine use, and adverse events. Univariate analyses were performed using Fisher's exact test for categorical data, and the t-test or Mann-Whitney test was carried out for analysis of numeric data. All P-values were two-sided, and values < 0.05 were considered statistically significant. RESULTS: We analyzed 47 patients in the combination group and 49 patients in the midazolam group. The primary outcome was a good trend in the combination group, but not significantly different (3.82 ± 2.3 in combination group versus 4.17 ± 2.75 in midazolam alone, P = 0.400). In the combination group, the visual analog scale score for pain during bronchoscopy was significantly lower (1.10 ± 1.88 versus 2.13 ± 2.42, P = 0.022), and the sedation level score per the modified observer's assessment of alertness/sedation scale was significantly deeper (3.49 ± 0.98 versus 3.94 ± 1.03, P = 0.031). Maximal systolic blood pressure during testing was significantly lower (162.39 ± 23.45 mmHg versus 178.24 ± 30.24 mmHg, P = 0.005), and the number of additional administrations of midazolam was significantly lower (2.06 ± 1.45 versus 2.63 ± 1.35, P = 0.049). There were also significantly fewer adverse events (30 versus 41, P = 0.036). CONCLUSIONS: The combination uses of midazolam and pethidine for sedation resulted in significant improvements in the pain, blood pressure, additional use of midazolam, and safety during bronchoscopy among patients. TRIAL REGISTRATION: This study was registered in the University Medical Hospital Information Network in Japan (UMINCTR Registration number: UMIN000032230 , Registered: 13/April/2018).


Assuntos
Meperidina , Midazolam , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Sedação Consciente/métodos , Humanos , Midazolam/efeitos adversos , Dor/etiologia , Estudos Prospectivos , Método Simples-Cego
16.
Chemosphere ; 301: 134710, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35487358

RESUMO

The present work focuses on the development of a new electrochemical platform based on CoMn2O4-rGO/1-ethyl-3-methylimidazolium chloride modified carbon paste electrode (CoMn2O4-rGO/IL/CPE) for electrochemical determination of pethidine in the presence of biological species. For the first time, the electrooxidation mechanism of pethidine in presences of morphine and olanzapine is investigated by cyclic voltammetry (CV) and differential pulse voltammetry (DPV) technologies. The as-synthesized CoMn2O4-rGO nanocomposites are characterized by physicochemical measurements such as X-ray diffraction (XRD), energy dispersive X-ray spectroscopy (EDX), Field emission scanning electron microscopy (FE-SEM), and Fourier transform infrared (FT-IR). The obtained results illustrated synergistic interactions between rGO and CoMn2O4 structures. Also, to investigate the electrode charge-transfer resistances, electrochemical features of the resulting nanocomposites are studied via electrochemical impedance spectroscopy (EIS) analysis. Based on the result, three segmented linear ranges are observed over the range 0.08-900 µM and detection limit of 0.024 µM. Over the 10.0-40.0 µM ranges of pethidine in phosphate buffer solution (PBS-pH 7.0), suitable diffusion coefficient of 5.67 × 10-7 cm2 s-1 is evaluated by chronoamperometry technique (CHA). Finally, the CoMn2O4-rGO/IL/CPE with high sensitivity, selectivity and repeatability is successfully used for determination of pethidine in real sample and drug formulation.


Assuntos
Carbono , Cloreto de Etil , Carbono/química , Cloretos , Técnicas Eletroquímicas/métodos , Eletrodos , Grafite , Imidazóis , Meperidina , Morfina , Olanzapina , Espectroscopia de Infravermelho com Transformada de Fourier
17.
Inflammopharmacology ; 30(3): 875-881, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35445990

RESUMO

OBJECTIVE: Imrecoxib is a novel cyclooxygenase-2 inhibitor independently developed in China, which exhibits a good efficacy and tolerance in orthopedic disorders. The current study aimed to further compare its efficacy and safety with celecoxib as postoperative analgesia in arthroscopic knee surgery (AKS). METHODS: Patients receiving AKS were enrolled and randomly assigned to imrecoxib (n = 64) and celecoxib (n = 62) group to receive analgesia for 72 h after surgery. Pain at rest and movement, pethidine consumption, patient's satisfaction, Lysholm score, and adverse events were assessed after AKS. Meanwhile the upper limit of 95% CI of pain-score mean difference (MD) between imrecoxib and celecoxib was calculated, then, the non-inferiority was defined if the all-time-point upper limits of 95% CI less than 1. RESULTS: Imrecoxib was non-inferior to celecoxib for alleviating pain at rest (upper limit of 95% CI of MD ranging from 0.443 to 0.782, all time-point values less than 1); as well as for attenuating pain at movement (upper limit of 95% CI of MD ranging from 0.398 to 0.582, all time-point values less than 1). Moreover, rescue analgesia rate (P = 0.583), pethidine consumption (P = 0.454), patient's satisfaction at 72 h (P = 0.408), and Lysholm score at M3 (P = 0.776) were of no difference between imrecoxib group and celecoxib group. Additionally, the main adverse events in two groups were nausea (P = 0.425), constipation (P = 1.000), vomiting (P = 0.715), headache (P = 1.000), and dizziness (P = 0.667), which were mild and manageable. CONCLUSION: Imrecoxib is non-inferior to celecoxib in postoperative analgesia and exhibits an acceptable tolerance in patients undergoing AKS.


Assuntos
Analgesia , Dor Pós-Operatória , Celecoxib/efeitos adversos , Humanos , Meperidina , Dor Pós-Operatória/tratamento farmacológico , Pirróis , Sulfetos
19.
Clin Neurol Neurosurg ; 215: 107208, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35316699

RESUMO

Meperidine (pethidine) is a µ-opioid receptor (MOR) agonist widely used in the treatment of cancer pain. While MOR agonists in experimental models have demonstrated both pro- and antitumorigenic properties, meperidine has unique features which may be predominantly anticancer in nature. Meperidine both inhibits NMDA (N-methyl-D-Aspartate) receptors, which are involved in the progression of glioblastoma, and blocks NADH:Ubiquinone Oxidoreductase, which may hinder mitochondrial respiration. In the developing embryonic neural tissue, meperidine reduces cell proliferation around the neural tube and lowers the expression of the B RE (brain and reproductive organ-expressed). This is notable given that the B RE gene is implicated in cancer chemoresistance and gliomagenesis. Further, meperidine inhibits P-glycoprotein, which is involved in cancer multidrug resistance and the degradation of the sphingolipid backbone, ceramide. By enhancing the pro-autophagic and pro-apoptotic ceramide levels in cancer cells, meperidine stimulates cell death and reverses multidrug resistance. Tamoxifen, a safe medication employed in the treatment of breast cancer, directly blocks P-glycoprotein and boosts levels of ceramide both via inhibition of glycosylceramide synthase and ceramidase. Further, tamoxifen blocks NMDA-neurotoxicity and therefore it may act synergistically with meperidine in reducing glioblastoma progression associated with NMDA-activation. Finally, tamoxifen blocks glycolysis which may enhance the mitochondrial-blocking activity of meperidine to shut down energy metabolism of glioblastoma cells. Because of these properties, we believe that the combination of meperidine and tamoxifen merits study in cell culture and animal models to investigate a potential synergistic relationship in the treatment of glioblastoma.


Assuntos
Glioblastoma , Tamoxifeno , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/metabolismo , Apoptose , Ceramidas/metabolismo , Ceramidas/farmacologia , Ceramidas/uso terapêutico , Glioblastoma/tratamento farmacológico , Humanos , Meperidina/farmacologia , Redes e Vias Metabólicas , N-Metilaspartato/metabolismo , Tamoxifeno/metabolismo , Tamoxifeno/farmacologia , Tamoxifeno/uso terapêutico
20.
Vet Med Sci ; 8(4): 1664-1670, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35353952

RESUMO

BACKGROUND: The use of combinations of α2 -adrenergic agonists and opioids has been published as providing superior sedation than either drug alone. INTRODUCTION: The present study aims to compare the sedative and physiological effects of intravenous (IV) administration of medetomidine alone and in combination with methadone, morphine, tramadol, and pethidine in goats. METHODS: Ten healthy goats aged 12 ± 3 months and weight of 22 ± 4 kg were used in an experimental, crossover (Latin square), randomized, and blinded study. The animals were assigned to five IV treatments with a minimum washout period of 8 days between treatments: medetomidine (20 µg kg-1 ), medetomidine/methadone (0.5 mg kg-1 ), medetomidine/morphine (0.5 mg kg-1 ), medetomidine/tramadol (5 mg kg-1 ), and medetomidine/pethidine (1 mg kg-1 ). RESULTS: Clinical adverse effects such as tremors (facial and generalized), bruxism, nystagmus, mydriasis, and vocalization were presented in all the medetomidine/opioid treatments. Clinical adverse effects were observed at 10-90 minutes in medetomidine/opioid treatments. Animals in all treatments were sedated at 5-90 minutes. Sedation was significantly higher in medetomidine/opioid treatments than in medetomidine at 15-30 minutes after administration (P < 0.05). In all treatments, heart rate and respiratory rate significantly decreased from baseline at 5-105 and 30-60 minutes, respectively. There was no significant difference in heart and respiratory rates between different treatments at any time point. Ruminal motility was decreased in medetomidine and medetomidine/opioid treatments at 10-75 and 10-105 minutes, respectively. Compared with medetomidine, ruminal motility was significantly lower in medetomidine/opioid treatments at 75-105 minutes. CONCLUSION: The use of combinations of medetomidine/opioids would be considered for superior sedation at 15-30 minutes after administration in goats. No significant differences were detected among opioids in combination with medetomidine in goats.


Assuntos
Medetomidina , Tramadol , Analgésicos Opioides/farmacologia , Animais , Cabras , Hipnóticos e Sedativos/farmacologia , Medetomidina/farmacologia , Meperidina , Metadona/farmacologia , Morfina/farmacologia , Tramadol/farmacologia
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