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intrathecal morphine

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https://www.readbyqxmd.com/read/29138593/intrathecal-pain-management-a-team-based-approach
#1
REVIEW
Jeremy A Adler, Neona M Lotz
Objective: Physician assistants (PAs), nurse practitioners (NPs), and registered nurses (RNs) provide professional services on pain management teams. This review provides an overview of the practical management of chronic pain with intrathecal (IT) therapy using an interprofessional approach (eg, physicians and other health care professionals), with a focus on the contributions of PAs, NPs, and RNs. Methods: Narrative review based on literature searches of the Medline database and treatment guidelines on the use of IT therapy in the management of patients with chronic pain...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29123622/retrospective-analysis-of-the-financial-break-even-point-for-intrathecal-morphine-pump-use-in-korea
#2
Eun Kyoung Kim, Ji Yeon Shin, Anyela Marcela Castañeda, Seung Jae Lee, Hyun Kyu Yoon, Yong Chul Kim, Jee Youn Moon
Background: The high cost of intrathecal morphine pump (ITMP) implantation may be the main obstacle to its use. Since July 2014, the Korean national health insurance (NHI) program began paying 50% of the ITMP implantation cost in select refractory chronic pain patients. The aims of this study were to investigate the financial break-even point and patients' satisfaction in patients with ITMP treatment after the initiation of the NHI reimbursement. Methods: We collected data retrospectively or via direct phone calls to patients who underwent ITMP implantation at a single university-based tertiary hospital between July 2014 and May 2016...
October 2017: Korean Journal of Pain
https://www.readbyqxmd.com/read/29042318/mechanisms-of-%C3%AE-opioid-receptor-inhibition-of-nmda-receptor-induced-substance-p-release-in-the-rat-spinal-cord
#3
Wenling Chen, Helena S Ennes, James A McRoberts, Juan Carlos Marvizón
The interaction between NMDA receptors and μ-opioid receptors in primary afferent terminals was studied by using NMDA to induce substance P release, measured as neurokinin 1 receptor internalization. In rat spinal cord slices, the μ-opioid receptor agonists morphine, DAMGO and endomorphin-2 inhibited NMDA-induced substance P release, whereas the antagonist CTAP right-shifted the concentration response of DAMGO. In vivo, substance P release induced by intrathecal NMDA after priming with BDNF was inhibited by DAMGO...
October 16, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/29027773/perioperative-pain-management-in-cardiac-surgery-a-systematic-review
#4
Elena Bignami, Alberto Castella, Vincenzo Pota, Francesco Saglietti, Antonio Scognamiglio, Cinzia Trumello, Maria C Pace, Massimo Allegri
BACKGROUND: Every year, more than 1.5 million patients, who undergo cardiac surgery worldwide, are exposed to a series of factors that can trigger acute postoperative pain associated with hemodynamic instability, respiratory complications, and psychological disorders. Through an evaluation of literature data about postoperative pain in cardiac surgery we define unmet needs and potential objectives for future research on this often underestimated problem. METHODS: Following PRISMA Guidelines, a systematic literature search was carried out by two independent researchers on Scopus, CINAHL, the Cochrane Library, and PubMed using the keywords: [(perioperative OR postoperative) analgesia AND "cardiac surgery"]...
October 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29016893/efficacy-safety-and-feasibility-of-the-morphine-microdose-method-in-community-based-clinics
#5
Denise M Wilkes, Susan J Orillosa, Erik C Hustak, Courtney G Williams, Gulshan R Doulatram, Daneshvari R Solanki, Eduardo A Garcia, Li-Yen M Huang
Objectives: The goal of this study was to assess the success of the morphine microdose method in a community pain clinic setting by monitoring follow-up frequency, dose escalation, and monotherapy/polytherapy ratio. The morphine microdose method involves a pretrial reduction or elimination of systemic opioids followed by a period of abstinence. Intrathecal (IT) morphine is then started at doses of less than 0.2 mg per day. Systemic opioid abstinence is then continued after pump implant and IT morphine monotherapy...
June 13, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28993160/inhibition-of-morphine-tolerance-by-mrgc-receptor-via-modulation-of-interleukin-1%C3%AE-and-matrix-metalloproteinase-9-in-dorsal-root-ganglia-in-rats
#6
Yue Zhang, Kai Wang, Minyan Lin, Qi Li, Yanguo Hong
Opiate tolerance is a critical issue in pain management. Previous studies show that activation of Mas-related gene (Mrg) C receptor can modulate the development of morphine tolerance. This study was designed to investigate the underlying mechanism(s). Intrathecal (i.t.) administration of morphine (20µg) increased the expression of interleukin-1β (IL-1β) and matrix metalloproteinase-9 (MMP-9) in small- and medium-sized neurons in dorsal root ganglia (DRG). Co-administration of bovine adrenal medulla 8-22 (BAM8-22), a selective MrgC receptor agonist, via i...
October 6, 2017: European Journal of Pharmacology
https://www.readbyqxmd.com/read/28991118/truncated-%C3%AE-opioid-receptors-with-6-transmembrane-domains-are-essential-for-opioid-analgesia
#7
Zhigang Lu, Jin Xu, Mingming Xu, Grace C Rossi, Susruta Majumdar, Gavril W Pasternak, Ying-Xian Pan
BACKGROUND: Most clinical opioids act through μ-opioid receptors. They effectively relieve pain but are limited by side effects, such as constipation, respiratory depression, dependence, and addiction. Many efforts have been made toward developing potent analgesics that lack side effects. Three-iodobenzoyl-6β-naltrexamide (IBNtxA) is a novel class of opioid active against thermal, inflammatory, and neuropathic pain, without respiratory depression, physical dependence, and reward behavior...
October 4, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28975565/inhibition-of-%C3%AE-ark1-ameliorates-morphine-induced-tolerance-and-hyperalgesia-via-modulating-the-activity-of-spinal-nmda-receptors
#8
Xue Zhang, Shaorui Chen, Hong Chen, Huilin Pan, Yilin Zhao
Our previous study has proposed that increased presynaptic NMDARs activities play pivotal roles in the development of opioid tolerance and hyperalgesia, and blocking spinal NMDARs attenuates chronic morphine-induced synaptic plasticity and behavior. However, the cellular signaling mechanisms remain to be investigated. The aim of this research was to address the role of β-ARK1 in opioid analgesia. Opioid tolerance and hyperalgesia was induced by daily systemic morphine injections in rats for eight consecutive days...
October 3, 2017: Molecular Neurobiology
https://www.readbyqxmd.com/read/28964640/a-prospective-study-of-post-cesarean-delivery-hypoxia-after-spinal-anesthesia-with-intrathecal-morphine-150%C3%AE-g
#9
Karim S Ladha, Rie Kato, Lawrence C Tsen, Brian T Bateman, Toshiyuki Okutomi
INTRODUCTION: Delayed respiratory depression is a feared complication of intrathecal morphine in patients undergoing cesarean delivery. The incidence, timing and risk factors for hypoxia in this population are not known. METHODS: Patients undergoing cesarean delivery under spinal anesthesia at a tertiary care center from October 2012 to March 2016 were included in the study. The Berlin sleep apnea Questionnaire was completed before surgery. Oxygen saturation was recorded every second for 24hours after the initiation of spinal anesthesia...
November 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28961489/spinal-ccl1-ccr8-signaling-interplay-as-a-potential-therapeutic-target-evidence-from-a-mouse-diabetic-neuropathy-model
#10
Magdalena Zychowska, Ewelina Rojewska, Anna Piotrowska, Grzegorz Kreiner, Irena Nalepa, Joanna Mika
BACKGROUND: Chemokine signaling has been implicated in the pathogenesis of diabetic neuropathy; however, the involvement of the chemokine CC motif ligand 1 (CCL1)-chemokine CC motif receptor 8 (CCR8) interaction remains unknown. The goal of this study was to examine the role of CCL1-CCR8 signaling interplay in the development of hypersensitivity and in opioid effectiveness in diabetic neuropathy. METHODS: Primary glial cell cultures and a streptozotocin (STZ; 200mg/kg, intraperitoneal)-induced mouse model of diabetic neuropathy were used...
September 25, 2017: International Immunopharmacology
https://www.readbyqxmd.com/read/28950244/severe-side-effects-from-intrathecal-morphine-for-chronic-pain-after-repeated-failed-spinal-operations
#11
Bård Lundeland, Lars Janerås, Gunnvald Kvarstein
No abstract text is available yet for this article.
September 23, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/28948894/minimally-invasive-technique-for-intrathecal-administration-of-morphine-in-rats-practicality-and-antinociceptive-properties
#12
Aurelie Anic Thomas, Johann Detilleux, Charlotte Friederike Sandersen, Paul Andrew Flecknell
The intrathecal (IT) route of administration represents a means to reduce the dose of morphine administered for analgesia, potentially minimizing interactions between opioid effects and experimental outcomes. Perceived technical difficulty, and previously described invasive methods, may limit its use. This report describes a minimally invasive technique for IT administration of morphine by direct transcutaneous lumbosacral puncture in rats; and assesses antinociceptive properties of morphine in anaesthetized rats...
October 2017: Laboratory Animals
https://www.readbyqxmd.com/read/28939014/novel-endomorphin-analogs-are-more-potent-and-longer-lasting-analgesics-in-neuropathic-postoperative-inflammatory-and-visceral-pain-relative-to-morphine
#13
Amy K Feehan, Jenny Morgenweck, Xing Zhang, Ariel Amgott-Kwan, James E Zadina
Activation of the mu-opioid receptor provides the gold standard for pain relief, but a majority of opioids used clinically have adverse effects that have contributed to an epidemic of overdose deaths. We recently characterized mu-opioid receptor selective endomorphin (EM) analogs that provide potent antinociception with reduction or absence of a number of side effects of traditionally prescribed opioids including abuse liability, respiratory depression, motor impairment, tolerance, and inflammation [91]. The current study explores the effectiveness of these EM analogs relative to morphine in four major pain models by both intrathecal and intravenous administration in male, Sprague-Dawley rats and male CD-1 mice...
September 19, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28924009/site-specific-regulation-of-p2x7-receptor-function-in-microglia-gates-morphine-analgesic-tolerance
#14
Heather Leduc-Pessah, Nicholas L Weilinger, Churmy Y Fan, Nicole E Burma, Roger J Thompson, Tuan Trang
Tolerance to the analgesic effects of opioids is a major problem in chronic pain management. Microglia are implicated in opioid tolerance, but the core mechanisms regulating their response to opioids remain obscure. By selectively ablating microglia in the spinal cord using a saporin-conjugated antibody to Mac1, we demonstrate a causal role for microglia in the development, but not maintenance, of morphine tolerance in male rats. Increased P2X7 receptor (P2X7R) activity is a cardinal feature of microglial activation, and in this study we found that morphine potentiates P2X7R-mediated Ca(2+) responses in resident spinal microglia acutely isolated from morphine tolerant rats...
October 18, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28918556/effects-of-pregabalin-on-postoperative-pain-after-hysterectomy-under-spinal-anesthesia-with-intrathecal-morphine-a-randomized-controlled-trial
#15
Taniga Kiatchai, Vimolluck Sanansilp, Namtip Triyasunant, Sasithorn Saengprateep, Paksiree Changkittirat, Vuthinun Achariyapota
PURPOSE: To determine if preoperative pregabalin could decrease 24-h postoperative morphine consumption after spinal anesthesia with intrathecal morphine compared with placebo. METHODS: A randomized, double-blind, controlled trial was performed in the tertiary care center. Patients aged between 18 and 65 years who were American Society of Anesthesiologists class I-II and scheduled for abdominal hysterectomy with or without salpingo-oophorectomy were randomly allocated to a placebo or a pregabalin group...
December 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28889721/spinal-myoclonus-responding-to-continuous-intrathecal-morphine-pump
#16
Jung-Eun Ahn, Dallah Yoo, Ki-Young Jung, Jong-Min Kim, Beomseok Jeon, Myung Chong Lee
Spinal myoclonus is a sudden, brief, and involuntary movement of segmental or propriospinal muscle groups. Spinal myoclonus has occasionally been reported in patients undergoing opioid therapy, but the pathophysiology of opioid-induced myoclonus has not been elucidated yet. Here, we present two patients with spinal segmental myoclonus secondary to ischemic and radiation myelopathy. Conventional medications did not help treat persistent myoclonus in both legs. Continuous intrathecal morphine infusion was implanted for pain control in one patient, which relieved spinal myoclonus entirely...
September 2017: Journal of Movement Disorders
https://www.readbyqxmd.com/read/28856511/local-infiltration-analgesia-a-2-year-follow-up-of-patients-undergoing-total-hip-arthroplasty
#17
Ján Kuchálik, Anders Magnuson, Anders Lundin, Anil Gupta
PURPOSE: Local infiltration analgesia (LIA) is commonly used for postoperative pain management following total hip arthroplasty (THA). However, the long-term effects of the component drugs are unclear. The aim of our study was to investigate functional outcome, quality of life, chronic post-surgical pain, and adverse events in patients within 2 years of undergoing THA. METHODS: The study was a secondary analysis of data from a previous larger study. Eighty patients were randomized to receive either intrathecal morphine (Group ITM) or local infiltration analgesia (Group LIA) for pain management in a double-blind study...
August 30, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28836932/a-better-journey-for-patients-a-better-deal-for-the-nhs-the-successful-implementation-of-an-enhanced-recovery-program-after-renal-transplant-surgery
#18
Ahmed Halawa, Stephen Rowe, Fleur Roberts, Chidambaram Nathan, Ahmed Hassan, Avneesh Kumar, Branislav Suvakov, Ben Edwards, Cavin Gray
OBJECTIVES: Our aim was to apply the principles of enhanced recovery in renal transplant recipients and to assess the changes in the quality of patient care and patient satisfaction. MATERIALS AND METHODS: Our study included 286 consecutive renal transplant patients. Of these, 135 patients went through the enhanced recovery program and 151 patients had traditional recovery. Patient education and discharge planning were commenced on admission. For enhanced recovery, prolonged preoperative fasting was avoided by carbohydrate loading...
August 24, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28830362/impact-of-intrathecal-morphine-analgesia-on-the-incidence-of-pulmonary-complications-after-cardiac-surgery-a-single-center-propensity-matched-cohort-study
#19
Christoph Ellenberger, Tornike Sologashvili, Krishnan Bhaskaran, Marc Licker
BACKGROUND: Acute pain and systemic opioids may both negatively impact respiratory function after cardiac surgery. This study analyzes the local practice of using intrathecal morphine analgesia (ITMA) with minimal parenteral opioid administration in cardiac surgery, specifically the impact on postoperative pulmonary complications (PPCs). METHODS: Data from adult patients who underwent elective cardiac surgery between January 2002, and December 2013 in a single center were analyzed...
August 22, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28814320/intrathecal-morphine-versus-femoral-nerve-block-for-pain-control-after-total-knee-arthroplasty-a-meta-analysis
#20
Yi Tang, Xu Tang, Qinghua Wei, Hui Zhang
BACKGROUND: This meta-analysis aims to illustrate the efficacy and safety of intrathecal morphine (ITM) versus femoral nerve block (FNB) for pain control after total knee arthroplasty (TKA). METHODS: In April 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, Cami Info. Inc., Casalini databases, EBSCO databases, Verlag database and Google database. Data on patients prepared for TKA surgery in studies that compared ITM versus FNB for pain control after TKA were collected...
August 16, 2017: Journal of Orthopaedic Surgery and Research
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