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intrathecal morphine

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https://www.readbyqxmd.com/read/28448398/intrathecal-morphine-versus-extended-release-epidural-morphine-for-postoperative-pain-control-in-pediatric-patients-undergoing-posterior-spinal-fusion
#1
Mindy Cohen, Jeannie Zuk, Nancy McKay, Mark Erickson, Zhaoxing Pan, Jeffrey Galinkin
BACKGROUND: Posterior spinal fusion for scoliosis is one of the most painful elective pediatric surgeries. Good postoperative pain control allows early ambulation and return of ability to tolerate oral intake. Options for analgesia in this patient population are suboptimal. We hypothesized that extended-release epidural morphine (EREM) would provide better pain control and less adverse effects compared to intrathecal (IT) morphine. METHODS: The primary outcome was total IV morphine consumption during 0-48 hours postoperatively...
April 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28448397/prophylactic-pentazocine-reduces-the-incidence-of-pruritus-after-cesarean-delivery-under-spinal-anesthesia-with-opioids-a-prospective-randomized-clinical-trial
#2
Masato Hirabayashi, Katsushi Doi, Noritaka Imamachi, Tomomune Kishimoto, Yoji Saito
BACKGROUND: The incidence of pruritus after cesarean delivery under spinal anesthesia with opioids is high, ranging from 50% to 100%. Pruritus is difficult to prevent; however, pentazocine has been shown to be an effective treatment. Despite this, the prophylactic effect of pentazocine on pruritus has not been defined. This randomized double-blind trial aimed to evaluate the effect of intraoperative IV pentazocine on the incidence of opioid-induced pruritus within the first 24 hours after administration of neuraxial opioids...
April 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28435667/neuraxial-opioids-as-analgesia-in-labour-and-postoperative-after-caesarean-section-and-hysterectomy-a-questionnaire-survey-in-sweden
#3
Anette Hein, Caroline Gillis-Haegerstrand, Jan G Jakobsson
Background: Neuraxial opioids improve labour analgesia and analgesia after caesarean section (CS) and hysterectomy. Undesirable side effects and difficulties in arranging postoperative monitoring might influence the use of these opioids. The aim of the present survey was to assess the use of intrathecal and epidural morphine in gynaecology and obstetrics in Sweden. Methods: A questionnaire was sent to 47 anaesthesiologists at obstetric units in Sweden concerning the use and postoperative monitoring of morphine, sufentanil and fentanyl in spinal/epidural anaesthesia...
2017: F1000Research
https://www.readbyqxmd.com/read/28422794/intrathecal-morphine-in-spine-surgery-a-meta-analysis-of-randomized-controlled-trials
#4
Arif Pendi, Frank L Acosta, Alexander Tuchman, Rana Movahedi, Lakshmanan Sivasundaram, Ibraheem Arif, Gligor Gucev
STUDY DESIGN: Meta-analysis of randomized controlled trials (RCTs). OBJECTIVE: To evaluate the effectiveness of intrathecal morphine (ITM) in reducing postoperative pain and opioid analgesic consumption following spine surgery. SUMMARY OF BACKGROUND DATA: The use of ITM following adult spine surgery is of particular interest due to the ease of access to the thecal sac and the potential to provide adequate analgesia at low doses. However, previous studies of ITM have been limited by small sample sizes and conflicting results...
April 18, 2017: Spine
https://www.readbyqxmd.com/read/28405033/post-caesarean-analgesia-what-is-new
#5
REVIEW
Sukhyanti Kerai, Kirti Nath Saxena, Bharti Taneja
Adequate post-operative analgesia after caesarean section (CS) is vital as it impacts the distinct surgical recovery requirements of the parturient. Although newer analgesic modalities and drugs for post-caesarean analgesia have been introduced over the recent years, review of the literature suggests suggests that we are far from achieving the goals of optimum post-operative analgesia. We conducted a systematic review of recent advances in modalities for post-caesarean analgesia. After systematic search and quality assessment of studies, we included a total of 51 randomised controlled trials that evaluated the role of opioids, transversus abdominis plane (TAP) block, wound infiltration/infusion, ketamine, gabapentin and ilioinguinal-iliohypogastric nerve block (II-IH NB) for post-caesarean analgesia...
March 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28368941/continuous-ropivacaine-subfascial-wound-infusion-compared-with-intrathecal-morphine-for-postcesarean-analgesia-a-prospective-randomized-controlled-double-blind-study
#6
Manon Lalmand, Madeleine Wilwerth, Jean-François Fils, Philippe Van der Linden
BACKGROUND: After cesarean delivery, postoperative pain management allows early rehabilitation and helps prevent postpartum depression and chronic pain. Our present prospective, randomized controlled, double-blind study assessed the duration and effect of intrathecal analgesia and continuous ropivacaine wound infiltration versus a control group after cesarean delivery. The primary outcome was analgesia duration, defined as time to first morphine request. Secondary outcomes were cumulative postoperative morphine consumption, number of patients who did not require IV morphine, incidence of adverse effects, and time to first ambulation...
March 31, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28352316/monocyte-chemoattractant-protein-1-contributes-to-morphine-tolerance-in-rats-with-cancer-induced-bone-pain
#7
Lei Liu, Xiu-Juan Gao, Chun-Guang Ren, Ji-Hua Hu, Xian-Wen Liu, Ping Zhang, Zong-Wang Zhang, Zhi-Jian Fu
Cancer-induced bone pain can severely compromise the life quality of patients, while tolerance limits the use of opioids in the treatment of cancer pain. Monocyte chemoattractant protein-1 (MCP-1) is known to contribute to neuropathic pain. However, the role of spinal MCP-1 in the development of morphine tolerance in patients with cancer-induced bone pain remains unclear. The aim of the present study was to investigate the role of spinal MCP-1 in morphine tolerance in bone cancer pain rats (MTBP rats). Bone cancer pain was induced by intramedullary injection of Walker 256 cells into the tibia of the rats, while morphine tolerance was induced by continuous intrathecal injection of morphine over a period of 9 days...
February 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28347772/bifunctional-opioid-nociceptin-hybrid-kgnop1-effectively-attenuates-pain-related-behaviour-in-a-rat-model-of-neuropathy
#8
Joanna Starnowska, Karel Guillemyn, Wioletta Makuch, Joanna Mika, Steven Ballet, Barbara Przewlocka
A bifunctional peptide containing an opioid and nociceptin receptor-binding pharmacophore, H-Dmt-D-Arg-Aba-β-Ala-Arg-Tyr-Tyr-Arg-Ile-Lys-NH2 (KGNOP1), was tested for its analgesic properties when administered intrathecally in naïve and chronic constriction injury (CCI)-exposed rats with neuropathy-like symptoms. KGNOP1 significantly increased the acute pain threshold, as measured by the tail-flick test, and also increased the threshold of a painful reaction to mechanical and thermal stimuli in CCI-exposed rats...
March 24, 2017: European Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/28347572/the-effect-of-nefopam-on-lactation-after-caesarean-section-a-single-blind-randomised-trial
#9
N E Baka, F Vial, G Iohom, P Guerci, C Hubert, M Rouabah, H Bouaziz
BACKGROUND: Nefopam is a centrally acting analgesic which has a theoretical risk of stopping lactation due to its anticholinergic and dopaminergic effects. The aim of this study was to evaluate the effect of nefopam on lactation and to investigate potential adverse effects on newborns. METHODS: Seventy-two women, scheduled to undergo a caesarean delivery under spinal anaesthesia and wanting to breastfeed, were randomised to one of two groups: nefopam (20mg, six hourly) or paracetamol (1g, six hourly)...
February 20, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28337574/the-rs504393-influences-the-level-of-nociceptive-factors-and-enhances-opioid-analgesic-potency-in-neuropathic-rats
#10
Klaudia Kwiatkowski, Anna Piotrowska, Ewelina Rojewska, Wioletta Makuch, Joanna Mika
Increasing evidence has indicated that activated glial cells releasing nociceptive factors, such as interleukins and chemokines, are of key importance for neuropathic pain. Significant changes in the production of nociceptive factors are associated with the low effectiveness of opioids in neuropathic pain. Recently, it has been suggested that CCL2/CCR2 signaling is important for nociception. Here, we studied the time course changes in the mRNA/protein level of CD40/Iba-1, CCL2 and CCR2 in the spinal cord/dorsal root ganglia (DRG) in rats following chronic constriction injury (CCI) of the sciatic nerve...
March 23, 2017: Journal of Neuroimmune Pharmacology: the Official Journal of the Society on NeuroImmune Pharmacology
https://www.readbyqxmd.com/read/28326948/rare-presentation-of-intrathecal-morphine-withdrawal-psychosis
#11
Rohit Aiyer, Vivek Jain, Anurag Bhatia, Boris Mekinulov, Semih Gungor
We report a case of a 57-year-old male patient with intrathecal morphine pump failure who presented with psychosis as part of a clinical presentation of opioid withdrawal. The patient was being treated for chronic back pain with an intrathecal morphine pump for several years. The patient spontaneously started to experience psychotic symptoms which included disorganized thinking, delusional thoughts, paranoia, auditory and visual hallucinations. Upon interrogation of intrathecal pump, it was found not to be functioning, thereby not delivering intrathecal morphine...
February 28, 2017: Pain Management
https://www.readbyqxmd.com/read/28296770/evaluation-of-intrathecal-drug-delivery-system-for-intractable-pain-in-advanced-malignancies-a-prospective-cohort-study
#12
Shuyue Zheng, Liangliang He, Xiaohui Yang, Xiuhua Li, Zhanmin Yang
Pain is prevalent in advanced malignancies; however, some patients cannot get adequate pain relief by conservative routes of analgesic administration or experience serious side effects related to high dose of opioids. For those who have exhausted multimodal conservative analgesic, intrathecal drug delivery is an alternative intervention for truly effective pain management. The objective of this study was to evaluate the clinical efficacy and safety of intrathecal drug delivery system (IDDS) for the treatment of intractable pain in advanced cancer patients...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28291511/%C3%A2-intrathecal-analgesia-by-bupivacaine-is-not-enhanced-by-coadministration-of-morphine-in-patients-with-severe-cancer-related-pain-a-randomized-double-blind-cross-over-study
#13
Ingalill Reif, Anders Wincent, Carl-Olav Stiller
The objective of this randomized double blind cross-over trial was to determine if patients with severe cancer-related pain and inadequate response to systemic opioids prefer intrathecal (IT) pain relief with a combination of bupivacaine and morphine or bupivacaine only. Adult patients with cancer-related pain (n = 23) scheduled for IT analgesia at the Pain Center at the Karo-linska University Hospital Solna, Stockholm, Sweden, were included. The optimal individual flow rate of IT bupivacaine (2 mg/mL) in addition to bolus doses was titrated and maintained for 4 days...
March 14, 2017: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28275350/blockade-of-p2x4-receptors-inhibits-neuropathic-pain-related-behavior-by-preventing-mmp-9-activation-and-consequently-pronociceptive-interleukin-release-in-a-rat-model
#14
Agnieszka M Jurga, Anna Piotrowska, Wioletta Makuch, Barbara Przewlocka, Joanna Mika
Neuropathic pain is still an extremely important problem in today's medicine because opioids, which are commonly used to reduce pain, have limited efficacy in this type of pathology. Therefore, complementary therapy is needed. Our experiments were performed in rats to evaluate the contribution of the purinergic system, especially P2X4 receptor (P2X4R), in the modulation of glia activation and, consequently, the levels of nociceptive interleukins after chronic constriction injury (CCI) of the right sciatic nerve, a rat model of neuropathic pain...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/28273133/postoperative-pain-treatment-after-total-knee-arthroplasty-a-systematic-review
#15
Anders Peder Højer Karlsen, Mik Wetterslev, Signe Elisa Hansen, Morten Sejer Hansen, Ole Mathiesen, Jørgen B Dahl
INTRODUCTION: The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). METHODS: This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-based analgesic interventions after TKA. Bias was evaluated according to Cochrane methodology. Outcomes were opioid consumption (primary), pain scores at rest and during mobilization, adverse events, and length of stay...
2017: PloS One
https://www.readbyqxmd.com/read/28256813/intraspinal-administration-of-morphine-hydrochloride-combined-with-low-doses-of-bupivacaine-in-hemorrhoidectomy-a-clinical-randomised-trial
#16
Manuel Ruiz-Castro, Marta San José Santos, Antonio Rodríguez-Miguel, Francisco J de Abajo Iglesias
BACKGROUND: Intrathecal local anesthetics, associated or not to opioids, is commonplace in anorectal surgery, but it is unknown which is the option with the best risk-benefit ratio. The main aim was to assess whether the combination of morphine (50 mcg) with low-dose bupivacaine (3 mg) in an intradural solution has a better analgesic short-term effect than bupivacaine alone at standard doses (5 mg) in hemorrhoidectomy. METHODS: 66 patients of any sex were randomly assigned to two alternative treatments and 63 patients were considered valid for analysis...
March 3, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28254422/comparison-of-intrathecal-and-local-infiltration-analgesia-by-morphine-for-pain-management-in-total-knee-and-hip-arthroplasty-a-meta-analysis-of-randomized-controlled-trial
#17
REVIEW
Xu-Feng Jia, Yong Ji, Guang-Ping Huang, Yu Zhou, Miao Long
OBJECTIVE: We performed a meta-analysis from randomized controlled trials to evaluate the efficiency and safety between local infiltration analgesia and intrathecal morphine for pain control in total knee and hip arthroplasty. METHODS: We systemically searched electronic databases including Embase (1980-2016.7), Medline (1966-2016.7), PubMed (1966-2016.7), ScienceDirect (1985-2016.7), web of science (1950-2016.7) and Cochrane Library for relevant articles. All calculation was carried out by Stata 11...
April 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28219639/leishmania-l-amazonensis-induces-hyperalgesia-in-balb-c-mice-contribution-of-endogenous-spinal-cord-tnf%C3%AE-and-nf%C3%AE%C2%BAb-activation
#18
Sergio M Borghi, Victor Fattori, Kenji W Ruiz-Miyazawa, Milena M Miranda-Sapla, Rúbia Casagrande, Phileno Pinge-Filho, Wander R Pavanelli, Waldiceu A Verri
Cutaneous leishmaniasis (CL) is the most common form of the leishmaniasis in humans. Ulcerative painless skin lesions are predominant clinical features of CL. Wider data indicate pain accompanies human leishmaniasis, out with areas of painless ulcerative lesions per se. In rodents, Leishmania (L.) major infection induces nociceptive behaviors that correlate with peripheral cytokine levels. However, the role of the spinal cord in pain processing after Leishmania infection has not been investigated. Balb/c mice received intraplantar (i...
April 25, 2017: Chemico-biological Interactions
https://www.readbyqxmd.com/read/28212183/cxcl12-cxcr4-signaling-contributes-to-the-pathogenesis-of-opioid-tolerance-a-translational-study
#19
Chih-Peng Lin, Kai-Hsiang Kang, Huang-Ju Tu, Ming-Yueh Wu, Tzu-Hung Lin, Houng-Chi Liou, Wei-Zen Sun, Wen-Mei Fu
BACKGROUND: Long-term opioid therapy for chronic pain may lead to analgesic tolerance, especially when administered intrathecally, thus preventing adequate pain relief. Discovering drug targets to treat opioid tolerance using a mechanism-based approach targeting opioid-induced neuroinflammation provides new therapeutic opportunities. In this study, we provide translational evidence that CXCL12/CXCR4 signaling contributes to the pathogenesis of opioid tolerance. METHODS: The CXCL12 levels in the cerebrospinal fluid of opioid-tolerant patients were compared with those of opioid-naive subjects...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28185794/neuraxial-opioids-for-post-cesarean-delivery-analgesia-can-hydromorphone-replace-morphine-a-retrospective-study
#20
B Marroquin, C Feng, A Balofsky, K Edwards, A Iqbal, J Kanel, M Jackson, M Newton, D Rothstein, E Wong, R Wissler
BACKGROUND: Cesarean delivery is the most common surgical procedure performed in the USA. We evaluated the postoperative analgesic properties of neuraxial hydromorphone compared to neuraxial morphine for post-cesarean delivery analgesia. METHODS: A retrospective chart review was performed of women who underwent cesarean delivery and received neuraxial anesthesia from March to November 2011 and from March to November 2012. A total of 450 patients received intrathecal morphine 200μg and 387 patients received intrathecal hydromorphone 60μg...
December 30, 2016: International Journal of Obstetric Anesthesia
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