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https://www.readbyqxmd.com/read/29137580/prevalence-and-predictors-of-persistent-post-surgical-opioid-use-a-prospective-observational-cohort-study
#1
N Stark, S Kerr, J Stevens
Post-surgical opioid prescribing intended for the short-term management of acute pain may lead to long-term opioid use. This study was undertaken to determine the prevalence of persistent post-surgical opioid use and patient-related factors associated with post-surgical opioid use. One thousand and thirteen opioid-naïve patients awaiting elective surgery in a tertiary private hospital in Sydney were enrolled. Preoperatively, patients completed a questionnaire comprising potential predictors of persistent post-surgical opioid use...
November 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29135590/the-analgesic-effect-of-ultrasound-guided-quadratus-lumborum-block-after-cesarean-delivery-a-randomized-clinical-trial
#2
Anders Krohg, Kyrre Ullensvang, Leiv Arne Rosseland, Eldrid Langesæter, Axel R Sauter
BACKGROUND: Landmark and ultrasound-guided transversus abdominis plane blocks have demonstrated an opioid-sparing effect postoperatively after cesarean delivery. The more posterior quadratus lumborum (QL) might provide superior local anesthetic spread to the thoracolumbar fascia and paravertebral space. The aim of our study was to evaluate the efficacy of the QL block after cesarean delivery. METHODS: A randomized, double-blind, controlled trial was performed. Forty parturients undergoing cesarean delivery received bilateral ultrasound-guided QL blocks with either 2 mg/mL ropivacaine or saline postoperatively...
November 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29135475/using-activity-trackers-to-quantify-postpartum-ambulation-a-prospective-observational-study-of-ambulation-after-regional-anesthesia-and-analgesia-interventions
#3
Julia Ma, Rachel Martin, Bokman Chan, Michael Gofeld, Michael P Geary, John G Laffey, Faraj W Abdallah
BACKGROUND: Early postoperative ambulation is associated with enhanced functional recovery, particularly in the postpartum population, but ambulation questionnaires are limited by recall bias. This observational study aims to objectively quantify ambulation after neuraxial anesthesia and analgesia for cesarean delivery and vaginal delivery, respectively, by using activity tracker technology. The hypothesis was that vaginal delivery is associated with greater ambulation during the first 24 h postdelivery, compared to cesarean delivery...
November 14, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29131554/the-pathophysiology-incidence-impact-and-treatment-of-opioid-induced-nausea-and-vomiting
#4
Theresa Mallick-Searle, Mechele Fillman
PURPOSE: Opioid medications are integral in managing acute moderate-to-severe pain. Opioid analgesics bind to μ (mu), κ (kappa), or δ (delta) opioid receptors in the brain, spinal cord, and digestive tract. However, opioids cause adverse effects that may interfere with their therapeutic use. Some adverse effects wane over time, but patients using opioids for acute pain struggle with opioid-induced nausea and vomiting (OINV) the entire time they take the opioid. This article discusses the underlying mechanisms, clinical implications, and treatment strategies of OINV...
November 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/29121296/are-perioperative-therapeutic-doses-of-statins-associated-with-postoperative-pain-and-opioid-consumption-after-hip-surgery-under-spinal-anaesthesia
#5
W Saasouh, S Leung, H O Yilmaz, O Koyuncu, J You, N M Zimmerman, K Ruetzler, A Turan
Background: The anti-inflammatory effects of statins have been suggested to relieve postoperative pain. This retrospective study tested the association between the perioperative routine use of statins in therapeutic doses, and opioid requirements and pain scores, after hip replacement surgery. Methods: With IRB approval, data was obtained for adult patients who had elective hip replacement surgery under spinal anaesthesia at Cleveland Clinic between 2005 and 2015...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29111148/effects-of-opioid-and-nonopioid-analgesics-on-canine-wheal-formation-and-cultured-human-mast-cell-degranulation
#6
Eric Schmidt-Rondon, Zhenping Wang, Shelle A Malkmus, Anna Di Nardo, Keith Hildebrand, Linda Page, Tony L Yaksh
Mast cell (MC) degranulation has been implicated in the side effect profile of a variety of clinically useful agents. Thus, after intrathecal delivery, formation of space-occupying, meningeally-derived masses may be related to local MC degranulation. We systematically characterized degranulating effects of opioid and nonopioid analgesics on cutaneous flares in the dog and in primary human MC (hMC) cultures. METHODS: Dogs were anesthetized with IV propofol and received intradermal (ID) injections (50μL)...
October 27, 2017: Toxicology and Applied Pharmacology
https://www.readbyqxmd.com/read/29102751/epidural-steroids-at-closure-post-microdiscectomy-laminectomy-for-reduction-of-post-operative-analgesia-systematic-review-and-meta-analysis
#7
Ash Wilson-Smith, Nicholas Chang, Victor M Lu, Ralph J Mobbs, Matthew Fadhil, Declan Lloyd, Sara Kim, Kevin Phan
BACKGROUND: This review assessed the efficacy of epidural steroid administration on the reduction of pain, hospital stay time and use of opioid analgesics postoperatively. METHODS: We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CCRCT) and Cochrane Database of Systematic Reviews (CDSR) for studies utilizing epidural steroids through any route following lumbar surgery. The primary study outcomes included pre- and postoperative pain as assessed through the use of a Visual Analogue Scale (VAS), length of hospital stay and postoperative use of opioid analgesics...
November 1, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29099960/parent-nurse-controlled-analgesia-compared-with-intravenous-prn-opioids-for-postsurgical-pain-management-in-children-with-developmental-delay-a-randomized-controlled-trial
#8
Michelle L Czarnecki, Keri R Hainsworth, Pippa M Simpson, Steven J Weisman
Objectives: The aim of this study was to conduct a randomized, controlled comparison of outcomes associated with parent/nurse-controlled analgesia (PNCA), with and without a basal (background) opioid infusion, with intravenous (IV) opioids intermittently administered by a nurse on an "as needed" basis (IV PRN) for postoperative pain management in children with developmental delay (DD). Methods: Participants included children with DD expected to require IV opioids for at least 24 postoperative hours...
November 1, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29091880/central-and-peripheral-anti-hyperalgesic-effects-of-diosmin-in-a-neuropathic-pain-model-in-rats
#9
Azucena Ibeth Carballo-Villalobos, María Eva González-Trujano, Francisco Pellicer, Noé Alvarado-Vásquez, Francisco Javier López-Muñoz
Flavonoids are natural compounds showing anti-hyperalgesic activity in models of pain. Diosmin is a compound poorly studied in the treatment of neuropathic pain. This study evaluates the anti-hyperalgesic actions of diosmin and possible mechanisms of action involved by using a neuropathic pain model in rats. Experimental neuropathic pain was induced by chronic constriction injury (CCI) in male Wistar rats, then aesthesiometric index and plantar tests were assessed to evaluate mechanical and thermal hyperalgesia, respectively, in order to explore the analgesic effects of acute and sub-chronic treatment with diosmin...
October 26, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/29078056/pain-management-after-outpatient-foot-and-ankle-surgery
#10
Akash Gupta, Kanupriya Kumar, Matthew M Roberts, Austin E Sanders, Mackenzie T Jones, David S Levine, Martin J O'Malley, Mark C Drakos, Andrew J Elliott, Jonathan T Deland, Scott J Ellis
BACKGROUND: The number of opioids prescribed and used has increased precipitously over the past 2 decades for a number of reasons and has led to increases in long-term dependency, opioid-related deaths, and diversion. Most studies examining the role of prescribing habits have investigated nonoperative providers, although there is some literature describing perioperative opioid prescription and use. There are no studies looking at the number of pills consumed after outpatient foot and ankle surgeries, nor are there guidelines for how many pills providers should prescribe...
October 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/29077889/long-term-improvements-in-chronic-axial-low-back-pain-patients-without-previous-spinal-surgery-a-cohort-analysis-of-10-khz-high-frequency-spinal-cord-stimulation-over-36%C3%A2-months
#11
Adnan Al-Kaisy, Stefano Palmisani, Thomas E Smith, Roy Carganillo, Russell Houghton, David Pang, William Burgoyne, Khai Lam, Jonathan Lucas
Objective: This prospective, open-label study was designed to evaluate the long-term effectiveness of 10-kHz high-frequency spinal cord stimulation (SCS) in the treatment of chronic axial low back pain with no history of spinal surgery. Methods: Patients with chronic low back pain without previous spinal surgery underwent assessment by a multidisciplinary pain and surgical team to confirm eligibility. After a successful temporary trial of 10-kHz HF-SCS therapy, defined by ≥50% back pain reduction, enrolled subjects underwent permanent system implantation and were followed up for 36 months...
October 24, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29075135/dnmt3a-methylation-in-neuropathic-pain
#12
Cuijie Shao, Yong Gao, Dan Jin, Xin Xu, Shuying Tan, Hui Yu, Qingxiang Zhao, Li Zhao, Wansheng Wang, Deqiang Wang
BACKGROUND: Mu opioid receptor (MOR) plays a crucial role in mediating analgesic effects of opioids and is closely associated with the pathologies of neuropathic pain. Previous studies have reported that peripheral nerve injury downregulates MOR expression, but the epigenetic mechanisms remain unknown. OBJECTIVE: Therefore, we investigated DNA methyltransferase3a (DNMT3a) expression or methylation changes within MOR promoter in the spinal cord in a neuropathic pain induced by a chronic constriction injury (CCI) mouse model and further determined whether these injury-associated changes are reversible by pharmacological interventions...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29063607/spinal-or-general-anaesthesia-for-lower-limb-amputation-in-peripheral-artery-disease-a-retrospective-cohort-study
#13
M Niskakangas, S Dahlbacka, J Liisanantti, M Vakkala, T Kaakinen
BACKGROUND: The present study aimed to determine which method of anaesthesia (spinal anaesthesia or general anaesthesia) is better in reducing post-operative analgesic requirements in patients undergoing major limb amputation for lower-limb ischaemia. Another aim was to find out if anaesthesiologists use neuraxial anaesthesia in high-risk patients despite abnormal coagulation profile or use of anticoagulation. METHODS: The study was a retrospective cohort study...
October 24, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29058361/pain-remission-at-one-year-follow-up-with-spinal-cord-stimulation
#14
Hirah Khan, Julie G Pilitsis, Julia Prusik, Heather Smith, Sarah E McCallum
OBJECTIVES: Spinal Cord Stimulation (SCS) is an effective treatment for chronic pain. How often pain remission follows SCS has not been evaluated. This is a retrospective analysis of patients who underwent an implantation of spinal cord stimulators for various chronic pain conditions. The objective of the study was to elucidate characteristics and features of patients with pain relief greater than 80% after one year of treatment. METHODS: A total of 86 patients with thoracic SCS and 12-month follow-up data were identified...
October 23, 2017: Neuromodulation: Journal of the International Neuromodulation Society
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
#15
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/29028639/implications-of-mitochondrial-dysfunction-for-the-anesthetic-and-perioperative-management-a-case-report-of-spinal-fusion-genetic-confusion-and-a-patient-s-perspective
#16
Linda S Aglio, Brian T Lockhart, Jeantine E Lunshof, Christoph S Nabzdyk
We describe a patient's personal struggle with a symptom complex consisting of profound muscle weakness requiring pyridostigmine, and metabolic abnormalities suggestive of mitochondrial disease. This included a profound sensitivity to opioids, which in the past caused severe respiratory depression during a prior hospital admission. Interestingly, the patient herself is a professor of ethics in genomic sciences, and she and her medical team thus far have not been able to formally diagnose her with mitochondrial disease...
October 12, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29025923/plasticity-of-signaling-by-spinal-estrogen-receptor-alpha-kappa-opioid-receptor-and-mglurs-over-the-rat-reproductive-cycle-regulates-spinal-endomorphin-2-antinociception-relevance-of-endogenous-biased-agonism
#17
Nai-Jiang Liu, Vijaya Murugaiyan, Emiliya M Storman, Stephen A Schnell, Arjun Kumar, Martin W Wessendorf, Alan R Gintzler
We previously showed that intrathecal application of endomorphin 2 [EM2; the highly specific endogenous mu-opioid receptor (MOR) ligand] induces antinociception that varies with stage of the rat estrous cycle -- minimal during diestrus and prominent during proestrus. Earlier studies, however, did not identify proestrus-activated signaling strategies that enable spinal EM2 antinociception. We now report that in female rats, increased spinal dynorphin release and kappa-opioid receptor (KOR) signaling, as well as the emergence of glutamate-activated mGluR1 signaling, are critical to the transition from an EM2 non-responsive (during diestrus) to an analgesically responsive state (during proestrus)...
October 12, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/29025452/management-of-failed-spinal-anaesthesia-for-caesarean-section
#18
Gavin Wyndham Jones, Raphael Anthony Samuel, Bruce McClure Biccard
BACKGROUND: Failed spinal anaesthesia for caesarean section (CS) may be partial or complete and the subsequent discomfort is the most commonly cited cause of litigation in obstetric anaesthesia. OBJECTIVES: To determine if there is a standardised approach to: (i) testing the level of block of spinal anaesthesia; and (ii) the management of failed spinal anaesthesia for CS. METHODS: A structured questionnaire to ascertain the current practice of testing the level of block and management of three different scenarios of failed spinal anaesthesia was distributed to 51 government hospitals in KwaZulu-Natal, South Africa (SA)...
June 30, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/28993838/delta-opioid-receptor-expression-and-function-in-primary-afferent-somatosensory-neurons
#19
Amaury François, Grégory Scherrer
The functional diversity of primary afferent neurons of the dorsal root ganglia (DRG) generates a variety of qualitatively and quantitatively distinct somatosensory experiences, from shooting pain to pleasant touch. In recent years, the identification of dozens of genetic markers specifically expressed by subpopulations of DRG neurons has dramatically improved our understanding of this diversity and provided the tools to manipulate their activity and uncover their molecular identity and function. Opioid receptors have long been known to be expressed by discrete populations of DRG neurons, in which they regulate cell excitability and neurotransmitter release...
October 10, 2017: Handbook of Experimental Pharmacology
https://www.readbyqxmd.com/read/28991063/dose-response-curves-for-intrathecal-bupivacaine-levobupivacaine-and-ropivacaine-given-for-labor-analgesia-in-nulliparous-women
#20
Warwick D Ngan Kee, Floria F Ng, Kim S Khaw, Shannon P Y Tang, Alison G P Koo
BACKGROUND AND OBJECTIVES: Bupivacaine, levobupivacaine, and ropivacaine are often given intrathecally for labor analgesia, but limited data are available for their dose-response properties in this context. The objective of this study was to describe the dose-response curves of these local anesthetics when given intrathecally for labor analgesia, to determine values for D50 (dose producing a 50% response) and to compare the calculated values of D50 for levobupivacaine and ropivacaine with those for bupivacaine...
November 2017: Regional Anesthesia and Pain Medicine
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