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morphine equivalents

Surena Namdari, Thema Nicholson, Joseph Abboud, Mark Lazarus, Dean Steinberg, Gerald Williams
BACKGROUND: Interscalene brachial plexus blockade (ISBPB) is an effective anesthetic technique for shoulder arthroplasty; however, "rebound pain" can increase the patient's postoperative pain experience and narcotic usage. Exparel (liposomal bupivacaine) injected into the soft tissues at the surgical site has theoretical efficacy for up to 72 hours after administration. The purpose of this study was to evaluate postoperative pain scores and narcotic consumption following shoulder arthroplasty performed with either ISBPB alone or ISBPB and intraoperative Exparel...
August 15, 2018: Journal of Bone and Joint Surgery. American Volume
Ariel Kiyomi Daoud, Tessa Mandler, Alexia Georgia Gagliardi, Harin Bhavin Parikh, Patrick M Carry, Anusara Carolyn Ice, Jay Albright
Background: Despite advancements in minimally invasive arthroscopic surgical techniques, post-operative pain management following ACL reconstruction remains a concern. This study compares the effectiveness of two common intraoperative pain management strategies - a femoral nerve catheter (FC) versus a combined femoral nerve catheter and single injection sciatic nerve block (FSB) - in pediatric patients undergoing ACL reconstruction. Methods: The medical records of patients age 8 to 18 who underwent ACL reconstruction at our institution were reviewed retrospectively...
2018: Iowa Orthopaedic Journal
Yuan Hong, Marco Geraci, Margaret A Turk, Bryan L Love, Suzanne W McDermott
OBJECTIVES: To investigate the opioid prescription patterns for adults with longstanding physical disability and inflammatory conditions, compared to a mixed group of other opioid users, after excluding cancer patients. DESIGN: Nationally representative cross-sectional study, 2010-2014 SETTING: Medical Expenditure Panel Survey (MEPS) PARTICIPANTS: The subjects were adults who participated in MEPS and had at least one opioid prescription, did not have cancer, and were between 18 years and 64 years of age...
August 10, 2018: Archives of Physical Medicine and Rehabilitation
Ashley W Gerrish, Sandy Fogel, Ellen Rachel Lockhart, Michael Nussbaum, Farrell Adkins
BACKGROUND: Enhanced recovery programs have demonstrated a decrease in opioid use in hospitals where patients have undergone colorectal surgery. This study is to investigate whether similar decreases in opioid prescribing are achieved at discharge and postdischarge. METHODS: Patients undergoing colorectal surgery November 2014-November 2016 were reviewed. Postdischarge opioid prescribing was quantified in morphine milligram equivalents at time of discharge, 30 days postdischarge, and 60 days postdischarge...
August 9, 2018: Surgery
Jason N Doctor, Andy Nguyen, Roneet Lev, Jonathan Lucas, Tara Knight, Henu Zhao, Michael Menchine
Most opioid prescription deaths occur among people with common conditions for which prescribing risks outweigh benefits. General psychological insights offer an explanation: People may judge risk to be low without available personal experiences, may be less careful than expected when not observed, and may falter without an injunction from authority. To test these hypotheses, we conducted a randomized trial of 861 clinicians prescribing to 170 persons who subsequently suffered fatal overdoses. Clinicians in the intervention group received notification of their patients' deaths and a safe prescribing injunction from their county's medical examiner, whereas physicians in the control group did not...
August 10, 2018: Science
Wen Hui Tan, Sara Feaman, Laurel Milam, Valerie Garber, Jared McAllister, Jeffrey A Blatnik, L Michael Brunt
BACKGROUND: In 2014, hydrocodone was moved from Schedule III to II, thus it could no longer be "called in" to a pharmacy. We analyzed current postoperative opioid prescribing patterns and the impact of the schedule change on the type and amount prescribed. METHODS: Opioid prescriptions for common surgeries at 1 medical center from 2013 to 2016 were analyzed retrospectively. Milligram morphine equivalents prescribed before and after the schedule change were compared by t tests, and interrupted time series models and drug frequencies were compared by χ2 and Fisher exact tests...
August 6, 2018: Surgery
Lichun Han, Yuqiang Su, Hongfei Xiong, Xiaoli Niu, Shajie Dang, Keqin Du, Quan Li, Jing Liu, Peng Zhang, Siyuan Li
BACKGROUND: A randomized controlled trial was performed to compare analgesic effects and adverse effects of oxycodone and sufentanil in patient-controlled intravenous analgesia (PCIA) after abdominal surgery under general anesthesia. METHODS: Adult patients undergoing elective abdominal surgery were randomly allocated into oxycodone and sufentanil groups according to the randomization sequence. Study personnel, health-care team members, and patients were masked to the group assignment throughout the study period...
August 2018: Medicine (Baltimore)
Trent W Stethen, Yasir A Ghazi, R Eric Heidel, Brian J Daley, Linda Barnes, James M McLoughlin
A multimodality approach to enhance recovery after bowel surgery is demonstrated to reduce complications and decrease patient length of stay (LOS). This study evaluates the factors that influence patient LOS within a formal enhanced recovery protocol. From January 2014 to December 2016, all consecutive patients admitted to one ward, who had undergone bowel resection and were enrolled in an enhanced recovery protocol, were evaluated prospectively. We entered every patient's data into the American College of Surgeons Risk Calculator (ACSRC) to compare predicted versus actual outcomes...
July 1, 2018: American Surgeon
Rhys Ponton, Richard Sawyer
Background: Long-term opioid analgesic prescribing in chronic non-cancer pain (CNCP) is a growing worldwide concern. This has implications for optimal healthcare management in general and chronic pain management specifically. This work documents the development of a review tool and its use in the South West of England in a locality that showed opioid prescribing levels higher than surrounding localities. Methods: An electronic tool which enabled calculation of total prescribed morphine-equivalent doses was developed to allow general practitioners (GPs) to undertake reviews of CNCP patients...
August 2018: British Journal of Pain
Ryan Howard, Mitchell Alameddine, Michael Klueh, Michael Englesbe, Chad Brummett, Jennifer Waljee, Jay Lee
BACKGROUND: Opioid prescribing after surgery is often excessive, resulting in leftover pills in the community available for diversion. Procedure-specific postoperative prescribing guidelines can reduce excessive prescribing, however it is unclear whether such guidelines are associated with reductions in opioid prescribing for other procedures. STUDY DESIGN: A retrospective chart review was conducted for patients undergoing laparoscopic appendectomy, laparoscopic inguinal hernia repair, laparoscopic sleeve gastrectomy, and thyroidectomy/parathyroidectomy between January 1, 2016 and August 31, 2017...
July 2, 2018: Journal of the American College of Surgeons
M Kit Delgado, Yanlan Huang, Zachary Meisel, Sean Hennessy, Michael Yokell, Daniel Polsky, Jeanmarie Perrone
STUDY OBJECTIVE: To inform opioid stewardship efforts, we describe the variation in emergency department (ED) opioid prescribing for a common minor injury, ankle sprain, and determine the association between initial opioid prescription intensity and transition to prolonged opioid use. METHODS: We analyzed 2011 to 2015 US private insurance claims (Optum Clinformatics DataMart) for ED-treated ankle sprains among opioid-naive patients older than 18 years. We determined the patient- and state-level variation in the opioid prescription rate and characteristics, and the risk-adjusted association between total morphine milligram equivalents (MMEs) of the prescription and transition to prolonged use (filling 4 or more opioid prescriptions 30 to 180 days after the index visit)...
July 24, 2018: Annals of Emergency Medicine
Mellar P Davis, Gavril Pasternak, Bertrand Behm
The buprenorphine receptor binding profile is unique in that it binds to all three major opioid receptors (mu, kappa, delta), and also binds to the orphan-like receptor, the receptor for orphanin FQ/nociceptin, with lower affinity. Within the mu receptor group, buprenorphine analgesia in rodents is dependent on the recently discovered arylepoxamide receptor target in brain, which involves a truncated 6-transmembrane mu receptor gene protein, distinguishing itself from morphine and most other mu opioids. Although originally designed as an analgesic, buprenorphine has mainly been used for opioid maintenance therapy and only now is increasingly recognized as an effective analgesic with an improved therapeutic index relative to certain potent opioids...
July 26, 2018: Drugs
Wangjun Qin, Botao Liu, Ang Deng, Ying Liu, Xianglin Zhang, Lei Zhang
Intrathecal morphine provides superior analgesia and minimizes side effects with ~1/300th of the oral dose necessary to achieve this effect. The conversion ratios from oral route to intrathecal route vary greatly among individuals, and this may be related with polymorphisms of the ATP-binding cassette B1 ( ABCB1 )/ multiple drug resistance 1 ( MDR1 ) gene encoding the transporter P-glycoprotein in the blood-brain barrier. In the case presented herein, a patient with cancer pain for over 3 months was treated with oxycodone hydrochloride prolonged-release tablets (Oxycontin) and morphine hydrochloride tablets for breakthrough pain...
2018: Journal of Pain Research
Ahmed I Eid, Christopher DePesa, Ask T Nordestgaard, Napaporn Kongkaewpaisan, Jae Moo Lee, Manasnun Kongwibulwut, Kelsey Han, April Mendoza, Martin Rosenthal, Noelle Saillant, Jarone Lee, Peter Fagenholz, David King, George Velmahos, Haytham M A Kaafarani
BACKGROUND: Diversion of unused prescription opioids is a major contributor to the current United States opioid epidemic. We aimed to study the variation of opioid prescribing in emergency surgery. METHODS: Between October 2016 and March 2017, all patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, or inguinal hernia repair in the acute care surgery service of 1 academic center were included. For each patient, we systematically reviewed the electronic medical record and the prescribing pharmacy platform to identify: (1) history of opioid abuse, (2) opioid intake 3 months preoperatively, (3) number of opioid pills prescribed, (4) prescription of nonopioid pain medications (eg, acetaminophen, ibuprofen), and (5) the need for opioid prescription refills...
July 23, 2018: Surgery
Katrina Hedberg, Lisa T Bui, Catherine Livingston, Lisa M Shields, Joshua Van Otterloo
CONTEXT: Oregon is experiencing an opioid overdose epidemic, similar to the United States as a whole. To address this crisis, the Oregon Health Authority (OHA) implemented a strategic Opioid Initiative, convening stakeholders and integrating public health and health care system activities across sectors. Recent data indicate progress: from 2015 to 2016, Oregon had the sharpest decline in prescription opioid overdose deaths of any state. PROGRAM: The Opioid Initiative, launched in 2015, focuses on integrating efforts to improve patient care and safety, and population health, by increasing access to nonopioid pain treatment, supporting medication-assisted treatment and naloxone access for people taking opioids, decreasing opioid prescribing, and using data to inform policies and interventions...
July 18, 2018: Journal of Public Health Management and Practice: JPHMP
Kathleen M O'Connell, D Alex Quistberg, Robert Tessler, Bryce R H Robinson, Joseph Cuschieri, Ronald V Maier, Frederick P Rivara, Monica S Vavilala, Paul I Bhalla, Saman Arbabi
OBJECTIVE: The aim of this study was to examine the risk of delirium in geriatric trauma patients with rib fractures treated with systemic opioids compared with those treated with regional analgesia (RA). SUMMARY OF BACKGROUND DATA: Delirium is a modifiable complication associated with increased morbidity and mortality. RA may reduce the need for opioid medications, which are associated with delirium in older adults. METHODS: Cohort study of patients ≥65 years admitted to a regional trauma center from 2011 to 2016...
September 2018: Annals of Surgery
Daniel B Larach, Jennifer F Waljee, Hsou-Mei Hu, Jay S Lee, Romesh Nalliah, Michael J Englesbe, Chad M Brummett
OBJECTIVE: To determine the proportion of initial opioid prescriptions for opioid-naive patients prescribed by surgeons, dentists, and emergency physicians. We hypothesized that the percentage of such prescriptions grew as scrutiny of primary care and pain medicine opioid prescribing increased and guidelines were developed. SUMMARY OF BACKGROUND DATA: Data regarding the types of care for which opioid-naive patients are provided initial opioid prescriptions are limited...
July 24, 2018: Annals of Surgery
Ji Su Jang, Youngsuk Kwon, Sung Mi Hwang, Jong Ho Kim, Taehyung Yun, Young Soo Kim, Rak Min Choi, Jae Jun Lee
BACKGROUND: Combination therapy with a gabapentinoid and an opioid improves the quality of life (QOL) of patients with chronic pain. However, the role of combination therapy in patients with spinal cord stimulation (SCS) has not been evaluated. OBJECTIVE: Our primary objective was to evaluate the clinical outcomes of combination therapy consisting of a gabapentinoid and an opioid in patients undergoing SCS. STUDY DESIGN: Retrospective evaluation...
July 2018: Pain Physician
Tak Kyu Oh, Nam Woo Kim, Jiyeon Yim, HyunJae Lim, Boram Park, Dae Hyun Kim
BACKGROUND: Interventional pain management is essential for patients with cancer who experience medically uncontrollable chest wall pain to help control their symptoms and improve their quality of life. However, there is a lack of data on this topic, so there is an urgent need for further research. OBJECTIVES: To identify the effects of radiofrequency ablation (RFA) of the thoracic nerve roots on pain outcomes in patients with cancer and intractable chest wall pain...
July 2018: Pain Physician
Laxmaiah Manchikanti, Jaya Sanapati, Ramsin M Benyamin, Sairam Atluri, Alan D Kaye, Joshua A Hirsch
The opioid epidemic has been called the "most consequential preventable public health problem in the United States." Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016...
July 2018: Pain Physician
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