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morphine equivalents

Kajan Kamalanathan, Tom Knight, Neil Rasburn, Natashi Joshi, Mathew Molyneux
OBJECTIVES: Paravertebral local analgesia is effective in providing pain relief after video assisted thoracoscopic surgery. This randomized, double-blind pilot clinical trial investigated the effect of early perioperative delivery of paravertebral local analgesia to reduce postoperative pain after video assisted thoracoscopic lung resection and the feasibility of a larger trial. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: University hospital, single institution...
July 7, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Kirk M Thompson, Richard A Smith, Tyler J Brolin, Frederick M Azar, Thomas W Throckmorton
BACKGROUND: Postoperative pain control, short-term and long-term narcotic consumption, complication rates, and costs of indwelling interscalene catheter (ISC) were compared with a liposomal bupivacaine (LBC) mixture in patients undergoing primary total elbow arthroplasty. METHODS: Forty-four consecutive patients were identified, the first 28 with an ISC and the later 16 with intraoperative LBC injection that also included ketorolac and 0.5% bupivacaine. Medical records were reviewed for visual analog scale scores for pain, oral morphine equivalent (OME) use, complications, and facility charges...
October 16, 2018: Journal of Shoulder and Elbow Surgery
Samanta Lalic, Jenni Ilomäki, J Simon Bell, Maarit Jaana Korhonen, Natasa Gisev
AIMS: To determine the prevalence and incidence of prescription opioid analgesic use in Australia and compare the characteristics of people with and without cancer initiating prescription opioid analgesics. METHODS: A retrospective population-based study was conducted using the random 10% sample of adults who were dispensed prescription opioid analgesics in Australia between July 2013 and June 2017 through the Pharmaceutical Benefits Scheme. Poisson regression was used to calculate rate ratios (RR) for opioid prevalence and incidence...
October 19, 2018: British Journal of Clinical Pharmacology
W Häuser, T Schubert, N Scherbaum, T Tölle
BACKGROUND: One major concern of long-term opioid therapy (LTOT) for chronic noncancer pain (CNCP) is the risk of abuse of prescribed opioids. OBJECTIVE: To examine the prevalence and predictors of opioid use-related hospitalizations and potential abuse of prescribed opioids by persons with LTOT for CNCP in a sample representative of the German statutory health insurance companies. METHODS: Retrospective cross-sectional study in 2014. Anonymized German health claims database, including 4,028,618 insured individuals of 69 German statutory health insurances...
October 16, 2018: Der Schmerz
Andrea Lamprecht, Jane Sorbello, Christina Jang, David J Torpy, Warrick J Inder
OBJECTIVE: To evaluate pituitary function, sexual function and quality of life (QoL) in patients on oral or transdermal opioids. DESIGN AND METHODS: Cross-sectional study comparing pituitary function, QoL and sexual function in people on long-term opioid therapy (n = 40) vs an age- and sex-matched control group (n = 25). Baseline pituitary function was assessed on blood samples collected prior to 0900 h. Further testing with corticotropin (250 μg IV) and metyrapone (30 mg/kg) stimulation tests was undertaken on participants with serum cortisol <250 nmol/L...
September 10, 2018: European Journal of Endocrinology
Mariano E Menendez, Sarah M Lawler, David Ring, Andrew Jawa
BACKGROUND: As reimbursement becomes increasingly tied to quality and patient experience, there is growing interest in alleviation of postoperative pain combined with optimal opioid stewardship. We characterized predictors of severe inpatient pain after elective total shoulder arthroplasty and evaluated its association with opioid use, operative time, hospital length of stay, discharge disposition, and cost. METHODS: We identified 415 patients undergoing elective primary total shoulder arthroplasty between 2016 and 2017 from our registry...
October 12, 2018: Journal of Shoulder and Elbow Surgery
Anyela Marcela Castañeda, Chang-Soon Lee, Yong-Chul Kim, Dasom Lee, Jee Youn Moon
Opioid consumption has increased worldwide, which carries the risk of opioid use disorder (OUD). However, the literature on OUD and opioid-related chemical coping (OrCC) in chronic noncancer pain (CNCP) is heterogeneous, with most studies conducted in the United States. We performed a multicenter, observational, cross-sectional study to address OrCC in long-term opioid therapy (LtOT) for CNCP in South Korea. The objectives were to determine the frequency and predictors of OrCC. We included 258 patients. Among them, fifty-five (21%) patients showed OrCC...
October 14, 2018: Journal of Clinical Medicine
Zlatan Cizmic, Emmanuel Edusei, Afshin A Anoushiravani, Joseph Zuckerman, Ronald Ruden, Ran Schwarzkopf
Poor outcomes associated with increased perioperative opioid use have led investigators to seek alternative pain management modalities after total joint arthroplasty. Nonpharmacological approaches, such as electroceuticals, have shown promise. The purpose of this study was to evaluate the effects of "havening," a specific form of psychosensory therapy, on postoperative pain scores and narcotic consumption. In this prospective, randomized controlled trial, the authors compared 19 patients who underwent psychosensory therapy with 22 patients who served as the control group...
October 15, 2018: Orthopedics
Ryan D Horsley, Ellen D Vogels, Daaron A P McField, David M Parker, Charles Medico, James Dove, Marcus Fluck, Jon D Gabrielsen, Michael R Gionfriddo, Anthony T Petrick
BACKGROUND: Opioids have been the mainstay for postoperative pain relief for many decades. Recently, opioid-related adverse events and death have been linked to postoperative dependency. Multimodal approaches to postoperative pain control may be part of the solution to this health care crisis. The safety and effectiveness of multimodal pain control regimens after laparoscopic Roux-en-Y gastric bypass (LRYGB) has not been well studied. The primary aim of our study was to determine if an evidence-based, multimodal pain regimen during hospitalization could decrease the total oral morphine equivalent (TME) use after LRYGB...
October 13, 2018: Obesity Surgery
Pietro Bortoletto, Malavika Prabhu, Elizabeth M Garry, Krista F Huybrechts, Raymond M Anchan, Brian T Bateman
OBJECTIVE: To study opioid dispensing patterns following oocyte retrieval. DESIGN: Retrospective cohort. SETTING: Not applicable. PATIENT(S): Women undergoing oocyte retrieval with a maximum of 1 opioid prescription in the 12 weeks prior to the procedure, without an opioid use or other substance use disorder. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): We measured the frequency of opioids dispensed within 3 days of oocyte retrieval, most common opioids dispensed; and quantity dispensed, in median (interquartile range [IQR] and 10th-90th percentile ranges) oral morphine milligram equivalents (MME)...
October 2018: Fertility and Sterility
Sara L Kroll, Emilija Nikolic, Franziska Bieri, Michael Soyka, Markus R Baumgartner, Boris B Quednow
RATIONALE: Non-medical prescription opioid use (NMPOU) has become a major public health issue in the USA and is also increasing in Europe. However, little is known about neuropsychological associations of NMPOU-specifically regarding social cognition, which is essential for social functioning and treatability of opioid dependence. Previous studies with heroin users and opioid-substituted patients reported deficits in various cognitive functions, but these results are likely confounded by comorbid physical and psychiatric diseases, overdose-associated hypoxia, and adulteration of street heroin...
October 11, 2018: Psychopharmacology
Sabrina Bajwah, Joanna M Davies, Hanan Tanash, David C Currow, Adejoke O Oluyase, Magnus Ekström
Safety concerns are a barrier to prescribing benzodiazepines (BDZ) and opioids in Interstitial Lung Disease (ILD). We therefore examined association of BDZ and opioids on risk of admission to hospital and death.We conducted a population based longitudinal cohort study of fibrotic ILD patients starting Long Term Oxygen Therapy in Sweden 2005-2014. Effects of BDZ and opioids on rates of admission to hospital and mortality were analysed using Fine-Gray and Cox regression whilst adjusting for potential confounders...
October 11, 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Melissa Henry, Ali Alias, Saul Frenkiel, Keith Richardson, Michael Hier, Anthony Zeitouni, Karen Kost, Alex Mlynarek, Martin Black, Christina MacDonald, Gabrielle Chartier, Zeev Rosberger
PURPOSE: The purpose of this study was to determine, within the first-year post-head and neck cancer (HNC) diagnosis, the contribution of past and upon HNC psychiatric diagnoses (i.e., substance use disorder (SUD), major depressive disorder (MDD), and anxiety disorder (AD)) to the extent (i.e., cumulated dose) of opioid prescription. METHODS: Prospective longitudinal study of 223 consecutive adults (on 313 approached; 72% participation) newly diagnosed (<2 weeks) with a first occurrence of primary HNC, including Structured Clinical Interviews for DSM-IV disorders, validated psychometric measures, and medical chart reviews...
October 11, 2018: Psycho-oncology
David R Rosen, Rachel C Wolfe, Aneel Damle, Chady Atallah, William C Chapman, Joel M Vetter, Matthew G Mutch, Steven R Hunt, Sean C Glasgow, Paul E Wise, Radhika K Smith, Matthew L Silviera
BACKGROUND: Thoracic epidural analgesia has been shown to be an effective method of pain control. The utility of epidural analgesia as part of an enhanced recovery after surgery protocol is debatable. OBJECTIVE: This study aimed to determine if the use of thoracic epidural analgesia in an enhanced recovery after surgery protocol decreases hospital length of stay or inpatient opioid consumption after elective colorectal resection. DESIGN: This is a single-institution retrospective cohort study...
October 10, 2018: Diseases of the Colon and Rectum
Ron Carico, Xinhua Zhao, Carolyn T Thorpe, Joshua M Thorpe, Florentina E Sileanu, John P Cashy, Jennifer A Hale, Maria K Mor, Thomas R Radomski, Leslie R M Hausmann, Julie M Donohue, Katie J Suda, Kevin Stroupe, Joseph T Hanlon, Chester B Good, Michael J Fine, Walid F Gellad
Background: Overlapping use of opioids and benzodiazepines is associated with increased risk for overdose. Veterans receiving medications concurrently from the U.S. Department of Veterans Affairs (VA) and Medicare may be at higher risk for such overlap. Objective: To assess the association between dual use of VA and Medicare drug benefits and receipt of overlapping opioid and benzodiazepine prescriptions. Design: Cross-sectional. Setting: VA and Medicare...
October 9, 2018: Annals of Internal Medicine
Dalila Masic, Edith Liang, Christina Long, Ethan J Sterk, Brian Barbas, Megan A Rech
The purpose of this systematic review is to evaluate the safety and efficacy of intravenous (IV) lidocaine for the treatment of acute pain in adult patients. The PubMed database was searched for randomized controlled trials, retrospective cohort studies, case series, and case reports evaluating use of IV lidocaine for the treatment of acute pain in adult patients, published between January 1970 and January 2018. The primary outcome was pain reduction via Visual Analog Scale, Verbal Rating Scale, or Numeric Rating Scale among patients treated with IV lidocaine and placebo or active controls...
October 10, 2018: Pharmacotherapy
Matthew Basilico, Abhiram R Bhashyam, Mitchel B Harris, Marilyn Heng
INTRODUCTION: A common belief is that some narcotic medications have a higher association with prolonged use. We assessed whether the initial opiate type prescribed to postoperative, opiate-naive orthopaedic trauma patients was associated with prolonged opioid use. METHODS: We studied 17,961 adult, opiate-naive patients treated for a surgical musculoskeletal injury. Discharge prescription in morphine milligram equivalents (MMEs, a standardized dosing unit that allows for comparison across opioid types) was calculated...
October 4, 2018: Journal of the American Academy of Orthopaedic Surgeons
Calista M Harbaugh, Kevin N Johnson, Courtney E Kein, Marcus D Jarboe, Ronald B Hirschl, James D Geiger, Samir K Gadepalli
BACKGROUND: This study aimed to evaluate postoperative outcomes after minimally invasive repair of pectus excavatum (Nuss procedure) using video-assisted intercostal nerve cryoablation (INC) compared to thoracic epidural (TE). MATERIALS AND METHODS: We performed a single center retrospective review of pediatric patients who underwent Nuss procedure with INC (n = 19) or TE (n = 13) from April 2015 to August 2017. Preoperative, intraoperative, and postoperative characteristics were collected...
November 2018: Journal of Surgical Research
Zyad J Carr, Brian Vells, Brendan R Wood, Joshua D Lowery, Ann M Rogers, Allen A Kunselman, Kunal Karamchandani, Sonia J Vaida
BACKGROUND: We theorized that modafinil, an atypical psychomotor stimulant, utilized to improve daytime somnolence in patients with obstructive sleep apnea, would improve functional recovery after general anesthesia by improving time to extubation, post-anesthesia care unit (PACU) length of stay and subjective recovery after general anesthesia. METHODS: A double blind, randomized, placebo-controlled pilot study was performed. 102 patients with the diagnosis of obstructive sleep apnea (OSA) were randomized to receive either 200 mg of modafinil or placebo before general anesthesia...
September 2018: Medicine (Baltimore)
Michael P Gaspar, Emily M Pflug, Alexander J Adams, Sidney M Jacoby, Eon K Shin, A Lee Osterman, Patrick M Kane
BACKGROUND: Although orthopaedic surgeons have been shown to prescribe excessive amounts of opioid analgesics postoperatively, the degree in which surgical trainees contribute to this trend is unknown. The purpose of this study was to compare self-reported opioid-prescribing behavior, factors influencing this behavior, and perceptions of patient opioid utilization and disposal between hand surgeons and trainees. METHODS: Attending hand surgeons and trainees in hand, orthopaedic, and plastic surgery programs were invited to participate in a web-based survey including demographic characteristics; self-reported prescribing behavior specific to 4 procedures: open carpal tunnel release, trigger finger release, thumb carpometacarpal arthroplasty, and distal radial fracture open reduction and internal fixation; and perceptions and influencing factors...
October 3, 2018: Journal of Bone and Joint Surgery. American Volume
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