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Morphine milligram equivalents

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
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
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
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
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
Brandon E Earp, Jacob A Silver, Ariana N Mora, Philip E Blazar
BACKGROUND: Opioid-prescribing patterns have been implicated as a contributing factor to the opioid epidemic, yet few evidence-based guidelines exist to assist health-care providers in assessing and possibly modifying their prescribing practices. METHODS: Five orthopaedic hand surgeons at a level-I trauma center developed a postoperative prescribing guideline for 25 common hand and upper-extremity outpatient procedures, which were delineated into 5 tiers. Postoperative opioid prescriptions in a 3-month period after implementation of the protocol were compared with those from a 3-month period before implementation of the protocol...
October 3, 2018: Journal of Bone and Joint Surgery. American Volume
Luke Brown, Tristan Weir, Mark Shasti, Omer Yousaf, Imran Yousaf, Oliver Tannous, Eugene Koh, Kelley Banagan, Daniel Gelb, Steven Ludwig
Background: Postoperative pain management in spine surgery holds unique challenges. The purpose of this study is to determine if the local anesthetic liposomal bupivacaine (LB) reduces the total opioid requirement in the first 3 days following posterior lumbar decompression and fusion (PLDF) surgery for degenerative spondylosis. Methods: Fifty patients underwent PLDF surgery in a prospective randomized control pilot trial between August 2015 and October 2016 and were equally allocated to either a treatment (LB) or a control (saline) group...
August 2018: International Journal of Spine Surgery
Marc A Miller, Jalaj Garg, Benjamin Salter, Thomas F Brouwer, Alex J Mittnacht, Morgan L Montgomery, Rafael Honikman, Derya E Arkonac, Subbarao Choudry, Srinivas R Dukkipati, Vivek Y Reddy, Menachem M Weiner
INTRODUCTION: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is most commonly implanted under general anesthesia (GA), due to the intra-operative discomfort associated with tunneling and dissection. Post-operative pain can be substantial, and is often managed with opioids. There is a growing interest in transitioning away from the routine use of GA during S-ICD implantation, while also controlling peri-operative discomfort without the use of narcotics. As such, we assessed the feasibility of a multimodal analgesia regimen that included regional anesthesia techniques in patients undergoing S-ICD implantation...
September 19, 2018: Journal of Cardiovascular Electrophysiology
Daniel B C Reid, Kalpit N Shah, Jack H Ruddell, Benjamin Shapiro, Edward Akelman, Alexander P Robertson, Mark A Palumbo, Alan H Daniels
BACKGROUND CONTEXT: Prescription opioid abuse is a public health emergency. Opioid prescriptions for spine patients account for a large proportion of use. Some states have implemented statutory limits on prescribers, however it remains unclear whether such laws are effective. PURPOSE: This investigation compares opioid prescription patterns for patients undergoing lumbar spine surgery before and after the passage of statewide narcotic-limiting legislation in Rhode Island...
September 14, 2018: Spine Journal: Official Journal of the North American Spine Society
Meghana Yajnik, Jonay N Hill, Oluwatobi O Hunter, Steven K Howard, T Edward Kim, T Kyle Harrison, Edward R Mariano
OBJECTIVE: Effects of patient education on perioperative analgesic utilization are not well defined. We designed a simple pain management educational card for total knee arthroplasty (TKA) patients and retrospectively reviewed clinical data before and after implementation to test the hypothesis that more informed patients will use less opioid. METHODS: With IRB approval, we analyzed clinical data collected perioperatively on all TKA patients one month before (PRE) and one month after (POST) card implementation...
September 5, 2018: Patient Education and Counseling
Tabish Aijaz, Kenneth D Candido, Utchariya Anantamongkol, Gleb Gorelick, Nebojsa Nick Knezevic
Background: Thoracic epidural analgesia (TEA) provides superior postoperative pain control compared to parenteral opioids after major thoracic and abdominal surgeries. However, some studies with respect to benefits of continuous TEA have shown mixed results. The purpose of this study was to determine the rate of successful TEA catheter insertion into the epidural space using contrast fluoroscopy and the impact of placement location on postoperative analgesia and opioid use. Patients and methods: After Advocate health care institutional review board approval, we conducted a prospective, open-label, single intervention study on patients undergoing thoracic or upper abdominal surgery...
2018: Local and Regional Anesthesia
Nagy Mekhail, Gerges Azer, Youssef Saweris, Diana S Mehanny, Shrif Costandi, Guangmei Mao
BACKGROUND AND OBJECTIVES: Despite the observation that select nicotine receptor agonists have analgesic effects, smokers report higher pain scores and more functional impairments than lifelong nonsmokers, attributable to exaggerated stress responses, receptor desensitization, and altered pharmacokinetics compounded by accelerated structural damage resulting from impaired bone healing, osteoporosis, and advancement of disk disease. We hypothesized that smoking diminishes the analgesic response to spinal cord stimulation (SCS) in patients with chronic spine-related pain conditions...
September 5, 2018: Regional Anesthesia and Pain Medicine
Irene B Murimi, Hsien-Yen Chang, Mark Bicket, Christopher M Jones, G Caleb Alexander
PURPOSE: In October 2014, the US Drug Enforcement Agency moved hydrocodone combination products (HCPs) from schedule III to II of the Controlled Substances Act, further restricting their access. The aim of the study is to quantify the effect of hydrocodone's "upscheduling" on the use of opioid and nonopioid analgesics among chronic users. METHODS: Using IQVIA LRx LifeLink anonymized pharmacy data 2013 to 2015, we performed interrupted time series analysis and group-based trajectory modeling to characterize the effect of rescheduling on 316 731 long-term hydrocodone users...
September 5, 2018: Pharmacoepidemiology and Drug Safety
Alexander S Chiu, Samantha L Ahle, Mollie R Freedman-Weiss, Peter S Yoo, Kevin Y Pei
BACKGROUND: Surgical residents are frequently responsible for prescribing postoperative analgesia, yet the vast majority are never formally educated on the subject. METHODS: A resident-led educational presentation on postoperative analgesia prescribing was provided to incoming surgical interns at a tertiary academic center. Pre- and post-surveys assessed comfort in prescribing postoperative analgesia. Following the educational intervention, opioid prescriptions during the interns' first two months were compared to that of the prior year's interns...
August 25, 2018: American Journal of Surgery
Michael L Barnett, Andrew R Olenski, N Marcus Thygeson, Denis Ishisaka, Salina Wong, Anupam B Jena, Ateev Mehrotra
Many insurers are using formulary design to influence opioid prescribing, but it is unclear if these changes lead to reduced use or just substitution between opioids. We evaluated the effect of a new prior authorization process implemented in July 2015 for extended-release (ER) oxycodone by Blue Shield of California. Compared to other commercially insured Californians, among 880,000 Blue Shield enrollees, there was a 36 percent drop in monthly rates of ER opioid initiation relative to control-group members, driven entirely by decreases in ER oxycodone initiation and without any substitution toward other ER opioids...
September 2018: Health Affairs
Amy S B Bohnert, Gery P Guy, Jan L Losby
Background: In response to adverse outcomes from prescription opioids, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain in March 2016. Objective: To test the hypothesis that the CDC guideline release corresponded to declines in specific opioid prescribing practices. Design: Interrupted time series analysis of monthly prescribing measures from the IQVIA transactional data warehouse and Real-World Data Longitudinal Prescriptions population-level estimates based on retail pharmacy data...
September 18, 2018: Annals of Internal Medicine
Scott G Weiner, Christin N Price, Alev J Atalay, Elizabeth M Harry, Erika A Pabo, Rajesh Patel, Joji Suzuki, Shelly Anderson, Stanley W Ashley, Allen Kachalia
BACKGROUND: The opioid overdose crisis now claims more than 40,000 lives in the United States every year, and many hospitals and health systems are responding with opioid-related initiatives, but how best to coordinate hospital or health system-wide strategy and approach remains a challenge. METHODS: An organizational opioid stewardship program (OSP) was created to reduce opioid-related morbidity and mortality in order to provide an efficient, comprehensive, multidisciplinary approach to address the epidemic in one health system...
August 28, 2018: Joint Commission Journal on Quality and Patient Safety
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