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Laura Baumgartner, Nicole Townsend, Katie Winkelman, Robert MacLaren
Findings indicate that adjunctive low-dose ketamine was safe and provided pain relief. ABSTRACT: Objectives: Traditional analgesic regimens often fail to control the severe pain patients experience during burn wound care, and the drugs are frequently administered at doses that can cause oversedation and respiratory depression. Ketamine may be an ideal agent for adjunctive analgesia in such patients because of its unique mechanism of action and lack of association with respiratory depression...
June 13, 2018: American Journal of Nursing
Katarzyna Kuczyńska, Piotr Grzonkowski, Łukasz Kacprzak, Jolanta B Zawilska
Fentanyl is a potent synthetic opioid used as a narcotic analgesic supplement in general and regional anesthesia as well as in management of persistent, severe chronic pain. Alarming epidemiological and forensic medicine reports, accumulated mainly during the last two decades, point to a growing increase in illicit use of fentanyl, mainly in North America and Europe. Toxicological data indicates that fentanyl use is inextricably linked with polydrug use. There are two main sources of fentanyl on the "recreational" drug market...
June 2, 2018: Forensic Science International
James Martin, Jack Cunliffe, David Décary-Hétu, Judith Aldridge
OBJECTIVE: To examine the effect on the trade in opioids through online illicit markets ("cryptomarkets") of the US Drug Enforcement Administration's ruling in 2014 to reschedule hydrocodone combination products. DESIGN: Interrupted time series analysis. SETTING: 31 of the world's largest cryptomarkets operating from October 2013 to July 2016. MAIN OUTCOME MEASURES: The proportion of total transactions, advertised and active listings for prescription opioids, prescription sedatives, prescription steroids, prescription stimulants, and illicit opioids, and the composition of the prescription opioid market between the US and elsewhere...
June 13, 2018: BMJ: British Medical Journal
Lynn R Webster, Randall P Brewer, Peter Lichtlen, Taryn Losch-Beridon, Shadreck Mareya, Martin Wang
Objectives: To examine the efficacy and safety of lubiprostone for the treatment of opioid-induced constipation (OIC) in patients by opioid class received. Design: Data were pooled from three phase III, randomized, double-blind, placebo-controlled studies. Subjects/Setting: Adults with chronic noncancer pain receiving opioid therapy for 30 or more days and diagnosed with OIC. Methods: Overall mean change from baseline in spontaneous bowel movement (SBM) frequency, overall treatment response (≥1 SBM/week improvement over baseline SBM frequency in all treatment weeks with available data and ≥3 SBMs/week for ≥9 of the 12 weeks of treatment), and OIC-related symptoms were examined in patients taking opioids...
June 1, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Viola Spahn, Giovanna Del Vecchio, Antonio Rodriguez-Gaztelumendi, Julia Temp, Dominika Labuz, Michael Kloner, Marco Reidelbach, Halina Machelska, Marcus Weber, Christoph Stein
Novel pain killers without adverse effects are urgently needed. Opioids induce central and intestinal side effects such as respiratory depression, sedation, addiction, and constipation. We have recently shown that a newly designed agonist with a reduced acid dissociation constant (pKa ) abolished pain by selectively activating peripheral μ-opioid receptors (MOR) in inflamed (acidic) tissues without eliciting side effects. Here, we extended this concept in that pKa reduction to 7.22 was achieved by placing a fluorine atom at the ethylidene bridge in the parental molecule fentanyl...
June 12, 2018: Scientific Reports
S Mallory Burns, Christopher W Cunningham, Susan L Mercer
Fentanyl rose to prominence as an alternative analgesic to morphine nearly 50 years ago; today, fentanyl has re-emerged as a dangerous recreational substance. The increased potency and analgesic effect of fentanyl are advantageous in the treatment of pain but are also responsible for the rise in unintentional opioid overdose deaths. In response to this crisis, fentanyl, its analogues, and even precursors are under heightened regulatory scrutiny. Despite this controversial history, derivatization of fentanyl has resulted in numerous synthetic analogues that provide valuable insights into opioid receptor binding and signaling events...
June 12, 2018: ACS Chemical Neuroscience
Jessica C Young, Jennifer L Lund, Nabarun Dasgupta, Michele Jonsson Funk
BACKGROUND: In recognition of potential for increased overdose risk, drug labels for extended-release and long-acting (ER/LA) opioids emphasize the need for established opioid tolerance prior to initiating high dosages. OBJECTIVES: Describe the proportion of patients with opioid tolerance prior to initiation of 90 morphine milligram equivalents (MME) ER/LA opioids and examine subsequent risk of opioid poisoning. METHODS: We used Truven Health Analytics' MarketScan Databases (2006-2015) to identify patients initiating ER/LA opioids ≥90 MME...
June 11, 2018: Pharmacoepidemiology and Drug Safety
Svetla Slavova, Julia F Costich, Terry L Bunn, Huong Luu, Michael Singleton, Sarah L Hargrove, Jeremy S Triplett, Dana Quesinberry, William Ralston, Van Ingram
No abstract text is available yet for this article.
June 7, 2018: International Journal on Drug Policy
Akira Shinohara, Tsugunobu Andoh, Ikuo Saiki, Yasushi Kuraishi
Fentanyl is an opioid commonly prescribed for cancer pain. Using melanoma-bearing mice, we investigated whether peripheral action would contribute to fentanyl analgesia in cancer pain. Intravenous injection of fentanyl inhibited mechanical nociception in healthy mice, which was markedly inhibited by the opioid antagonist naloxone, but not naloxone methiodide, a peripherally acting opioid antagonist. Melanoma-bearing mice showed mechanical allodynia and spontaneous licking, a pain-related behavior, which were suppressed by intravenous and local injections of fentanyl...
June 7, 2018: European Journal of Pharmacology
Mark T Astoria, Leroy Thacker, Karen D Hendricks-Muñoz
OBJECTIVE:  The objective of this study was to assess the association of analgesics and sedatives on oral feeding function and need for feeding tube at discharge in the very low birth weight (VLBW) (<1,500 g) preterm infant. STUDY DESIGN:  A retrospective review of surviving inborn infants < 1,500 g and < 32 weeks' gestation ( n  = 209), discharged between January 1, 2012, and December 31, 2014, from the neonatal intensive care unit identified exposure to analgesic and sedative medications, demographics, medical course, and nasogastric or gastrostomy tube (GT) feeding at discharge...
June 8, 2018: American Journal of Perinatology
Evelien J M Kuip, Wendy H Oldenmenger, Martine F Thijs-Visser, Peter de Bruijn, Astrid W Oosten, Esther Oomen-de Hoop, Stijn L W Koolen, Carin C D Van der Rijt, Ron H J Mathijssen
The transdermal fentanyl patch is widely used to treat cancer-related pain despite its wide inter- and intrapatient variability in pharmacokinetics. The aim of this study was to investigate whether smoking and body size (i.e. body mass index) influence fentanyl exposure in patients with cancer. These are factors that typically change during treatment and disease trajectories. We performed an explorative cohort study in patients with cancer using transdermal fentanyl patches (Durogesic®), by taking a blood sample for pharmacokinetic analysis one day after applying a patch in patients with a stable fentanyl dose...
2018: PloS One
Abbas Moallemy, Hashem Jarineshin, Fereydoon Fekrat, Alireza Abdullahzadeh Baghaaei, Manuchehr Kamali, Bibi Mona Razavi, Zobeir Shaerzadeh
Background: Intravenous regional anesthesia (IVRA) is an ideal technique for short surgery on the distal extremities. Different additives have been used to improve lidocaine's block quality. Objective: The aim of this study was to determine the effect of adding dexamethasone to lidocaine on improving the quality of IVRA. Methods: This study is a prospective, double-blind randomized study which was done on patients with upper extremity injuries of the distal elbow in Shahid Mohammadi Hospital, Bandar Abbas from October 2014 to December 2015...
April 2018: Electronic Physician
Tomi Ashaye, Natalia Hounsome, Dawn Carnes, Stephanie J C Taylor, Kate Homer, Sandra Eldridge, Anne Spencer, Anisur Rahman, Jens Foell, Martin R Underwood
OBJECTIVE: To establish the level of opioid prescribing for patients with chronic musculoskeletal pain in a sample of patients from primary care and to estimate prescription costs. DESIGN: Secondary data analyses from a two-arm pragmatic randomised controlled trial (COPERS) testing the effectiveness of group self-management course and usual care against relaxation and usual care for patients with chronic musculoskeletal pain (ISRCTN 24426731). SETTING: 25 general practices and two community musculoskeletal services in the UK (London and Midlands)...
June 6, 2018: BMJ Open
Joe S Smith, Jonathan P Mochel, David J Borts, Kerrie A Lewis, Johann F Coetzee
OBJECTIVE: To describe adverse reactions and measure plasma fentanyl concentrations in calves following administration of a fentanyl transdermal patch (FTP). STUDY DESIGN: Prospective, experimental clinical study. ANIMALS: Six female Holstein calves and one male Angus calf. Four calves were healthy experimental animals and three calves were clinical patients. METHODS: Plasma fentanyl concentrations were measured in blood collected from a jugular vein...
April 11, 2018: Veterinary Anaesthesia and Analgesia
T Plecko, K Berbalk, E Wieland, M Shipkova
BACKGROUND: Oral fluid (OF) is increasingly used as an alternative sample matrix in drug of abuse (DOA) screening. Screening is commonly performed by immunoassays and results confirmed using laborious GC-MS based methods. Therefore, an easy to operate ion trap mass spectrometric (IT-MS) commercial screening method (Toxtyper, Bruker Daltronik, Bremen, Germany) combined with a laboratory-developed sample preparation procedure have been evaluated for their application to OF. METHODS: Oral fluid samples were subjected to protein precipitation followed by HybridSPE-phospholipid extraction...
June 6, 2018: Therapeutic Drug Monitoring
Poupak Rahimzadeh, Seyed Hamid Reza Faiz, Farnad Imani, Pooya Derakhshan, Saeed Amniati
BACKGROUND: Spinal block is a common procedure for lower limbs surgery. Fentanyl, a synthetic opioid and dexmedetomidine, a selective α2 agonist have been used as adjuvants in spinal anesthesia to prolong intraoperative and postoperative analgesia. The aim of current study is to compare the efficacy of dexmedetomidine and fentanyl added to intrathecal bupivacaine in orthopedic procedures in lower limbs. METHODS: In this randomized clinical trial, 90 patients undergoing elective lower limb surgeries were randomly allocated to three groups...
June 6, 2018: BMC Anesthesiology
Shabbar I Ranapurwala, Rebecca B Naumann, Anna E Austin, Nabarun Dasgupta, Stephen W Marshall
PURPOSE: The ongoing opioid epidemic has claimed more than a quarter million Americans' lives over the past 15 years. The epidemic began with an escalation of prescription opioid deaths and has now evolved to include secondary waves of illicit heroin and fentanyl deaths, while the deaths due to prescription opioid overdoses are still increasing. In response, the Centers for Disease Control and Prevention (CDC) moved to limit opioid prescribing with the release of opioid prescribing guidelines for chronic noncancer pain in March 2016...
June 3, 2018: Pharmacoepidemiology and Drug Safety
Shiho Satomi, Nami Kakuta, Chiaki Murakami, Yoko Sakai, Katsuya Tanaka, Yasuo M Tsutsumi
Background: It is well known that the programmed intermittent epidural bolus (PIEB) technique effectively provides epidural anesthesia in labor. This randomized double-blind trial compared the postoperative analgesic efficacy of PIEB with that of continuous epidural infusion (CEI) in patients undergoing gynecological surgery under combined general-epidural anesthesia. Methods: Patients undergoing open gynecological surgery under combined general-epidural anesthesia were randomized at a 1 : 1 ratio to receive PIEB or CEI...
2018: BioMed Research International
Farshid Alizadeh, Seyed Morteza Heydari, Reza Nejadgashti
BACKGROUND: Intraoperative blood loss is considered to be an important issue in hypospadias surgery. Some studies have demonstrated the utility of caudal epidural block (CEB) in this regard among pediatric patients with hypospadias. Though there is evidence in favor of the use of CEB as the only anesthetic method for pediatric surgeries, it is usually used in combination with general anesthesia. In this form of use, it could have more favorable outcomes for both intra- and postoperative periods...
May 21, 2018: Journal of Pediatric Urology
Phillip F Yang, David J R Links, Johnny Petrovski
Hereditary spastic paraplegia (HSP), also known as familial spastic paraparesis or Strümpell-Lorrain disease, is a rare group of inherited disorders characterized by progressive spastic weakness in the lower limbs due to axonal degeneration of the corticospinal tracts. We describe the anesthetic management of a 52-year-old man with HSP who underwent an Ivor-Lewis esophagectomy for esophageal adenocarcinoma. This is the first report in the literature describing the anesthetic management of a patient with HSP successfully undergoing complex thoracoabdominal surgery...
May 29, 2018: A&A practice
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