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ketamine pain management

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https://www.readbyqxmd.com/read/28631150/low-dose-subcutaneous-ketamine-for-postoperative-pain-management-in-rwanda-a-dose-finding-study
#1
Jon Tuchscherer, William P McKay, Theogene Twagirumugabe
PURPOSE: Good pain control is not a normal part of surgical care in sub-Saharan Africa due to lack of resources. The primary objective of this study was to determine an efficacious dose of subcutaneous ketamine for postoperative pain for use in a future randomized controlled trial. METHODS: Following research ethics board and local hospital approval for this research, we obtained informed consent from 31 patients undergoing major surgery for a random walk dose-finding study...
June 19, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28625307/postcesarean-delivery-analgesia
#2
REVIEW
Brendan Carvalho, Alexander J Butwick
Effective pain management should be a key priority in women undergoing cesarean delivery. Suboptimal perioperative pain management is associated with chronic pain, greater opioid use, delayed functional recovery, impaired maternal-fetal bonding, and increased postpartum depression. Severe acute postoperative pain is also strongly associated with persistent pain after cesarean delivery. Multimodal analgesia is the core principle for cesarean delivery pain management. The use of neuraxial morphine and opioid-sparing adjuncts such as scheduled nonsteroidal anti-inflammatory medications and acetaminophen is recommended for all women undergoing cesarean delivery with neuraxial anesthesia unless contraindicated...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28536358/modulation-of-nmda-receptor-activity-in-fibromyalgia
#3
REVIEW
Geoffrey Littlejohn, Emma Guymer
Activation of the N-methyl-d-aspartate receptor (NMDAR) results in increased sensitivity of spinal cord and brain pathways that process sensory information, particularly those which relate to pain. The NMDAR shows increased activity in fibromyalgia and hence modulation of the NMDAR is a target for therapeutic intervention. A literature review of interventions impacting on the NMDAR shows a number of drugs to be active on the NMDAR mechanism in fibromyalgia patients, with variable clinical effects. Low-dose intravenous ketamine and oral memantine both show clinically useful benefit in fibromyalgia...
April 11, 2017: Biomedicines
https://www.readbyqxmd.com/read/28526150/pharmacogenomics-in-pain-management
#4
REVIEW
Ramsey Saba, Alan D Kaye, Richard D Urman
There is interpatient variability to analgesic administration. Much can be traced to pharmacogenomics variations between individuals. Certain ethnicities are more prone to reduced function of CYP2D6. Weak opioids are subject to interpatient variation based on their CYP2D6 type. Strong opioids have variations based on their transport and individual metabolism. Several cytochrome enzymes have been found to be involved with ketamine but there is no strong evidence of individual polymorphisms manifesting in clinical outcomes...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28525529/is-intravenous-ketamine-effective-for-postoperative-pain-management-in-adults
#5
Camila Stuardo, Diego Lobos-Urbina, Fernando Altermatt
Ketamine is a N-Metil-D-Aspartate receptor antagonist that has been used as adjuvant in the acute postoperative pain management because of its analgesic properties. However, its role is not clearly determined. To answer this question, we searched in Epistemonikos database, which is maintained by screening multiple information sources. We identified 19 systematic reviews including 226 randomized trials overall. We extracted data and generated a summary of findings table using the GRADE approach. We concluded intravenous ketamine probably has little or no effect in reducing postoperative pain...
May 17, 2017: Medwave
https://www.readbyqxmd.com/read/28489643/factors-influencing-quality-of-pain-management-in-a-physician-staffed-helicopter-emergency-medical-service
#6
Nicole Oberholzer, Alexander Kaserer, Roland Albrecht, Burkhardt Seifert, Mario Tissi, Donat R Spahn, Konrad Maurer, Philipp Stein
BACKGROUND: Pain is frequently encountered in the prehospital setting and needs to be treated quickly and sufficiently. However, incidences of insufficient analgesia after prehospital treatment by emergency medical services are reported to be as high as 43%. The purpose of this analysis was to identify modifiable factors in a specific emergency patient cohort that influence the pain suffered by patients when admitted to the hospital. METHODS: For that purpose, this retrospective observational study included all patients with significant pain treated by a Swiss physician-staffed helicopter emergency service between April and October 2011 with the following characteristics to limit selection bias: Age > 15 years, numerical rating scale (NRS) for pain documented at the scene and at hospital admission, NRS > 3 at the scene, initial Glasgow coma scale > 12, and National Advisory Committee for Aeronautics score < VI...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28469132/population-scale-data-reveals-the-antidepressant-effects-of-ketamine-and-other-therapeutics-approved-for-non-psychiatric-indications
#7
Isaac V Cohen, Tigran Makunts, Rabia Atayee, Ruben Abagyan
Current therapeutic approaches to depression fail for millions of patients due to lag in clinical response and non-adherence. Here we provide new support for the antidepressant effect of an anesthetic drug, ketamine, by Inverse-Frequency Analysis of eight million reports from the FDA Adverse Effect Reporting System. The results of the examination of population scale data revealed that patients who received ketamine had significantly lower frequency of reports of depression than patients who took any other combination of drugs for pain...
May 3, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28468999/ketamine-induced-converged-synchronous-gamma-oscillations-in-the-cortico-basal-ganglia-network-of-non-human-primates
#8
Maya Slovik, Boris Rosin, Shay Moshel, Rea Mitelman, Eitan Schechtman, Renana Eitan, Aeyal Raz, Hagai Bergman
NMDA (N-methyl-D-aspartate) antagonists are widely used in anesthesia, pain management, schizophrenia animal model studies and recently as potential antidepressants. However the mechanisms underlying their anesthetic, psychotic, cognitive and emotional effects are still elusive. The basal-ganglia (BG) integrate input from different cortical domains through its dopamine modulated connections, to achieve optimal behavior control. NMDA antagonists have been shown to induce gamma oscillations in human EEG recordings and in rodents cortical and BG networks...
May 3, 2017: Journal of Neurophysiology
https://www.readbyqxmd.com/read/28463863/is-subdissociative-ketamine-as-safe-and-effective-as-morphine-for-pain-management-in-the-emergency-department
#9
Patricia Kunz Howard, Christine M Gisness
: Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial." This prospective, randomized controlled inquiry enrolled 90 patients into 2 groups (ketamine vs. morphine) for patients seeking care in an emergency department with acute pain. Data regarding pain scores were collected at baseline, 15, 30, 60, 90, and 120 min...
April 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/28460699/case-study-of-high-dose-ketamine-for-treatment-of-complex-regional-pain-syndrome-in-the-pediatric-intensive-care-unit
#10
REVIEW
Tracy Ann Pasek, Kelli Crowley, Catherine Campese, Rachel Lauer, Charles Yang
Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient...
June 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28435316/subanesthetic-ketamine-for-pain-management-in-hospitalized-children-adolescents-and-young-adults-a-single-center-cohort-study
#11
Kathy A Sheehy, Caroline Lippold, Amy L Rice, Raissa Nobrega, Julia C Finkel, Zenaide Mn Quezado
BACKGROUND: Subanesthetic doses of ketamine, an N-methyl-d-aspartate receptor antagonist used as an adjuvant to opioid for the treatment of pain in adults with acute and chronic pain, have been shown, in some instances, to improve pain intensity and to decrease opioid intake. However, less is known about the role of ketamine in pain management in children, adolescents, and young adults. PURPOSE: We examined the effects of subanesthetic ketamine on pain intensity and opioid intake in children, adolescents, and young adults with acute and chronic pain syndromes treated in an inpatient setting...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28383472/battlefield-pain-management-a-view-of-17-years-in-israel-defense-forces
#12
Avi Benov, Margaux M Salas, Helit Nakar, Ben Antebi, Bader Tarif, Avraham Yitzhak, Elon Glassberg
BACKGROUND: Pain control in trauma is an integral part of treatment in combat casualty care (CCC). More soldiers injured on the battlefield will need analgesics for pain than those who will need lifesaving interventions (LSI). It has been shown that early treatment of pain improves outcomes after traumatic injury, whereas inadequate treatment leads to higher rates of PTSD. The purpose of this article is to report the Israel Defense Forces Medical Corps (IDF-MC) experience with point of injury (POI) use of analgesia...
July 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28366351/when-to-pick-the-nose-out-of-hospital-and-emergency-department-intranasal-administration-of-medications
#13
REVIEW
Megan A Rech, Brian Barbas, Whitney Chaney, Elizabeth Greenhalgh, Charles Turck
The intranasal route for medication administration is increasingly popular in the emergency department and out-of-hospital setting because such administration is simple and fast, and can be used for patients without intravenous access and in situations in which obtaining an intravenous line is difficult or time intensive (eg, for patients who are seizing or combative). Several small studies (mostly pediatric) have shown midazolam to be effective for procedural sedation, anxiolysis, and seizures. Intranasal fentanyl demonstrates both safety and efficacy for the management of acute pain...
March 25, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28358229/intractable-acute-pain-related-to-fluoroquinolone-induced-peripheral-neuropathy
#14
Matthew Dukewich, Arash Danesh, Chiemeka Onyima, Anita Gupta
Fluoroquinolones are widely prescribed antibiotics, used for various infectious etiologies. These antibiotics carry the possibility of the serious adverse effect of peripheral neuropathy, with a true incidence not known owing to its rare existence. Recently, the Food and Drug Administration (FDA) has required alterations to drug labels to highlight this adverse effect of fluoroquinolones. This is a case report of a single patient at an inpatient neurology service at an urban academic medical center in the United States...
June 2017: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/28339443/clinical-outcome-of-augmentation-enterocystoplasty-for-patients-with-ketamine-induced-cystitis
#15
Yu Khun Lee, Jia-Fong Jhang, Hann-Chorng Kuo
BACKGROUND: Ketamine abuse has become a global phenomenon in recent years. Ketamine-induced cystitis (KC) is a new clinical syndrome which can result in severely inflamed bladder and intractable bladder pain. Currently there is no guideline for managing patients with KC. OBJECTIVES: To analyze the clinical outcome of patients with KC managed with augmentation enterocystoplasty (AE). STUDY DESIGN: Retrospective interventional study. SETTING: A tertiary teaching hospital, Hualien Tzu Chi Hospital...
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28339433/management-of-neuropathic-chronic-pain-with-methadone-combined-with-ketamine-a-randomized-double-blind-active-controlled-clinical-trial
#16
Flavia Karine Rigo, Gabriela Trevisan, Maria C Godoy, Mateus Fortes Rossato, Gerusa D Dalmolin, Mariane A Silva, Mirian S Menezes, Wolnei Caumo, Juliano Ferreira
BACKGROUND: Methadone and ketamine are used in neuropathic pain management. However, the benefits of both drugs association are uncertain in the treatment of neuropathic pain. OBJECTIVE: Our primary objective was test the hypothesis that oral methadone combined with oral ketamine is more effective than oral methadone or ketamine alone in reducing neuropathic pain. STUDY DESIGN: We conducted a randomized, double blind, active-controlled parallel-group clinical trial...
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28339431/perioperative-ketamine-administration-for-thoracotomy-pain
#17
Daniel W Moyse, Alan D Kaye, James H Diaz, Muhammad Y Qadri, David Lindsay, Srinivas Pyati
BACKGROUND: Of all the postsurgical pain conditions, thoracotomy pain poses a particular therapeutic challenge in terms of its prevalence, severity, and ensuing postoperative morbidity. Multiple pain generators contribute to the severity of post-thoracotomy pain, and therefore a multimodal analgesic therapy is considered to be a necessary strategy. Along with opioids, thoracic epidural analgesia, and paravertebral blocks, N-Methyl-D-Aspartate (NMDA) receptor antagonists such as ketamine have been used as adjuvants to improve analgesia...
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28333667/effect-of-penetration-enhancers-on-the-percutaneous-delivery-of-pain-management-actives
#18
John Trimble, Bob Light
Transdermal compositions for pain management are comprised of nonsteroidal anti-inflammatory drugs, opioid drugs, and adjuvant drugs acting on: voltage-gated channels, gamma-aminobutyric acid receptors, acute musculoskeletal pain, and as an antidepressant. In this work, baclofen, bupivacaine, cyclobenzaprine, diclofenac, gabapentin, ibuprofen, ketamine, and pentoxifylline were loaded in transdermal compositions, prepared using a mixture of lipids (isopropyl palmitate and mineral oil) and one of two selected penetration enhancer mixtures: alkyl dimethicone, phenyl trimethicone, and polyoxyethylene sorbitan monostearate; and cetostearyl polyoxyethylene ether and ethylene oxide/propylene oxide copolymer...
May 2016: International Journal of Pharmaceutical Compounding
https://www.readbyqxmd.com/read/28321251/analgesic-effects-of-preincision-ketamine-on-postspinal-caesarean-delivery-in-uganda-s-tertiary-hospital-a-randomized-clinical-trial
#19
Richard Mwase, Tonny Stone Luggya, John Mark Kasumba, Humphrey Wanzira, Andrew Kintu, Joesph V B Tindimwebwa, Daniel Obua
Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine's postoperative analgesic effects. Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale...
2017: Anesthesiology Research and Practice
https://www.readbyqxmd.com/read/28299720/ketamine-infusion-as-a-counter-measure-for-opioid-tolerance-in-mechanically-ventilated-children-a-pilot-study
#20
Felix Neunhoeffer, Anja Hanser, Martin Esslinger, Vanja Icheva, Matthias Kumpf, Ines Gerbig, Michael Hofbeck, Jörg Michel
BACKGROUND: Drug rotation to prevent opioid tolerance is well recognized in chronic pain management. However, ketamine infusion as a counter measure for opioid tolerance is rarely described in mechanically ventilated children developing tolerance from prolonged opioid infusion. PATIENTS AND METHODS: We performed a retrospective study in a 14-bed medical-surgical-cardiac pediatric intensive care unit. Thirty-two mechanically ventilated children who had developed tolerance from prolonged intravenous infusion of opioids received a continuous intravenous infusion of ketamine as an opioid substitute for more than 2 days, scheduled in a drug rotation protocol...
June 2017: Paediatric Drugs
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