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Morphine use in fractures

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https://www.readbyqxmd.com/read/29680509/opioids-delay-healing-of-spinal-fusion-a-rabbit-posterolateral-lumbar-fusion-model
#1
Nikhil Jain, Khaled Himed, Jeffrey M Toth, Karen C Briley, Frank M Phillips, Safdar N Khan
BACKGROUND CONTEXT: Opioid use is prevalent for management of pre- and post-operative pain in patients undergoing spinal fusion. There is evidence that opioids downregulate osteoblasts in-vitro, and one previous study found that morphine delays the maturation and remodeling of callus in a rat femur fracture model. However, the effect of opioids on healing of spinal fusion has not been investigated before. Isolating the effect of opioid exposure in humans would be limited by the numerous confounding factors that affect fusion healing...
April 19, 2018: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29674340/opioid-analgesics-and-adverse-outcomes-among-hemodialysis-patients
#2
Julie H Ishida, Charles E McCulloch, Michael A Steinman, Barbara A Grimes, Kirsten L Johansen
BACKGROUND AND OBJECTIVES: Patients on hemodialysis frequently experience pain and may be particularly vulnerable to opioid-related complications. However, data evaluating the risks of opioid use in patients on hemodialysis are limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, we conducted a cohort study evaluating the association between opioid use (modeled as a time-varying exposure and expressed in standardized oral morphine equivalents) and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011...
April 19, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29611249/association-rules-method-and-big-data-evaluating-frequent-medication-combinations-associated-with-fractures-in-older-adults
#3
Prasad S Nishtala, Te-Yuan Chyou, Fabian Held, David G Le Couteur, Danijela Gnjidic
BACKGROUND: The association rules method is a novel methodology to ascertain patterns of medication use and combinations associated with adverse drug events. OBJECTIVES: The aim of this case-crossover study was to apply the association rules method to ascertain medication combinations contributing to the risk of fractures in older adults. METHODS: A nationwide representative sample of New Zealanders aged ≥65 years was sourced from the pharmaceutical collection...
April 2, 2018: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/29607659/ketamine-as-an-analgesic-adjuvant-in-adult-trauma-intensive-care-unit-patients-with-rib-fracture
#4
Mary K Walters, Joseph Farhat, James Bischoff, Mary Foss, Cory Evans
BACKGROUND: Rib fracture associated pain is difficult to control. There are no published studies that use ketamine as a therapeutic modality to reduce the amount of opioid to control rib fracture pain. OBJECTIVE: To examine the analgesic effects of adjuvant ketamine on pain scale scores in trauma intensive care unit (ICU) rib fracture. METHODS: This retrospective, case-control cohort chart review evaluated ICU adult patients with a diagnosis of ≥1 rib fracture and an Injury Severity Score >15 during 2016...
March 1, 2018: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29443860/a-novel-rat-model-of-extremity-trauma-for-pre-hospital-pain-management-research
#5
Lusha Xiang, Harold G Klemcke, Nathan A Wienandt, Kathy L Ryan, Carmen Hinojosa-Laborde
BACKGROUND: Pain management is important in pre-hospital care of patients with extremity trauma (ET). The goal of this study was to establish a rat model of ET for pre-hospital pain research, and validate it using pain behaviors and analgesics. METHODS: Rats were anesthetized using isoflurane and ET was induced in one hindlimb via clamping retrofemoral tissues for 30 sec, followed by closed fibula fracture. Rats regained consciousness after ET. Pain responses in the injured hindlimb to thermal hyperalgesia (paw withdrawal latency, PWL), mechanical allodynia (paw withdrawal pressure, PWP), and weight bearing (WB) were determined before and 90 minutes after ET...
February 14, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29384419/procedural-sedation-and-analgesia-in-trauma-patients-in-an-out-of-hospital-emergency-setting-a-prospective-multicenter-observational-study
#6
Michel Galinski, Laure Hoffman, Delphine Bregeaud, Mounir Kamboua, François-Xavier Ageron, Catherine Rouanet, Jean-Christophe Hubert, Jacques Istria, Mirko Ruscev, Karim Tazarourte, Florence Pevirieri, Frédéric Lapostolle, Frédéric Adnet
BACKGROUND: The quality of procedural analgesia and sedation among trauma patients has not been studied much in the prehospital setting. The main objective of this study was to characterize the quality of procedural analgesia sedation practices in prehospital settings in trauma patients. METHODS: This was an open-label observational prospective multicenter study (January 01, 2012-December 31, 2013). We included all consecutive trauma victims undergoing a potentially painful procedure on the accident scene...
January 31, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29379807/efficacy-and-safety-of-morphine-and-low-dose-ketamine-for-pain-control-of-patients-with-long-bone-fractures-a-randomized-double-blind-clinical-trial
#7
Fatemeh Jahanian, Seyed Mohammad Hosseininejad, Hamed Amini Ahidashti, Farzad Bozorgi, Iraj Goli Khatir, Seyyed Hosein Montazar, Vahideh Azarfar
Objective: To compare the effects of intravenous morphine and a low dose of ketamine on pain intensity of patients with traumatic fractures of the long bones. Methods: This randomized, controlled, double-blinded, clinical trial was conducted in the adult emergency department (ED) of Emam Khomeini hospital, a tertiary general hospital affiliated with Mazandaran University of Medical Sciences, in Northern Iran, during a 6-month period. Patients were randomly assigned to receive intravenous morphine (0...
January 2018: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/29207772/comparison-of-pain-relief-from-different-intravenous-doses-of-ketorolac-after-reduction-of-mandibular-fractures
#8
Saeed Nezafati, Reza Khorshidi Khiavi, Seyyed Sina Mirinejhad, Dawood Aghamoh Ammadi, Milad Ghanizadeh
Introduction: Pain is an unpleasant feeling due to tissue destruction, which disturbs an individual's daily routines even at its lowest levels. The majority of surgeons and anaesthesiologists are increasingly trying to administer non-opioid analgesics because excessive use of opioids after surgery results in patient dissatisfaction. Aim: To evaluate the analgesic effect of intravenous injection of different doses of ketorolac at different intervals in patients undergoing surgery for unilateral fractures of the mandible...
September 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/29200140/evaluating-the-implementation-barriers-of-an-intranasal-fentanyl-pain-pathway-for-pediatric-long-bone-fractures
#9
Tamara Arnautovic, Kathryn Sommese, Paul C Mullan, Steven Barron Frazier, Turaj Vazifedan, Dana Erikson Ramirez
OBJECTIVES: This study aimed to assess physician comfort, knowledge, and implementation barriers regarding the use of intranasal fentanyl (INF) for pain management in patients with long-bone fractures in a pediatric emergency department (ED) with an INF pain pathway. METHODS: A retrospective chart review was conducted of patients, 3 to 21 years old, in our ED with an International Classification of Diseases-9th Revision code for a long-bone fracture from September 1, 2013, to August 31, 2015...
December 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29196879/the-feasibility-of-physiologically-based-pharmacokinetic-modeling-in-forensic-medicine-illustrated-by-the-example-of-morphine
#10
Nadine Schaefer, Daniel Moj, Thorsten Lehr, Peter H Schmidt, Frank Ramsthaler
In forensic medicine, expert opinion is often required concerning dose and time of intake of a substance, especially in the context of fatal intoxications. In the present case, a 98-year-old man died 4 days after admission to a hospital due to a femur neck fracture following a domestic fall in his retirement home. As he had obtained high morphine doses in the context of palliative therapy and a confusion of his supplemental magnesium tablets with a diuretic by the care retirement home was suspected by the relatives, a comprehensive postmortem examination was performed...
March 2018: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/29189367/oxycodone-ingestion-patterns-in-acute-fracture-pain-with-digital-pills
#11
Peter R Chai, Stephanie Carreiro, Brendan J Innes, Brittany Chapman, Kristin L Schreiber, Robert R Edwards, Adam W Carrico, Edward W Boyer
BACKGROUND: Opioid analgesics are commonly prescribed on an as-needed (PRN) basis for acute painful conditions. Uncertainty of how patients actually take PRN opioids, coupled with a desire to completely cover pain, leads to variable and overly generous opioid prescribing practices, resulting in a surplus of opioids. This opioid surplus becomes a source for diversion and nonmedical opioid use. Understanding patterns of actual opioid ingestion after acute painful conditions can help clinicians counsel patients on safe opioid use, and allow timely recognition and intervention when escalating opioid self-dosing occurs, to prevent tolerance and addiction...
December 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29168404/impact-of-a-chronic-pain-management-pathway-on-opioid-administration-and-prescribing-in-an-emergency-department
#12
Caroline Pace, Sneha Shah, Amy X Zhang, Amy E Zosel
CONTEXT: Prescription opioid abuse and misuse is a significant public health crisis. In 2012, an opioid prescribing pathway for patients with chronic pain presenting to the Emergency Department (ED) was implemented. The objective of this study is to determine the impact of the pathway for administration of opioids in the ED as well as the prescribing of opioids for home use after discharge. METHODS: Retrospective pre- and post-intervention time series study of consecutive patients presenting to the ED with acute and chronic pain complaints before and after implementation of the pathway...
November 23, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/29065039/opioid-prescribing-practices-by-orthopaedic-trauma-surgeons-after-isolated-femur-fractures
#13
Basem Attum, Andres Rodriguez-Buitrago, Nichelle Harrison, Adam Evans, William Obremskey, Manish K Sethi, A Alex Jahangir
OBJECTIVE: The purpose of this retrospective study was to identify opioid prescribing practices, determine the number of morphine milliequivalents (MMEs) prescribed by orthopaedic/nonorthopaedic members to narcotic naive and previously exposed patients, and provide narcotic prescribing recommendations. METHODS: Patients older than 18 years with an isolated femur fracture sustained between 2013 and 2015 were identified using the CPT code 27506. Prescribing information was obtained from the State Controlled Substance Monitoring Database...
March 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29052225/peripheral-nerve-block-in-ankle-fracture-surgery-a-qualitative-study-of-patients-experiences
#14
M J Henningsen, R Sort, A M Møller, S F Herling
Peripheral nerve blocks are popular as a mode of anaesthesia for limb surgery and their beneficial effects are well documented in elective surgery. However, concerns have been raised about potential rebound pain outweighing the benefits in acute ankle fracture surgery. Furthermore, pain scores and morphine consumption do not provide a full picture, as pain is subjective. To evaluate the clinical usefulness of peripheral nerve blocks, we explored patients' expectations and experiences by means of semi-structured interviews analysed with systematic text condensation...
January 2018: Anaesthesia
https://www.readbyqxmd.com/read/28956669/prehospital-pain-management-disparity-by-age-and-race
#15
Hilary A Hewes, Mengtao Dai, N Clay Mann, Tanya Baca, Peter Taillac
IMPORTANCE: Historically, pain management in the prehospital setting, specifically pediatric pain management, has been inadequate despite many EMS (emergency medical services) transports related to traumatic injury with pain noted as a symptom. The National Emergency Services Information System (NEMSIS) database offers the largest national repository of prehospital data, and can be used to assess current patterns of EMS pain management across the country. OBJECTIVES: To analyze prehospital management of pain using NEMSIS data, and to assess if variables such as patient age and/or race/ethnicity are associated with disparity in pain treatment...
March 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28918661/comparable-postoperative-pain-levels-using-2-different-nerve-blocks-in-the-operative-treatment-of-displaced-intra-articular-calcaneal-fractures
#16
Siem A Dingemans, Kristian J de Ruiter, Merel F N Birnie, J Carel Goslings, Gan van Samkar, Tim Schepers
BACKGROUND: The aim of this study was to compare the postoperative pain levels in patients undergoing osteosynthesis of the calcaneus with either a popliteal nerve block or an ankle block. METHODS: A retrospective analysis of all consecutive patients undergoing operative fixation of a calcaneal fracture via a sinus tarsi approach between August 2012 and April 2017 in a single foot/ankle specialized center was performed. Single-shot popliteal blocks were placed using ultrasound guidance by an anesthesiologist while ankle blocks were placed by a foot/ankle specialized surgeon...
December 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28890120/fascia-iliaca-block-for-pain-control-in-hip-fracture-patients
#17
P Castillón, M Veloso, O Gómez, J Salvador, A Bartra, F Anglés
INTRODUCTION: Pain treatment for patients with hip fracture has been based on the use of nonsteroidal anti-inflammatories and opioid derived drugs. These medications have been associated with multiple adverse effects. Fascia iliaca block is a recent pain management alternative for these patients. The objective of this study was to evaluate the effectiveness of fascia iliaca block performed in the emergency room (ER) for patients over 65years of age with hip fracture. MATERIALS AND METHODS: A cohort of 216 patients, from January to December 2016, was studied prospectively...
November 2017: Revista Española de Cirugía Ortopédica y Traumatología
https://www.readbyqxmd.com/read/28828342/effect-of-intravenous-morphine-and-ketorolac-on-pain-control-in-long-bones-fractures
#18
Babak Masoumi, Behdad Farzaneh, Omid Ahmadi, Farhad Heidari
BACKGROUND: According to the lack of adequate studies on comparing the analgesic effect and complications of ketorolac with morphine in long bone fractures, this study aimed to compare the efficacy of ketorolac with morphine in patients referring to the Emergency Department with long bones damage and fracture. MATERIALS AND METHODS: In this clinical trial study, 88 patients with long bone fracture were selected randomly and divided into two groups. To scale the intensity of pain, visual analog scale (VAS) were used...
2017: Advanced Biomedical Research
https://www.readbyqxmd.com/read/28780196/can-we-reduce-morphine-use-in-elderly-proximal-femoral-fracture-patients-using-a-fascia-iliac-block
#19
Al-Amin M Kassam, Anthony T Gough, Joanna Davies, Rathan Yarlagadda
Proximal femoral fractures are becoming increasingly common with an ageing population. Many patients have multiple comorbidities increasing their risk of opiate complications. 40 consecutive patients presenting with a proximal femoral fracture to a trauma centre in the UK were given either a Fascia Iliaca Block (FIB) with oral analgesia or just oral analgesia to control their pre-operative pain. Numeric pain scores and morphine consumption were used as outcome measures. Patients receiving a FIB had significant reduction in their pain scores compared to patients only receiving oral pain relief...
January 2018: Geriatric Nursing
https://www.readbyqxmd.com/read/28641968/femoral-nerve-catheters-improve-home-disposition-and-pain-in-hip-fracture-patients-treated-with-total-hip-arthroplasty
#20
Diren Arsoy, James I Huddleston, Derek F Amanatullah, Nicholas J Giori, William J Maloney, Stuart B Goodman
BACKGROUND: Opioids have been the mainstay of treatment in the physiologically young geriatric hip fracture patient undergoing total hip arthroplasty (THA). However opioid-related side effects increase morbidity. Regional anesthesia may provide better analgesia, while decreasing opioid-related side effects. The goal of this study was to examine the effect of perioperative continuous femoral nerve blockade with regards to pain scores, opioid-related side effects and posthospital disposition in hip fracture patients undergoing THA...
November 2017: Journal of Arthroplasty
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