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Ketamine and morphine

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https://www.readbyqxmd.com/read/29775117/intravenous-low-dose-ketamine-provides-greater-pain-control-compared-to-fentanyl-in-a-civilian-prehospital-trauma-system-a-propensity-matched-analysis
#1
E Stein Bronsky, Catherine Koola, Alessandro Orlando, Diane Redmond, Cecile D'Huyvetter, Heather Sieracki, Allen Tanner, Ray Fowler, Charles Mains, David Bar-Or
OBJECTIVE: A few studies report comparable analgesic efficacy between low-dose ketamine and opioids such as morphine or fentanyl; however, limited research has explored the safety and effectiveness of intravenous low-dose ketamine as a primary analgesic in a civilian prehospital setting. The objective of this study is to compare pain control between low-dose ketamine and fentanyl when administered intravenously (IV) for the indication of severe pain. METHODS: This was a retrospective, observational review of prehospital adult patients (≥18 years) who presented with severe pain (numeric rating scale, 7-10) and were treated solely with either low-dose ketamine IV or fentanyl IV between January 1, 2014 and December 31, 2016...
May 18, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29745328/a-case-of-acute-intoxication-due-to-the-assumption-of-the-new-psychoactive-substance-nps-u-47700-identification-in-urine-blood-and-pubic-hair-by-liquid-chromatography-high-resolution-mass-spectrometry
#2
Donata Favretto, Vogliardi Susanna, Stocchero Giulia, Maietti Sergio, Tucci Marianna, Nalesso Alessandro, Snenghi Rossella
BACKGROUND/OBJECTIVE: We report on a case of severe intoxication after insufflation of U-47700, a synthetic opioid that acts as a selective agonist of the µ-opioid receptor, several times more potent than morphine. A man in his 30s was found irresponsive in his apartment and was brought to the emergency department of a local hospital. A comatous state and severe respiratory depression were diagnosed. Anamnesis revealed that the patient could have taken the substance named "U-47700", bought in the Internet...
May 9, 2018: Current Pharmaceutical Biotechnology
https://www.readbyqxmd.com/read/29737933/case-report-utility-of-ketamine-lidocaine-and-mexiletine-as-nonopioid-adjuvants-in-complex-cancer-associated-pain
#3
Robert C Hakim, Kyle P Edmonds, Rabia S Atayee
Ketamine, lidocaine, and mexiletine are potential nonopioid adjuvant medications for the use of refractory cancer-related pain, particularly when opioids are demonstrating limited objective benefit. This is a case report of a single patient admitted to a large academic medical center in the United States. The patient is a 43-year-old woman with a history of Crohn's disease complicated by rectal squamous cell carcinoma and complex, progressive, and intractable pelvic and rectal pain. Over the course of hospitalization, her pain demonstrated limited opioid responsiveness despite marked fluctuations of her oral morphine equivalent doses...
May 8, 2018: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/29720754/effects-of-adding-dexamethasone-or-ketamine-to-bupivacaine-for-ultrasound-guided-thoracic-paravertebral-block-in-patients-undergoing-modified-radical-mastectomy-a-prospective-randomized-controlled-study
#4
Mona Blough El Mourad, Asmaa Fawzy Amer
Background and Aims: Pain after modified radical mastectomy (MRM) has been successfully managed with thoracic paravertebral block (TPVB). The purpose of this study was to evaluate the effect of adding dexamethasone or ketamine as adjuncts to bupivacaine in TPVB on the quality of postoperative analgesia in participants undergoing MRM. Methods: This prospective randomised controlled study enrolled ninety adult females scheduled for MRM. Patients were randomised into three groups (30 each) to receive ultrasound-guided TPVB before induction of general anaesthesia...
April 2018: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29716637/is-intravenously-administered-subdissociative-dose-ketamine-non-inferior-to-morphine-for-prehospital-analgesia-the-ketamorph-study-study-protocol-for-a-randomized-controlled-trial
#5
Clément Le Cornec, Said Lariby, Vivien Brenckmann, Jean Benoit Hardouin, Claude Ecoffey, Marion Le Pottier, Philippe Fradin, Hélène Broch, Amine Kabbaj, Yannick Auffret, Florence Deciron, Céline Longo, François Javaudin, Quentin Le Bastard, Joël Jenvrin, Emmanuel Montassier
BACKGROUND: Acute pain is a common condition among prehospital patients and prompt management is pivotal. Opioids are the most frequently analgesics used in the prehospital setting. However, opioids are highly addictive, and some patients may develop opioid dependence, even when they are exposed to brief opioid treatments. Therefore, alternative non-opioid analgesia should be developed to manage pain in the prehospital setting. Used at subdissociative doses, ketamine, a noncompetitive N-methyl-D-aspartate and glutamate receptor antagonist, provides analgesic effects accompanied by preservation of protective airway reflexes...
May 2, 2018: Trials
https://www.readbyqxmd.com/read/29696126/acute-pain-management-in-emergency-department-low-dose-ketamine-versus-morphine-a-randomized-clinical-trial
#6
Babak Mahshidfar, Mani Mofidi, Maryam Fattahi, Davood Farsi, Peyman Hafezi Moghadam, Saeed Abbasi, Mahdi Rezai
Background: Ketamine, as an opium alternative, has been proposed for pain relief in the emergency department (ED). Objectives: This study was carried out to compare low dose ketamine (LDK) with morphine for pain relief in trauma patients. Methods: In this randomized double-blinded clinical trial, 300 trauma patients from the ED of 2 teaching hospitals in Tehran, Iran were enrolled and randomly divided into 2 equal groups. The 1st group received 0...
December 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/29660154/local-mepivacaine-before-castration-of-horses-under-medetomidine-isoflurane-balanced-anaesthesia-is-effective-to-reduce-perioperative-nociception-and-cytokine-release
#7
M Abass, S Picek, J F Glaus Carzòn, C Kühnle, A Zaghlou, R Bettschart-Wolfensberger
BACKGROUND: In horses castration with primary intention healing is usually performed under balanced inhalation anaesthesia. To optimise analgesia, the use of local anaesthesia was tested. OBJECTIVES: To investigate the effect of local mepivacaine before castration with first intention healing under balanced medetomidine-isoflurane anaesthesia and flunixin meglumine, morphine analgesia on perioperative cytokine levels and pain in horses. STUDY DESIGN: Prospective blinded clinical study...
April 16, 2018: Equine Veterinary Journal
https://www.readbyqxmd.com/read/29607659/ketamine-as-an-analgesic-adjuvant-in-adult-trauma-intensive-care-unit-patients-with-rib-fracture
#8
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/29576122/ketamine-and-norketamine-attenuate-oxycodone-tolerance-markedly-less-than-that-of-morphine-from-behaviour-to-drug-availability
#9
T Lilius, E Kangas, M Niemi, P Rauhala, E Kalso
BACKGROUND: Ketamine attenuates morphine tolerance by antagonising N-methyl-d-aspartate receptors. However, a pharmacokinetic interaction between morphine and ketamine has also been suggested. The interaction between oxycodone and ketamine is unclear. We studied the effects of ketamine and norketamine on the attenuation of morphine and oxycodone tolerance focusing on both the pharmacodynamic and pharmacokinetic interactions. METHODS: Morphine 9.6 mg day-1 or oxycodone 3...
April 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29574346/evaluation-of-three-rapid-oral-fluid-test-devices-on-the-screening-of-multiple-drugs-of-abuse-including-ketamine
#10
Magdalene H Y Tang, C K Ching, Simon Poon, Suzanne S S Chan, W Y Ng, M Lam, C K Wong, Ronnie Pao, Angus Lau, Tony W L Mak
Rapid oral fluid testing (ROFT) devices have been extensively evaluated for their ability to detect common drugs of abuse; however, the performance of such devices on simultaneous screening for ketamine has been scarcely investigated. The present study evaluated three ROFT devices (DrugWipe® 6S, Ora-Check® and SalivaScreen® ) on the detection of ketamine, opiates, methamphetamine, cannabis, cocaine and MDMA. A liquid chromatography tandem mass spectrometry (LCMS) assay was firstly established and validated for confirmation analysis of the six types of drugs and/or their metabolites...
March 12, 2018: Forensic Science International
https://www.readbyqxmd.com/read/29570151/incidence-and-risk-factors-for-chronic-postoperative-opioid-use-after-major-spine-surgery-a-cross-sectional-study-with-longitudinal-outcome
#11
Lauren K Dunn, Sandeep Yerra, Shenghao Fang, Mark F Hanak, Maren K Leibowitz, Siny Tsang, Marcel E Durieux, Edward C Nemergut, Bhiken I Naik
BACKGROUND: Chronic opioid use is a significant public health concern. Surgery is a risk factor for developing chronic opioid use. Patients undergoing major spine surgery frequently are prescribed opioids preoperatively and may be at risk for chronic opioid use postoperatively. The aim of this study was to investigate the incidence of and perioperative risk factors associated with chronic opioid use after major spine surgery. METHODS: The records of patients who underwent elective major spine surgery at the University of Virginia between March 2011 and February 2016 were retrospectively reviewed...
March 21, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29553101/pain-perception-after-colorectal-surgery-a-propensity-score-matched-prospective-cohort-study
#12
Fabian Grass, Matthieu Cachemaille, David Martin, Nicolas Fournier, Dieter Hahnloser, Catherine Blanc, Nicolas Demartines, Martin Hübner
The purpose of this prospective cohort study was to compare multimodal pain management and pain perception after open vs. laparoscopic colorectal surgery within enhanced recovery care. Pain scores at rest and at mobilization were prospectively assessed in consecutive patients using Visual Analog Scales (VAS 0-10) and consumption of different analgesics was recorded daily until 96 hours postoperatively. Uni- and multivariate risk factors for pain peaks (≥ 4/10) were identified by logistic regression and compared between two propensity score matched groups (open vs...
2018: Bioscience Trends
https://www.readbyqxmd.com/read/29498951/association-of-multimodal-pain-management-strategies-with-perioperative-outcomes-and-resource-utilization-a-population-based-study
#13
Stavros G Memtsoudis, Jashvant Poeran, Nicole Zubizarreta, Crispiana Cozowicz, Eva E Mörwald, Edward R Mariano, Madhu Mazumdar
BACKGROUND: Multimodal analgesia is increasingly considered routine practice in joint arthroplasties, but supportive large-scale data are scarce. The authors aimed to determine how the number and type of analgesic modes is associated with reduced opioid prescription, complications, and resource utilization. METHODS: Total hip/knee arthroplasties (N = 512,393 and N = 1,028,069, respectively) from the Premier Perspective database (2006 to 2016) were included. Analgesic modes considered were opioids, peripheral nerve blocks, acetaminophen, steroids, gabapentin/pregabalin, nonsteroidal antiinflammatory drugs, cyclooxygenase-2 inhibitors, or ketamine...
May 2018: Anesthesiology
https://www.readbyqxmd.com/read/29474216/anesthesia-and-analgesia-for-gynecological-surgery
#14
Allana Munro, Ana Sjaus, Ronald B George
PURPOSE OF REVIEW: High-quality analgesia has been linked to improved patient satisfaction as well as improved short-term and long-term postoperative outcomes. Acute surgical pain is a modifiable risk factor for development of chronic postoperative pain, which is reported by up to 26% of gynecologic surgical patients. In other surgical populations, multimodal analgesia has shown improved pain control and decreased reliance on opioids. This review examines recent evidence for various analgesic modalities applied specifically to the gynecologic surgical population...
June 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29458790/non-pharmacological-interventions-and-non-fentanyl-pharmacological-treatments-for-breakthrough-cancer-pain-a-systematic-and-critical-review
#15
REVIEW
Sebastiano Mercadante
BACKGROUND: Oral opioids or other pharmacological or non-pharmacological interventions are often suggested in the management of breakthrough cancer pain (BTcP). The aim of this systematic and critical review was to analyse and critically comment the evidence of any non-fentanyl therapies proposed for BTcP. METHODS: A systematic literature search was carried out to find studies providing clinical data on any treatment excluding fentanyl products. RESULTS: No data exist about the use of oral opioids...
February 2018: Critical Reviews in Oncology/hematology
https://www.readbyqxmd.com/read/29448876/evaluation-of-injectable-anaesthesia-with-five-medetomidine-midazolam-based-combinations-in-egyptian-fruit-bats-rousettus-aegyptiacus
#16
Avishag Tuval, Liora Las, Yael Shilo-Benjamini
Egyptian fruit bats are increasingly used as model animals in neuroscience research. Our aim was to characterize suitable injectable anaesthesia for this species, possibly replacing inhalant anaesthesia, thus minimizing occupational health hazards. Eight bats were randomly assigned by a crossover design for subcutaneously administered combinations of medetomidine-midazolam with: saline (MM-Sal), ketamine (MM-Ket), fentanyl (MM-Fen), morphine (MM-Mor), or butorphanol (MM-But). The anaesthetic depth and vital signs were monitored at baseline and every 10 min until bats recovered...
January 1, 2018: Laboratory Animals
https://www.readbyqxmd.com/read/29443860/a-novel-rat-model-of-extremity-trauma-for-pre-hospital-pain-management-research
#17
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/29412051/prehospital-analgesia-for-pediatric-trauma-patients-in-iraq-and-afghanistan
#18
Steven G Schauer, Allyson A Arana, Jason F Naylor, Guyon J Hill, Michael D April
BACKGROUND: Previous studies have evaluated prehospital analgesia during combat operations in Iraq and Afghanistan, but were limited to the adult population. However, a significant portion of the casualties of those conflicts were children. We describe the prehospital analgesia administered to wartime pediatric trauma patients. METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric patients (<18 years of age) admitted to United States and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016...
February 7, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29408729/analysis-of-illicit-drugs-seized-in-the-province-of-florence-from-2006-to-2016
#19
Elisabetta Bertol, Laura Bigagli, Stefano D'Errico, Francesco Mari, Diego Palumbo, Jennifer P Pascali, Fabio Vaiano
Comprehension of illicit drug market's features at local level is useful to plan and to correctly set-up specific informative and contrast activities. In this paper we report trends, purities and consumption estimations of illicit substances available on the Florentine territory from 2006 to 2016. These data were obtained by the analysis of 10,451 samples seized by the Law Enforcement Agencies in case of personal use offence. Analytical procedures consisted in targeted and untargeted analyses by gas chromatography-flame ionization detector, gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry...
March 2018: Forensic Science International
https://www.readbyqxmd.com/read/29396996/intranasal-ketamine-and-its-potential-role-in-cancer-related-pain
#20
REVIEW
Vinita Singh, Theresa W Gillespie, Robert Donald Harvey
Cancer-related pain continues to be a significant therapeutic challenge, made more difficult by contemporary opioid use and diversion concerns. Conventional treatment using a tiered approach of nonsteroidal antiinflammatory drugs (NSAIDs), opioids, and adjuvant agents is limited; and alternatives are needed for patients with rapidly progressing pain and those who develop hyperalgesia and tolerance to opioids. Ketamine, an N-methyl-d-aspartate (NMDA) selective antagonist, has historically been used for anesthesia in adult and pediatric populations but has also been investigated for depression, bipolar disorder, and general and postoperative pain management...
March 2018: Pharmacotherapy
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