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Narcotic prescribing

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https://www.readbyqxmd.com/read/29318006/naloxone-dosage-for-opioid-reversal-current-evidence-and-clinical-implications
#1
REVIEW
Rachael Rzasa Lynn, J L Galinkin
Opioid-related mortality is a growing problem in the United States, and in 2015 there were over 33,000 opioid-related deaths. To combat this mortality trend, naloxone is increasingly being utilized in a pre-hospital setting by emergency personnel and prescribed to laypersons for out-of-hospital administration. With increased utilization of naloxone there has been a subsequent reduction in mortality following an opioid overdose. Reversal of opioid toxicity may precipitate an opioid-withdrawal syndrome. At the same time, there is a risk of inadequate response or re-narcotization after the administration of a single dose of naloxone in patients who have taken large doses or long-acting opioid formulations, as the duration of effect of naloxone is shorter than that of many opioid agonists...
January 2018: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/29279713/tramadol-induced-adrenal-insufficiency-histological-immunohistochemical-ultrastructural-and-biochemical-genetic-experimental-study
#2
Shereen Abdelhakim Abdelaleem, Osama A Hassan, Rasha F Ahmed, Nagwa M Zenhom, Rehab A Rifaai, Nashwa F El-Tahawy
Tramadol is a synthetic, centrally acting analgesic. It is the most consumed narcotic drug that is prescribed in the world. Tramadol abuse has dramatically increased in Egypt. Long term use of tramadol can induce endocrinopathy. So, the aim of this study was to analyze the adrenal insufficiency induced by long term use of tramadol in experimental animals and also to assess its withdrawal effects through histopathological and biochemical genetic study. Forty male albino rats were used in this study. The rats were divided into 4 groups (control group, tramadol-treated group, and withdrawal groups)...
2017: Journal of Toxicology
https://www.readbyqxmd.com/read/29261036/communication-with-orthopedic-trauma-patients-via-an-automated-mobile-phone-messaging-robot
#3
Chris A Anthony, Alexander Volkmar, Apurva S Shah, Mike Willey, Matt Karam, J Lawrence Marsh
BACKGROUND: Communication with orthopedic trauma patients is traditionally problematic with low response rates (RRs). The purpose of this investigation was to (1) evaluate the feasibility of communicating with orthopedic trauma patients postoperatively, utilizing an automated mobile phone messaging platform; and (2) assess the first 2 weeks of postoperative patient-reported pain and opioid use after lower extremity orthopedic trauma procedures. MATERIALS AND METHODS: This was a prospective investigation at a Level 1 trauma center in the United States...
December 20, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/29249547/current-pain-prescribing-habits-for-common-shoulder-operations-a-survey-of-the-american-shoulder-and-elbow-surgeons-membership
#4
K Linnea Welton, Matthew J Kraeutler, Eric C McCarty, Armando F Vidal, Jonathan T Bravman
BACKGROUND: Orthopedic surgeons are among the highest prescribers of narcotic pills, and no guidelines currently exist for appropriate management of postoperative pain within this field. The purpose of this study was to gain understanding of the current pain management strategies used perioperatively and postoperatively among orthopedic shoulder surgeons. METHODS: Members of the American Shoulder and Elbow Surgeons were e-mailed an online survey regarding methods for managing pain in the perioperative and postoperative setting for total shoulder arthroplasty, labral and capsular stabilization procedures, and rotator cuff repair...
December 14, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/29179909/surgical-interns-preparedness-for-opioid-prescribing-before-and-after-a-training-intervention
#5
Michael J Nooromid, Neel A Mansukhani, Benjamin W Deschner, Simon Moradian, Nabil Issa, Karen J Ho, Jonah J Stulberg
INTRODUCTION: Exposure to pain management curriculum in medical school is currently variable. This paper reports on formal prescribing education, self-perceived prescribing readiness, and prescribing practices among incoming surgical residents before and after a pain management training session. METHODS: Pre-residency survey of thirty surgical interns at a single urban medical center, followed by a repeat survey after an educational session on prescription writing and opioid abuse...
November 20, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29121158/opioid-use-by-patients-after-rhinoplasty
#6
Sagar Patel, Angela Sturm, Michael Bobian, Peter F Svider, Giancarlo Zuliani, Russell Kridel
Importance: Given the increase in opioid addiction and overdose in the United States, reasoned opioid use after outpatient surgery may affect prescription medication abuse. Objectives: To examine patient use of opioids after rhinoplasty and establish an optimal postrhinoplasty pain management regimen. Design, Setting, and Participants: In this case series, opioid use was evaluated in 62 patients who underwent rhinoplasty performed by 3 fellowship-trained facial plastic surgeons, 2 in private practice in Texas and 1 in an academic setting in Michigan, from February 2016 to September 2016...
November 9, 2017: JAMA Facial Plastic Surgery
https://www.readbyqxmd.com/read/29084006/review-and-update-on-postoperative-opioid-use-after-nasal-and-sinus-surgery
#7
Sophia D Becker, Daniel G Becker
PURPOSE OF REVIEW: We examine the current literature on pain management after sinus and nasal surgery. The goal after surgery is to provide effective pain management without having too many 'leftovers', as leftover medications are an important source of opioids that are fueling the current prescription narcotic epidemic in the United States. There are more than 250 000 sinus operations and 260 000 septoplasties performed annually, and surgeons commonly prescribe a narcotic pain medication for postoperative pain management...
October 27, 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/29078056/pain-management-after-outpatient-foot-and-ankle-surgery
#8
Akash Gupta, Kanupriya Kumar, Matthew M Roberts, Austin E Sanders, Mackenzie T Jones, David S Levine, Martin J O'Malley, Mark C Drakos, Andrew J Elliott, Jonathan T Deland, Scott J Ellis
BACKGROUND: The number of opioids prescribed and used has increased precipitously over the past 2 decades for a number of reasons and has led to increases in long-term dependency, opioid-related deaths, and diversion. Most studies examining the role of prescribing habits have investigated nonoperative providers, although there is some literature describing perioperative opioid prescription and use. There are no studies looking at the number of pills consumed after outpatient foot and ankle surgeries, nor are there guidelines for how many pills providers should prescribe...
October 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/29065039/opioid-prescribing-practices-by-orthopaedic-trauma-surgeons-after-isolated-femur-fractures
#9
Basem Attum, Andres Buitrago Rodriguez, Nichelle Harrison, Adam Evans, William Obremskey, Manish Sethi, 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/non-orthopaedic members to narcotic naive and previously exposed patients and provide narcotic prescribing recommendations. METHODS: Patients over 18 years old 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 (CSMD)...
October 14, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29028641/postoperative-care-after-tonsillectomy-what-s-the-evidence
#10
Patrick Carpenter, Daniel Hall, Jeremy D Meier
PURPOSE OF REVIEW: The purpose of this review is to evaluate the current literature regarding postoperative management after tonsillectomy in children. RECENT FINDINGS: Controversy remains regarding the ideal medication regimen to manage pain after tonsillectomy. Acetaminophen and ibuprofen are routinely used, although concerns of more severe postoperative hemorrhage with ibuprofen remain. Narcotics are prescribed commonly, but with extreme caution in children with severe obstructive sleep apnea...
December 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/29023594/first-trimester-medication-abortion-practice-in-the-united-states-and-canada
#11
Heidi E Jones, Katharine O'Connell White, Wendy V Norman, Edith Guilbert, E Steve Lichtenberg, Maureen Paul
We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, n = 703) and Canada (n = 94) to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time of fielding, mifepristone was not approved in Canada. 383 (54.5%) US and 78 (83.0%) Canadian facilities participated...
2017: PloS One
https://www.readbyqxmd.com/read/28990210/the-impact-of-practice-guidelines-on-opioid-utilization-for-injured-workers
#12
Christine Buttorff, Antonio J Trujillo, Renan Castillo, Andres I Vecino-Ortiz, Gerard F Anderson
BACKGROUND: Opioid use is rising in the US and may cause special problems in workers compensation cases, including addiction and preventing a return to work after an injury. OBJECTIVE: This study evaluates a physician-level intervention to curb opioid usage. An insurer identified patients with out-of-guideline opioid utilization and called the prescribing physician to discuss the patient's treatment protocol. RESEARCH DESIGN: This study uses a differences-in-differences study design with a propensity-score-matched control group...
October 9, 2017: American Journal of Industrial Medicine
https://www.readbyqxmd.com/read/28968623/responsible-opioid-prescribing-for-chronic-pain-interpreting-the-cdc-guideline-understanding-new-rhode-island-regulations
#13
Alan L Gordon, Amy F Snyder
New Rhode Island regulations require physicians and other licensed practitioners to make significant adjustments to comply with new requirements for prescribing narcotics for chronic pain. Responding to the opioid epidemic, the new rules are intended to improve patient safety by changing physicians' prescribing patterns. However, the new rules may overlook the importance of treatment-access problems and the importance of buprenorphine products for treating pain and opioid dependence. Empirical data have demonstrated the safety and efficacy of buprenorphine in treating opioid-dependent patients with chronic pain, including those with and without substance abuse histories, but access to buprenorphine treatment remains limited throughout the state...
October 2, 2017: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/28955004/successful-treatment-of-mixed-mainly-cancer-pain-by-tramadol-preparations
#14
Shinji Kawahito, Tomohiro Soga, Naoji Mita, Shiho Satomi, Hiroyuki Kinoshita, Tomoko Arase, Akira Kondo, Hitoshi Miki, Kazumi Takaishi, Hiroshi Kitahata
The patient, a 70-year-old Japanese woman diagnosed with parotid gland cancer, underwent wide excision and reconstruction (facial nerve ablation, nerve transposition). At 1 month after the surgery, she was brought to our hospital's pain medicine department because her postoperative pain and cancer-related pain were poorly controlled. She had already been prescribed a tramadol (37.5 mg)/acetaminophen (325 mg) combination tablet (5 tablets/day). However, in addition to the continuous pain in her face and lower limbs, she was troubled by a trigeminal neuralgia-like prominence ache...
2017: Journal of Medical Investigation: JMI
https://www.readbyqxmd.com/read/28953194/guideline-recommended-vs-high-dose-long-term-opioid-therapy-for-chronic-noncancer-pain-is-associated-with-better-health-outcomes-data-from-a-representative-sample-of-the-german-population
#15
Winfried Häuser, Tino Schubert, Norbert Scherbaum, Thomas Tölle
Recent evidence-based guidelines for long-term opioid therapy (LTOT) for chronic noncancer pain (CNCP) have defined daily morphine equivalent doses (MEQ/d) that require particular caution. The recommendation for a threshold MEQ/d is based on North American studies that have demonstrated negative health outcomes associated with high-dose LTOT for CNCP. We have conducted a retrospective cross-sectional study using an anonymized German health claims database, including 4,028,618 persons insured by 69 German statutory health insurances, representative of age and sex for the German population in 2014...
October 31, 2017: Pain
https://www.readbyqxmd.com/read/28887020/narcotic-use-and-total-knee-arthroplasty
#16
Jourdan M Cancienne, Kishan J Patel, James A Browne, Brian C Werner
BACKGROUND: Although the United States is in the midst of a narcotic epidemic, risk factors for use and the impact of perioperative narcotic use on total knee arthroplasty (TKA) outcomes is ill-defined. METHODS: A national database was queried for patients who underwent primary TKA from 2007 to 2015. Patients taking narcotics in the preoperative, and for a prolonged period of time postoperatively, were identified. The risk factors for prolonged narcotic use were analyzed with a regression analysis, in addition to evaluating preoperative and prolonged postoperative use as independent risk factors for short-term and long-term complications...
August 17, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28862884/opioid-prescribing-patterns-by-obstetrics-and-gynecology-residents-in-the-united-states
#17
Adam D Baruch, Daniel McBurney Morgan, Vanessa K Dalton, Carolyn Swenson
BACKGROUND: Despite the opioid epidemic in the U.S., little data exist to guide postoperative opioid prescribing in Obstetrics & Gynecology (Ob/Gyn). OBJECTIVE: To describe Ob/Gyn resident opioid prescription patterns in the U.S. and assess influential factors. METHODS: An anonymous survey was emailed to Ob/Gyn residents in the U.S. between January-February 2015. Respondents reported the typical number of discharge narcotic tablets prescribed following six common procedures...
September 1, 2017: Substance Use & Misuse
https://www.readbyqxmd.com/read/28735156/adaptive-periodic-paralysis-allows-weaning-deep-sedation-overcoming-the-drowning-syndrome-in-ecmo-patients-bridged-for-lung-transplantation-a-case-series
#18
Irina Timofte, Michael Terrin, Erik Barr, June Kim, Joseph Rinaldi, Nicholas Ladikos, Jay Menaker, Ali Tabatabai, Zachary Kon, Bartley Griffith, Richard Pierson, Si Pham, Aldo Iacono, Daniel Herr
PURPOSE: Sedation in extracorporeal membrane oxygenation (ECMO) is challenging. Patients require deep sedation because of extremely high respiratory rates and increased work of breathing ("Drowning Syndrome") resulting in altered intra-thoracic pressure and reduced pump flow associated with hemodynamic compromise and decreased oxygenation. However, deep sedation impedes essential active rehabilitation with physical therapy. METHODS: We reviewed data on 3 ECMO patients for whom we used a novel approach to replace continuous drips with periodic sedation/paralysis...
December 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28705485/trainees-as-agents-of-change-in-the-opioid-epidemic-optimizing-the-opioid-prescription-practices-of-surgical-residents
#19
Alexander S Chiu, James M Healy, Michael P DeWane, Walter E Longo, Peter S Yoo
OBJECTIVE: Opioid abuse has become an epidemic in the United States, causing nearly 50,000 deaths a year. Postoperative pain is an unavoidable consequence of most surgery, and surgeons must balance the need for sufficient analgesia with the risks of overprescribing. Prescribing narcotics is often the responsibility of surgical residents, yet little is known about their opioid-prescribing habits, influences, and training experience. DESIGN: Anonymous online survey that assessed the amounts of postoperative opioid prescribed by residents, including type of analgesia, dosage, and number of pills, for a series of common general surgery procedures...
July 10, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28699380/addressing-the-barriers-related-with-opioid-therapy-for-management-of-chronic-pain-in-india
#20
Gur Prasad Dureja, Paramanand N Jain, Muralidhar Joshi, Ashok Saxena, Gautam Das, Jaishid Ahdal, Prashant Narang
India has a high prevalence of chronic disorders which may be associated with persistent pain. Despite the availability of multiple treatment options, chronic pain is largely untreated and contributes to disability and mortality. Medical consumption of opioids remains low due to various barriers that prevent access to opioids for patients and healthcare practitioners. Stringent regulatory provisions outlined in the Narcotic Drugs and Psychotropic Substances Act (1985) have been major deterrents to adequate opioid use...
July 2017: Pain Management
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