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R Brent Dixon, Amitava Dasgupta
BACKGROUND: We evaluated the analytical performance of the DRI hydrocodone/hydromorphone assay by comparing semi-quantitative values obtained by this assay with values obtained by a liquid chromatography combined with tandem mass spectrometry (LC-MS/MS) method. We also evaluated the possibility of lowering the cutoff of the DRI assay from 300 to 100 ng/mL. MATERIALS AND METHODS: We compared semi-quantitative values obtained by the DRI assay in 97 specimens with values obtained by using the LC-MS/MS method including 10 specimens containing hydrocodone and/ or hydromorphone concentrations between 105...
October 19, 2016: Therapeutic Drug Monitoring
Julie M Waldfogel, Suzanne Nesbit, Steven P Cohen, Sydney M Dy
Opioids remain the mainstay of treatment for severe cancer pain, but up to 20% of patients have persistent or refractory pain despite rapid and aggressive opioid titration, or develop refractory pain after long-term opioid use. In these scenarios, alternative agents and mechanisms for analgesia should be considered. This case report describes a 28-year-old man with metastatic pancreatic neuroendocrine cancer with severe, intractable pain despite high-dose opioids including methadone and a hydromorphone patient-controlled analgesia (PCA)...
October 18, 2016: Journal of Pain & Palliative Care Pharmacotherapy
Katherine Moore, Rachel Haroz
BACKGROUND: Intractable bone pain is a notorious adverse effect of granulocyte-colony stimulating factors (G-CSFs), such as pegfilgrastim and filgrastim, which are given to help prevent neutropenia in patients who are undergoing chemotherapy. G-CSF-induced bone pain is surprisingly common and often refractory to treatment with conventional analgesics. CASE REPORT: This article describes an emergency department case of opiate and nonsteroidal anti-inflammatory drug-resistant pegfilgrastim-induced bone pain that was successfully alleviated with 10 mg of oral loratadine, allowing for discharge home...
October 14, 2016: Journal of Emergency Medicine
Yan J Bao, Wei Hou, Xiang Y Kong, Liping Yang, Jun Xia, Bao J Hua, Roger Knaggs
BACKGROUND: Cancer pain is an important and distressing symptom that tends to increase in frequency and intensity as the cancer advances. For people with advanced cancer, the prevalence of pain can be as high as 90%. It has been estimated that 30% to 50% of people with cancer categorise their pain as moderate to severe, with between 75% and 90% of people with cancer experiencing pain that they describe as having a major impact on their daily life. Epidemiological studies suggest that approximately 15% of people with cancer pain fail to experience acceptable pain relief with conventional management...
October 11, 2016: Cochrane Database of Systematic Reviews
Bruno H Pypendop, Yael Shilo-Benjamini, Jan E Ilkiw
OBJECTIVE: To determine the effects of morphine, methadone, hydromorphone or oxymorphone on the thermal threshold in cats, following buccal and intravenous (IV) administration. STUDY DESIGN: Randomized crossover study. ANIMALS: Six healthy adult female ovariohysterectomized cats weighing 4.5 ± 0.4 kg. METHODS: Morphine sulfate (0.2 mg kg(-1) IV or 0.5 mg kg(-1) buccal), methadone hydrochloride (0.3 mg kg(-1) IV or 0...
November 2016: Veterinary Anaesthesia and Analgesia
Andrew W Gorlin, David M Rosenfeld, Jillian Maloney, Christopher S Wie, Johnathan McGarvey, Terrence L Trentman
The conversion of high-dose intravenous (IV) opioids to an equianalgesic epidural (EP) or intrathecal (IT) dose is a common clinical dilemma for which there is little evidence to guide practice. Expert opinion varies, though a 100 IV:10:EP:1 IT conversion ratio is commonly cited in the literature, especially for morphine. In this study, the authors surveyed 724 pain specialists to elucidate the ratios that respondents apply to convert high-dose IV morphine, hydromorphone, and fentanyl to both EP and IT routes...
2016: Journal of Pain Research
Pongkwan Sitasuwan, Cathleen Melendez, Margarita Marinova, Kaylee R Mastrianni, Alicia Darragh, Emily Ryan, L Andrew Lee
Drug monitoring laboratories utilize a hydrolysis process to liberate the opiates from their glucuronide conjugates to facilitate their detection by tandem mass spectrometry (MS). Both acid and enzyme hydrolysis have been reported as viable methods, with the former as a more effective process for recovering codeine-6-glucuronide and morphine-6-glucuronide. Here, we report concerns with acid-catalyzed hydrolysis of opioids, including a significant loss of analytes and conversions of oxycodone to oxymorphone, hydrocodone to hydromorphone and codeine to morphine...
October 2016: Journal of Analytical Toxicology
Lukas Rycek, John J Hayward, Marwa Abdel Latif, James Tanko, Razvan Simionescu, Tomas Hudlicky
A 2nd generation approach to the synthesis of hydromorphone by oxidative dearomatization/Diels-Alder cycloaddition was investigated. Detailed analysis of the stereochemical outcome of the [4+2] cycloaddition was performed first on a truncated model system as well as on the material leading to ent-hydromorphone. The stereochemical assignments were made by NMR and X-ray methods. The 2nd generation synthesis of hydromorphone was completed in both enantiomeric series. Improvements in the dearomatization conditions were attained by using hypervalent iodine reagents instead of Pb(OAc)4...
September 30, 2016: Journal of Organic Chemistry
Jin Hee Ahn, Hyun Joo Ahn
STUDY OBJECTIVE: We investigated whether thoracic epidural analgesia (TEA) shortens the first gas-out time compared to intravenous patient-controlled analgesia (iv-PCA) and promotes earlier discharge after major upper abdominal surgery. DESIGN: Prospective observational study. SETTING: A tertiary care university hospital. PATIENTS: Fifty-six patients undergoing major upper abdominal surgery. INTERVENTIONS: TEA (n=28) was performed using a paramedian approach at T6-7 or T7-8...
November 2016: Journal of Clinical Anesthesia
G C Lynde
BACKGROUND: Morphine is the most common opioid injected into the intrathecal space for postoperative analgesia following cesarean delivery, but ongoing medication shortages have resulted in limited availability. One proposed morphine alternative is hydromorphone. Studies investigating its use in post-cesarean analgesia are limited. This study was conducted to determine the median effective dose of intrathecal hydromorphone 12h postpartum. METHODS: Twenty healthy women undergoing elective cesarean delivery were recruited into this study...
July 16, 2016: International Journal of Obstetric Anesthesia
Sausan El Burai Félix, Karin A Mack, Christopher M Jones
OBJECTIVE: Limited information has been published about opioid prescribing practices in Puerto Rico. The objective of this study was to create baseline trends of opioids distributed over a period of fourteen years in Puerto Rico. METHODS: We examined data from the U.S. Drug Enforcement Administration's Automation of Reports and Consolidated Orders System (ARCOS) for the period 1999-2013. ARCOS data reflects the amount of controlled substances legally dispensed. Analyses include the distribution of opioids (in morphine milligram equivalent kg per 10,000 persons) by year and entity (pharmacy, hospital, practitioner)...
September 2016: Puerto Rico Health Sciences Journal
Allan W Belcher, Ashish K Khanna, Steve Leung, Amanda J Naylor, Matthew T Hutcherson, Bianka M Nguyen, Natalya Makarova, Daniel I Sessler, P J Devereaux, Leif Saager
BACKGROUND: Opioids can contribute to postoperative desaturation. Short-acting opioids, titrated to need, may cause less desaturation than longer-acting opioids. We thus tested the primary hypothesis that long-acting patient-controlled intravenous opioids are associated with more hypoxemia (defined as an integrated area under a postoperative oxyhemoglobin saturation of 95%) than short-acting opioids. METHODS: This analysis was a substudy of VISION, a prospective cohort study focused on perioperative cardiovascular events (NCT00512109)...
September 7, 2016: Anesthesia and Analgesia
Renata Nascimento, Alphonse Poklis, Carl E Wolf
A new Hydrocodone Enzyme Immunoassay (HEIA; Lin-Zhi International, Inc.) was evaluated for the detection of hydrocodone and its main metabolite, hydromorphone. All specimens were tested with two different cutoff calibrators, 100 and 300 ng/mL, on an ARCHITECT Plus c4000 Clinical Chemistry Analyzer. Controls containing -25% (negative control) and +25% (positive control) of the cutoff calibrators and a drug-free control were analyzed with each batch. All 1,025 urine specimens were previously analyzed by ultra-performance liquid chromatography-mass spectrometry/mass spectrometry (UPLC-MS-MS) for opiates...
October 2016: Journal of Analytical Toxicology
Scott Masson, Matthew Villerot, Bhavinkumar Dalal
Hydromorphone, unlike other opioids associated with histamine release, has never been reported to cause angioedema. We report a rare case of hydromorphone-induced angioedema in a 34-year-old woman with history of deep venous thrombosis and pulmonary embolism who presented with leg swelling and pain after trauma. Hydromorphone was administered with subsequent rapid development of stridor and edematous changes of the tongue, uvula, and surrounding mucosa. The difficult airway response team was activated, and the airway was secured by emergent awake fiberoptic intubation in the operating room...
August 22, 2016: A & A Case Reports
Rachel A Knudson, Paul W Dunlavy, Jan Franko, Shankar R Raman, Soren R Kraemer
BACKGROUND: Prior industry conducted studies have shown that long acting liposomal bupivacaine injection improves pain control postoperatively. OBJECTIVE: To evaluate whether liposomal bupivacaine reduced the use of postoperative opioid ( pain medication as compared to standard bupivacaine following colorectal surgery. DESIGN: A double blinded, prospective, randomized controlled trial comparing liposomal bupivacaine versus standard bupivacaine in patients undergoing elective colon resection...
September 2016: Diseases of the Colon and Rectum
I Elias Veizi, Salim M Hayek, Michael Hanes, Ryan Galica, Sivakanth Katta, Tony Yaksh
BACKGROUND: Intrathecal drug delivery therapy has been used effectively in treating patients with intractable chronic pain. The development of an intrathecal catheter tip granuloma (ICTG) related to delivery of intrathecal opiates is a relatively infrequent, but potentially devastating complication. While there are many morphine-related ICTG cases described, reports of hydromorphone-related ICTG are limited. In addition, studies suggest a strong correlation between the use of higher doses and concentrations of intrathecal opiates and ICTG formation...
October 2016: Neuromodulation: Journal of the International Neuromodulation Society
Justin L Poklis, Amanda J Mohs, Carl E Wolf, Alphonse Poklis, Michelle R Peace
In healthcare settings drug diversion and impairment of physicians are major concerns requiring a rapid and efficient method for surveillance and detection. A Direct Analysis in Real Time ion source coupled to a JEOL AccuTOF(TM) time-of-flight mass spectrometer (DART-MS) method was developed to screen parenteral pharmaceutical formulations for potential drug diversion. Parenteral pharmaceutical formulations are also known as injectable formulations and are used with intravenous, subcutaneous, intramuscular and intra-articular administration...
October 2016: Journal of Analytical Toxicology
Astrid W Oosten, Maja Matic, Ron H van Schaik, Maxime P Look, Joost L Jongen, Ron H Mathijssen, Carin C van der Rijt
AIM: To identify clinical and genetic factors associated with outcome of opioid treatment. PATIENTS & METHODS: We performed an exploratory analysis in a cohort of 353 patients treated with fentanyl, morphine, oxycodone and/or hydromorphone for cancer-related pain, exploring selected clinical and pharmacogenetic factors for a correlation with treatment failure for all and per type of opioid. RESULTS: Use of adjuvant pain medication, intensity of pain at rest and age were associated with treatment failure in the various cohorts...
August 2016: Pharmacogenomics
Eunjung Oh, Hyun Joo Ahn, Woo Seog Sim, Jin Young Lee
BACKGROUND: An intravenous form of ibuprofen has recently been approved by the Food and Drug Administration (FDA) and reports are rare on its co-administration with opioids. OBJECTIVES: We researched whether an intravenous ibuprofen-hydromorphone combination is synergistic, additive, or infra-additive on postoperative pain. STUDY DESIGN: A parallel-group, 1:1:1 allocation, randomized, double-blind controlled trial. SETTING: University teaching hospital in Korea...
July 2016: Pain Physician
Naama Levy-Cooperman, Kerri A Schoedel, Joseph L Reiz, David Thompson, Bijan Chakaraborty, Pierre Geoffroy, Kenneth J Michalko
OBJECTIVE: To assess the reduction in intravenous (IV) abuse potential of hydromorphone from different dose ratio combinations with naloxone in opioid-dependent drug users. DESIGN: Randomized, blinded, dose ratio escalation study. SETTING: Single center. PARTICIPANTS: Following conversion to a stable IV dose of hydromorphone, 12 non-treatment-seeking, opioid-dependent subjects were randomly assigned and received at least one dose of study drug; seven subjects received all five study treatments...
May 2016: Journal of Opioid Management
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