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https://www.readbyqxmd.com/read/29680809/impact-of-dexmedetomidine-infusion-during-general-anaesthesia-on-incidence-of-postoperative-delirium-in-elderly-patients-after-major-non-cardiac-surgery-study-protocol-of-a-randomised-double-blinded-and-placebo-controlled-trial
#1
Bo-Jie Wang, Chun-Jing Li, Jian Hu, Huai-Jin Li, Chao Guo, Zhen-Han Wang, Qiao-Chu Zhang, Dong-Liang Mu, Dong-Xin Wang
INTRODUCTION: Delirium is a common complication in the elderly after surgery and is associated with worse outcomes. Multiple risk factors are related with postoperative delirium, such as exposure to general anaesthetics, pain and postoperative inflammatory response. Preclinical and clinical studies have shown that dexmedetomidine attenuated neurotoxicity induced by general anaesthetics, improved postoperative analgesia and inhibited inflammatory response after surgery. Several studies found that intraoperative use of dexmedetomidine can prevent postoperative delirium, but data were inconsistent...
April 21, 2018: BMJ Open
https://www.readbyqxmd.com/read/29680509/opioids-delay-healing-of-spinal-fusion-a-rabbit-posterolateral-lumbar-fusion-model
#2
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/29680426/willis-ekbom-disease-restless-legs-syndrome-in-patients-with-opioid-withdrawal
#3
Ravi Gupta, Ramjan Ali, Rajat Ray
INTRODUCTION: Many patients with opioid use disorder report symptoms similar to restless legs syndrome (RLS) during withdrawal. However, whether these symptoms are true RLS, their predictors and effect of treatment with pregabalin are still unknown. METHOD: A total of 19 consecutive patients with opioid use disorder who were admitted for detoxification were included in this study after obtaining informed consent. Information regarding addiction was noted, and they were screened for RLS every morning and evening...
May 2018: Sleep Medicine
https://www.readbyqxmd.com/read/29680003/the-comparative-effectiveness-of-quadratus-lumborum-blocks-and-paravertebral-blocks-in-radical-cystectomy-patients
#4
Austin J Lee, Jonathan G Yabes, Nathan Hale, Ronald L Hrebinko, Jeffrey R Gingrich, Jodi K Maranchie, Mina M Fam, Robert M Turner I I, Benjamin J Davies, Bruce Ben-David, Bruce L Jacobs
INTRODUCTION: Multimodal analgesia is an effective way to control pain and limit opioid use after surgery. The quadratus lumborum block and paravertebral block are two regional anesthesia techniques that leverage multimodal analgesia to improve postoperative pain control. We sought to compare the efficacy of these blocks for pain management following radical cystectomy. MATERIALS AND METHODS: We performed a retrospective review of radical cystectomy patients who received bilateral continuous paravertebral blocks (n = 125) or bilateral single shot quadratus lumborum blocks (n = 50) between 2014-2016...
April 2018: Canadian Journal of Urology
https://www.readbyqxmd.com/read/29679881/ventrolateral-orbital-cortex-oxytocin-attenuates-neuropathic-pain-through-periaqueductal-gray-opioid-receptor
#5
Mina Taati, Esmaeal Tamaddonfard
BACKGROUND: Oxytocin plays an important role in supraspinal modulation of pain. In the present study, we investigated the effects of ventrolateral orbital cortex (VLOC) microinjection of oxytocin on neuropathic pain after blockade of opioid receptors in this area and ventrolateral periaqueductal gray (vlPAG). METHODS: Neuropathic pain was induced by complete transcection of preoneal and tibial branches of sciatic nerve. The VLOC and vlPAG were unilaterally (contralateral to the sciatic nerve-injured side) and bilaterally implanted with guide cannulas, respectively...
December 21, 2017: Pharmacological Reports: PR
https://www.readbyqxmd.com/read/29679681/inhibition-of-protein-kinase-a-and-girk-channel-reverses-fentanyl-induced-respiratory-depression
#6
Xiaonan Liang, Zheng Yong, Ruibin Su
Opioid-induced respiratory depression is a major obstacle to improving the clinical management of moderate to severe chronic pain. Opioids inhibit neuronal activity via various pathways, including calcium channels, adenylyl cyclase, and potassium channels. Currently, the underlying molecular pathway of opioid-induced respiratory depression is only partially understood. This study aimed to investigate the mechanisms of opioid-induced respiratory depression in vivo by examining the effects of different pharmacological agents on fentanyl-induced respiratory depression...
April 18, 2018: Neuroscience Letters
https://www.readbyqxmd.com/read/29679440/effects-of-a-prior-authorization-policy-for-extended-release-long-acting-opioids-on-utilization-and-outcomes-in-a-state-medicaid-program
#7
Shellie L Keast, Hyunjee Kim, Richard A Deyo, Luke Middleton, K John McConnell, Kun Zhang, Sharia M Ahmed, Nancy Nesser, Daniel M Hartung
BACKGROUND AND AIMS: In response to the opioid overdose epidemic, USA state Medicaid programs have adopted restrictive policies for opioid analgesics, yet effects on prescribing patterns and health outcomes are uncertain. This study aimed to examine effects of a prior authorization policy for extended-release/long-acting (ER/LA) opioids on opioid use in the Oklahoma, USA state Medicaid program. DESIGN: Retrospective difference-in-differences design study comparing changes in opioid use in Oklahoma Medicaid to control (Oregon Medicaid)...
April 20, 2018: Addiction
https://www.readbyqxmd.com/read/29678969/reducing-the-default-dispense-quantity-for-new-opioid-analgesic-prescriptions-study-protocol-for-a-cluster-randomised-controlled-trial
#8
Marcus A Bachhuber, Denis Nash, William N Southern, Moonseong Heo, Matthew Berger, Mark Schepis, Chinazo O Cunningham
INTRODUCTION: As opioid analgesic consumption has grown, so have opioid use disorder and opioid-related overdoses. Reducing the quantity of opioid analgesics prescribed for acute non-cancer pain can potentially reduce risks to the individual receiving the prescription and to others who might unintentionally or intentionally consume any leftover tablets. Reducing the default dispense quantity for new opioid analgesic prescriptions in the electronic health record (EHR) is a promising intervention to reduce prescribing...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29678564/prescription-medication-use-among-community-based-us-adults-with-chronic-low-back-pain-a-cross-sectional-population-based-study
#9
Anna Shmagel, Linh Ngo, Kristine Ensrud, Robert Foley
Many classes of medications have been evaluated in chronic low back pain (cLBP), however their utilization in the community remains unclear. We examine patterns of prescription medication use among Americans with cLBP in a nationally representative, community-based sample. The Back Pain Survey was administered to a representative sample of US adults aged 20-69 (N = 5103) during the 2009-2010 cycle of the National Health and Nutrition Examination Survey (NHANES). cLBP was defined as self-reported pain in the area between the lower posterior margin of the ribcage and the horizontal gluteal fold on most days for at least 3 months (N = 700)...
April 17, 2018: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/29678158/dexmedetomidine-infusion-as-an-analgesic-adjuvant-during-laparoscopic-%C3%B1-holecystectomy-a-randomized-controlled-study
#10
Kateryna Bielka, Iurii Kuchyn, Volodymyr Babych, Kseniia Martycshenko, Oleksii Inozemtsev
BACKGROUND: Dexmedetomidine (DEX) has sedative, sympatholytic and analgesic effects and might be beneficial if used as an adjuvant to: improve analgesia; modulate haemodynamic responses to intubation and pneumoperitoneum and; reduce the number of opioid-associated adverse events. The aim of this study was to evaluate the efficacy and safety of DEX infusion during elective laparoscopic cholecystectomy (LC). METHODS: A randomized, single-centre, parallel-group, placebo-controlled study was carried out between May 2016 and June 2017...
April 20, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29677442/synthesis-and-pharmacological-evaluation-of-novel-c-8-substituted-tetrahydroquinolines-as-balanced-affinity-mu-delta-opioid-ligands-for-the-treatment-of-pain
#11
Anthony F Nastase, Nicholas W Griggs, Jessica P Anand, Thomas J Fernandez, Aubrie A Harland, Tyler J Trask, Emily M Jutkiewicz, John R Traynor, Henry I Mosberg
The use of opioids for the treatment of pain, while largely effective, is limited by detrimental side effects including analgesic tolerance, physical dependence, and euphoria, which may lead to opioid abuse. Studies have shown that compounds with a -opioid receptor (MOR) agonist/-opioid receptor (DOR) antagonist profile reduce or eliminate some of these side effects including development of tolerance and dependence. Herein we report the synthesis and pharmacological evaluation of a series of tetrahydroquinoline-based peptidomimetics with substitutions at the C-8 position...
April 20, 2018: ACS Chemical Neuroscience
https://www.readbyqxmd.com/read/29677062/opioid-oversupply-after-joint-and-spine-surgery-a-prospective-cohort-study
#12
Mark C Bicket, Elizabeth White, Peter J Pronovost, Christopher L Wu, Myron Yaster, G Caleb Alexander
BACKGROUND: Many patients receive prescription opioids at hospital discharge after surgery, yet little is known regarding how often these opioids go unused. We estimated the prevalence of unused opioids, use of nonopioid analgesics, and storage and disposal practices after same-day and inpatient surgery. METHODS: In this prospective cohort study at a large, inner-city tertiary care hospital, we recruited individuals ≥18 years of age undergoing elective same-day or inpatient joint and spine surgery from August to November 2016...
April 17, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29677019/mu-opioid-receptors-in-nociceptive-afferents-produce-a-sustained-suppression-of-hyperalgesia-in-chronic-pain
#13
Amie Severino, Wenling Chen, Joshua K Hakimian, Brigitte L Kieffer, Claire Gaveriaux-Ruff, Wendy Walwyn, Juan Carlos Marvizon
The latent sensitization model of chronic pain reveals that recovery from some types of long-term hyperalgesia is an altered state in which nociceptive sensitization persists but is suppressed by the ongoing activity of analgesic receptors such as µ-opioid receptors (MORs). To determine whether these MORs are the ones present in nociceptive afferents, we bred mice expressing Cre-recombinase under the Nav1.8 channel promoter (Nav1.8cre) with MOR-floxed mice (flMOR). These Nav1.8cre/flMOR mice had reduced MOR expression in primary afferents, as revealed by quantitative PCR, in situ hybridization and immunofluorescence colocalization with the neuropeptide CGRP...
April 17, 2018: Pain
https://www.readbyqxmd.com/read/29677001/impact-of-intravenous-acetaminophen-on-perioperative-opioid-utilization-and-outcomes-in-open-colectomies-a-claims-database-analysis
#14
Isaac Wasserman, Jashvant Poeran, Nicole Zubizarreta, Jason Babby, Stelian Serban, Andrew T Goldberg, Alexander J Greenstein, Stavros G Memtsoudis, Madhu Mazumdar, Andrew B Leibowitz
BACKGROUND: The value of intravenous acetaminophen in postoperative pain management remains debated. The authors tested the hypothesis that intravenous acetaminophen use, in isolation and in comparison to oral, would be associated with decreased opioid utilization (clinically significant reduction defined as 25%) and opioid-related adverse effects in open colectomy patients. METHODS: Using national claims data from open colectomy patients (Premier Healthcare Database, Premier Healthcare Solutions, Inc...
April 20, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29676223/opiate-free-tricuspid-valve-replacement-case-report
#15
Jeffrey P Cardinale, George Gilly
The utility of opioid pain medications for perioperative analgesia is well described. However, opioids have many dangerous side effects including respiratory depression, acute tolerance, hyperalgesia, and chronic opioid dependence. Multimodal approaches continue to be used in more invasive and complex surgical procedures for enhanced recovery and decreased postoperative complications from opioid administration. The current case report centers on a 30-year-old male recovering from opioid addiction presenting with severe tricuspid regurgitation scheduled to undergo a tricuspid valve replacement...
April 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29676050/part-2-current-prescribing-trends-of-dental-non-antibacterial-medicines-in-australia-from-2013-to-2016
#16
L Teoh, K Stewart, R J Marino, M J McCullough
BACKGROUND: There is limited literature regarding dental prescribing preferences for medicines other than antibiotics. This study aimed to describe the prescribing trends of dispensed prescription medicines by dentists in Australia from 2013 and 2016 and assess adherence to current guidelines. METHODS: Data was accessed from the Department of Health of all dental prescriptions dispensed under the Pharmaceutical Benefits Scheme (PBS) from 2013 to 2016 and prescribing patterns were analysed...
April 19, 2018: Australian Dental Journal
https://www.readbyqxmd.com/read/29675943/relationship-of-anxiety-with-joint-pain-and-its-management-a-population-survey
#17
Lauren A Barnett, Mark G Pritchard, John J Edwards, Ebenezer K Afolabi, Kelvin P Jordan, Emma L Healey, Andrew G Finney, Carolyn A Chew-Graham, Christian D Mallen, Krysia S Dziedzic
OBJECTIVES: The aims of the present study was to examine the associations between the severity of pain and anxiety in a community population reporting joint pain, and to investigate the management of joint pain in the presence of comorbid anxiety. METHODS: A population survey was carried out of people aged ≥45 years, registered with eight general practices in Cheshire, Shropshire and Staffordshire, UK. Respondents were asked to report pain intensity in their hands, hips, knees and feet (on a numerical rating scale), anxiety symptoms (Generalized Anxiety Disorder seven-item [GAD-7] scale) and guideline-recommended treatments used to manage pain...
April 20, 2018: Musculoskeletal Care
https://www.readbyqxmd.com/read/29675893/characteristics-of-opioid-maintained-clients-smoking-fentanyl-patches-the-importance-of-confirmatory-drug-analysis-illustrated-by-a-case-series-and-mini-review
#18
Andreas Kimergård, Jacklyn Dunne, Anette Bøgen, Peter Hindersson, Torben Breindahl
The increase in opioid prescribing in many European countries over the last decade has raised concerns about associated diversion, overdose and mortality. Fentanyl is one of these synthetic opioids that is typically prescribed as a transdermal patch for pain that requires continuous pain relief and has been the focus of investigations due to reports of overdose and death. We report a case series of 14 drug addiction treatment entrants who entered treatment in one service located in the region of Southern Denmark from August 2015 to December 2015 for smoking fentanyl patches...
April 19, 2018: Drug Testing and Analysis
https://www.readbyqxmd.com/read/29675582/multifunctional-opioid-ligands
#19
Jessica P Anand, Deanna Montgomery
The opioid receptor system plays a major role in the regulation of mood, reward, and pain. The opioid receptors therefore make attractive targets for the treatment of many different conditions, including pain, depression, and addiction. However, stimulation or blockade of any one opioid receptor type often leads to on-target adverse effects that limit the clinical utility of a selective opioid agonist or antagonist. Literature precedent suggests that the opioid receptors do not act in isolation and that interactions among the opioid receptors and between the opioid receptors and other proteins may produce clinically useful targets...
April 20, 2018: Handbook of Experimental Pharmacology
https://www.readbyqxmd.com/read/29675049/administration-of-intravenous-morphine-for-acute-pain-in-the-emergency-department-inflicts-an-economic-burden-in-europe
#20
Montserrat Casamayor, Karen DiDonato, Marc Hennebert, Luca Brazzi, Gregor Prosen
Background: Acute pain is among the leading causes of referral to the emergency department (ED) in industrialized countries. Its management mainly depends on intensity. Moderate-to-severe pain is treated with intravenous (IV) administered opioids, of which morphine is the most commonly used in the ED. We have estimated the burden of IV administration of morphine in the five key European countries (EU5) using a micro-costing approach. Scope: A structured literature review was conducted to identify clinical guidelines for acute pain management in EU5 and clinical studies conducted in the ED setting...
2018: Drugs in Context
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