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Opioid dosing

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https://www.readbyqxmd.com/read/28542675/analgesic-effects-of-intravenous-acetaminophen-vs-placebo-for-endoscopic-sinus-surgery-and-postoperative-pain-a-randomized-clinical-trial
#1
Matthew A Tyler, Kent Lam, Faramarz Ashoori, Chunyan Cai, Joshua J Kain, Samer Fakhri, Martin J Citardi, Davide Cattano, Amber Luong
Importance: Intravenous acetaminophen is a commonly prescribed analgesic for the prevention and treatment of postsurgical pain. Its efficacy in the context of endoscopic sinus surgery (ESS) has yielded mixed results. Objective: To compare the efficacy of perioperative intravenous acetaminophen (IVAPAP) with that of placebo in improving early postoperative pain after endoscopic sinus surgery (ESS). Design, Setting, and Participants: A prospective, randomized clinical trial including 62 patients undergoing ESS for chronic rhinosinusitis in a single tertiary referral hospital...
May 25, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28541119/treatment-of-opioid-use-disorder-with-ibogaine-detoxification-and-drug-use-outcomes
#2
Thomas Kingsley Brown, Kenneth Alper
BACKGROUND: Ibogaine is a monoterpene indole alkaloid used in medical and nonmedical settings for the treatment of opioid use disorder. Its mechanism of action is apparently novel. There are no published prospective studies of drug use outcomes with ibogaine. OBJECTIVES: To study outcomes following opioid detoxification with ibogaine. METHODS: In this observational study, 30 subjects with DSM-IV Opioid Dependence (25 males, 5 females) received a mean total dose of 1,540 ± 920 mg ibogaine HCl...
May 25, 2017: American Journal of Drug and Alcohol Abuse
https://www.readbyqxmd.com/read/28540195/conversion-from-prolonged-intravenous-fentanyl-infusion-to-enteral-methadone-in-critically-ill-children
#3
Vijay Srinivasan, Daniel Pung, Sean P O'Neill
AIM: To describe our institutional experience with conversion from intravenous (IV) fentanyl infusion directly to enteral methadone and occurrence of withdrawal in critically ill mechanically ventilated children exposed to prolonged sedation and analgesia. METHODS: With Institutional Review Board approval, we retrospectively studied consecutively admitted invasively mechanically ventilated children (0-18 years) sedated with IV fentanyl infusion > 5 d and subsequently converted directly to enteral methadone...
May 8, 2017: World Journal of Clinical Pediatrics
https://www.readbyqxmd.com/read/28538457/patterns-of-opioid-prescribing-for-an-orthopaedic-trauma-population
#4
John Ruder, Meghan K Wally, McKell Oliverio, Rachel B Seymour, Joseph R Hsu
OBJECTIVES: To determine opioid-prescribing practices to the orthopaedic trauma (OT) population at one Level I trauma center. DESIGN: A retrospective study of discharge prescriptions for adult patients with OT. Prescription details, injury burden, and patient demographics were abstracted for patients from initial injury through a 2-month follow-up. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Adult patients with OT admitted over a 30-day period (n = 110)...
June 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28537773/a-new-generation-of-comfort-care-order-sets-aligning-protocols-with-current-principles
#5
Melissa A Bender, Caroline Hurd, Nicole Solvang, Kathy Colagrossi, Diane Matsuwaka, J Randall Curtis
BACKGROUND: There are few published comfort care order sets for end-of-life symptom management, contributing to variability in treatment of common symptoms. At our academic medical centers, we have observed that rapid titration of opioid infusions using our original comfort care order set's titration algorithm causes increased discomfort from opioid toxicity. OBJECTIVE: The aim of this study was to describe the process and outcomes of a multiyear revision of a standardized comfort care order set for clinicians to treat end-of-life symptoms in hospitalized patients...
May 24, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28536865/the-c-2-derivatives-of-salvinorin-a-ethoxymethyl-ether-sal-b-and-%C3%AE-tetrahydropyran-sal-b-have-anti-cocaine-properties-with-minimal-side-effects
#6
Amy W M Ewald, Peter J Bosch, Aimee Culverhouse, Rachel Saylor Crowley, Benjamin Neuenswander, Thomas E Prisinzano, Bronwyn M Kivell
RATIONALE: Kappa-opioid receptor (KOPr) agonists have pre-clinical anti-cocaine and analgesic effects. However, side effects including sedation, dysphoria, aversion, anxiety and depression limit their therapeutic development. The unique structure of salvinorin A has been used to develop longer acting KOPr agonists. OBJECTIVES: We evaluate two novel C-2 analogues of salvinorin A, ethoxymethyl ether Sal B (EOM Sal B) and β-tetrahydropyran Sal B (β-THP Sal B) alongside U50,488 for their ability to modulate cocaine-induced behaviours and side effects, pre-clinically...
May 23, 2017: Psychopharmacology
https://www.readbyqxmd.com/read/28535569/reinstituting-the-bolus-new-reasoning-for-an-existing-technique
#7
Porter W McRoberts, Jason E Pope, Catalina Apostol
Improved intrathecal (IT) pump technology is increasing the accuracy of IT opioid bolus dosing and promising advances in pain therapy. Opioid bolus dosing can be used with a minimal continuous infusion or it can function as the sole therapy. Bolus-only dosing is characterized by minimal use of opioid (often less than 1 mg of IT morphine). It achieves adequate pain control while reducing tolerance and possibly opioid-induced hyperalgesia. It may prevent receptor saturation, and provide a "washing out" of the opioid receptor that prevents the observed dose escalation resulting from continuous infusions...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28535455/the-effectiveness-of-telemedicine-delivered-opioid-agonist-therapy-in-a-supervised-clinical-setting
#8
Joseph K Eibl, Graham Gauthier, David Pellegrini, Jeffery Daiter, Michael Varenbut, John C Hogenbirk, David C Marsh
OBJECTIVE: Opioid use disorder has been declared a public health crisis across North America and opioid agonist therapy (OAT) is the standard of care for these patients. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not yet been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT. METHODS: We conducted a non-randomized cohort comparison study using an administrative database for patients who commenced OAT between 2011 and 2012 across 58 clinic sites in the province of Ontario, Canada...
May 17, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28535454/frequency-and-severity-of-non-fatal-opioid-overdoses-among-clients-attending-the-sydney-medically-supervised-injecting-centre
#9
Amanda Roxburgh, Shane Darke, Allison M Salmon, Timothy Dobbins, Marianne Jauncey
BACKGROUND: Pharmaceutical opioid overdose rates have increased in recent years. The current study aimed to compare rates per 1000 injections of non-fatal overdose after heroin or oxycodone injection, and their comparative clinical severity. METHODS: Analysis of prospectively collected data from the Sydney Medically Supervised Injecting Centre (MSIC). Severity of overdose was measured using the Glasgow Coma Scale, oxygen saturation levels, and the administration of naloxone...
May 17, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28535115/use-of-naloxone-nasal-spray-4%C3%A2-mg-in-the-community-setting-a-survey-of-use-by-community-organizations
#10
George K Avetian, Phillip Fiuty, Silvana Mazzella, Dave Koppa, Vivian Heye, Pratibha Hebbar
OBJECTIVE: Naloxone hydrochloride, an opioid antagonist, has been approved as a concentrated 4-mg dose intranasal formulation for the emergency treatment of known or suspected opioid overdose. This new formulation is easier to use and contains a higher dose of naloxone compared with earlier, unapproved kits. A survey of first responders and community-based organizations was conducted to understand initial real-world experiences with this new formulation for opioid overdose reversal. METHODS: In August 2016, 152 US organizations known to have received units of the approved 4-mg dose/unit naloxone nasal spray (NARCAN® Nasal Spray 4 mg [NNS]; Adapt Pharma, Inc...
May 23, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28533997/metoclopramide-for-acute-migraine-treatment-in-the-emergency-department-an-effective-alternative-to-opioids
#11
REVIEW
Mejdi Najjar, Tyler Hall, Blanca Estupinan
In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings...
April 20, 2017: Curēus
https://www.readbyqxmd.com/read/28532487/degree-of-dyspnoea-at-admission-and-discharge-in-patients-with-heart-failure-and-respiratory-diseases
#12
Lourdes Vicent, Juan Manuel Nuñez Olarte, Luis Puente-Maestu, Alicia Oliva, Juan Carlos López, Andrea Postigo, Irene Martín, Raquel Luna, Francisco Fernández-Avilés, Manuel Martínez-Sellés
BACKGROUND: Dyspnoea is a disabling symptom in patients admitted with heart failure (HF) and respiratory diseases (RD). The main aim of this study is to evaluate its intensity at admission and discharge and the relation with quality of life. We also describe its management, intensity, and evolution in HF and RD. METHODS: In this descriptive, cross-sectional study, we included prospectively all patients admitted with decompensated HF and chronic obstructive pulmonary disease (COPD)/pulmonary fibrosis during 4 months...
May 22, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28530786/morphine-for-chronic-neuropathic-pain-in-adults
#13
REVIEW
Tess E Cooper, Junqiao Chen, Philip J Wiffen, Sheena Derry, Daniel B Carr, Dominic Aldington, Peter Cole, R Andrew Moore
BACKGROUND: Neuropathic pain, which is caused by a lesion or disease affecting the somatosensory system, may be central or peripheral in origin. Neuropathic pain often includes symptoms such as burning or shooting sensations, abnormal sensitivity to normally painless stimuli, or an increased sensitivity to normally painful stimuli. Neuropathic pain is a common symptom in many diseases of the nervous system. Opioid drugs, including morphine, are commonly used to treat neuropathic pain...
May 22, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28529359/the-journey-of-opioid-substitution-therapy-in-india-achievements-and-challenges
#14
Ravindra Rao
Opioids are one of the most problematic illegal substances globally. Opioid abuse is associated with complications in various spheres of the user's life, his/her family, and the society. Injecting drug use (IDU) is also linked to public health problems such as HIV infection and viral hepatitis. Medications form an important cornerstone in the treatment of opioid dependence. Treatment strategies such as "detoxification" alone or long-term treatment with opioid antagonist have limited acceptability and retention rates...
January 2017: Indian Journal of Psychiatry
https://www.readbyqxmd.com/read/28527421/a-phase-iii-randomized-multi-center-double-blind-placebo-controlled-study-of-safety-and-efficacy-of-lofexidine-for-relief-of-symptoms-in-individuals-undergoing-inpatient-opioid-withdrawal
#15
Charles W Gorodetzky, Sharon L Walsh, Peter R Martin, Andrew J Saxon, Kristen L Gullo, Kousick Biswas
BACKGROUND: Lofexidine is an alpha-2-adrenergic receptor agonist approved in the United Kingdom (UK) for the treatment of opioid withdrawal symptoms. Lofexidine has demonstrated better efficacy than placebo for reducing opioid withdrawal symptoms in patients undergoing opioid withdrawal with less reported hypotension than clonidine. METHODS: Designed as an FDA registration trial, this 8-day, randomized, double-blind, placebo-controlled, parallel-group study in 264 patients dependent on short-acting opioids evaluated the efficacy of lofexidine hydrochloride in reducing withdrawal symptoms in patients undergoing opioid withdrawal...
May 10, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28526150/pharmacogenomics-in-pain-management
#16
REVIEW
Ramsey Saba, Alan D Kaye, Richard D Urman
There is interpatient variability to analgesic administration. Much can be traced to pharmacogenomics variations between individuals. Certain ethnicities are more prone to reduced function of CYP2D6. Weak opioids are subject to interpatient variation based on their CYP2D6 type. Strong opioids have variations based on their transport and individual metabolism. Several cytochrome enzymes have been found to be involved with ketamine but there is no strong evidence of individual polymorphisms manifesting in clinical outcomes...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28525632/effect-of-baseline-characteristics-on-the-pain-response-to-pregabalin-in-fibromyalgia-patients-with-comorbid-depression
#17
Stuart L Silverman, Miroslav Backonja, Lynne Pauer, Jaren Landen, Pritha Bhadra Brown, Joseph M Scavone, Richard Vissing, Andrew Clair
Objective. : To evaluate the effect of baseline characteristics on the treatment response to pregabalin in fibromyalgia (FM) patients with depression. Design. : Post hoc analysis from a randomized, double-blind, placebo-controlled, two-way crossover study of pregabalin (300 or 450 mg/day, twice daily). Subjects. : A total of 193 FM patients taking an antidepressant for comorbid depression. Methods. : The effect of patient baseline characteristics on the treatment response to pregabalin vs placebo was assessed for the primary efficacy end point (mean pain score on an 11-point numeric rating scale)...
May 19, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28525512/parecoxib-supplementation-to-morphine-analgesia-decreases-incidence-of-delirium-in-elderly-patients-after-hip-or-knee-replacement-surgery-a-randomized-controlled-trial
#18
Dong-Liang Mu, Da-Zhi Zhang, Dong-Xin Wang, Geng Wang, Chun-Jing Li, Zhao-Ting Meng, Ya-Wei Li, Chao Liu, Xue-Ying Li
BACKGROUND: Severe pain and high-dose opioids are both associated with increased risk of postoperative delirium. The authors investigated whether parecoxib-supplemented IV morphine analgesia could decrease the incidence of delirium in elderly patients after total hip or knee replacement surgery. METHODS: In a randomized, double-blind, 2-center trial, patients of 60 years or older who underwent elective total hip or knee replacement surgery were assigned in a 1:1 ratio to receive either parecoxib (40 mg at the end of surgery and then every 12 hours for 3 days) or placebo (normal saline)...
June 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28524907/breakthrough-cancer-pain-a-systematic-review-of-pharmacologic-management%C3%A2
#19
Jeannine M Brant, Barbara B Rodgers, Eva Gallagher, Thiruppavai Sundaramurthi
BACKGROUND: Breakthrough cancer pain (BtCP), defined as a transient exacerbation of pain that occurs in conjunction with well-controlled background pain, is a common and burdensome problem in patients with cancer.
. OBJECTIVES: The aim of this systematic review is to identify evidence-based pharmacologic modalities for adequate management of BtCP. 
. METHODS: PubMed and CINAHL® databases were searched to identify literature regarding pharmacologic strategies for BtCP published from January 2006 to June 2016...
June 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28523735/variability-in-prescription-opioid-intake-and-reinforcement-amongst-129-substrains
#20
Susan M Jimenez, Aiden F Healy, Michal A Coelho, Chelsea N Brown, Tod E Kippin, Karen K Szumlinski
Opioid abuse in the United States has reached epidemic proportions, with treatment admissions and deaths associated with prescription opioid abuse quadrupling over the past 10 years. Although genetics are theorized to contribute substantially to inter-individual variability in the development, severity, and treatment outcomes of opioid abuse/addiction, little direct preclinical study has focused on the behavioral genetics of prescription opioid reinforcement and drug-taking. Herein, we employed different 129 substrains of mice currently available from The Jackson Laboratory (129S1/SvlmJ, 129X1/SvJ, 129S4/SvJaeJ and 129P3/J) as a model system of genetic variation and assayed mice for oral opioid intake and reinforcement, as well as behavioral and somatic signs of dependence...
May 19, 2017: Genes, Brain, and Behavior
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