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Opioid dose ranges

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https://www.readbyqxmd.com/read/29661389/esketamine-counters-opioid-induced-respiratory-depression
#1
K Jonkman, E van Rijnsoever, E Olofsen, L Aarts, E Sarton, M van Velzen, M Niesters, A Dahan
BACKGROUND: Opioids can produce life-threatening respiratory depression. This study tested whether subanaesthetic doses of esketamine stimulate breathing in an established human model of opioid-induced respiratory depression. METHODS: In a study with a randomised, double blind, placebo controlled, crossover design, 12 healthy, young volunteers of either sex received a dose escalating infusion of esketamine (cumulative dose 40 mg infused in 1 h) on top of remifentanil-induced respiratory depression...
May 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29661386/association-between-intraoperative-opioid-administration-and-30-day-readmission-a-pre-specified-analysis-of-registry-data-from-a-healthcare-network-in-new-england
#2
D R Long, A L Lihn, S Friedrich, F T Scheffenbichler, K C Safavi, S M Burns, J C Schneider, S D Grabitz, T T Houle, M Eikermann
BACKGROUND: The use of intraoperative opioids may influence the rate of postoperative complications. This study evaluated the association between intraoperative opioid dose and the risk of 30-day hospital readmission. METHODS: We conducted a pre-specified analysis of existing registry data for 153 902 surgical cases performed under general anaesthesia at Massachusetts General Hospital and two affiliated medical centres. We examined the association between total intraoperative opioid dose (categorised in quintiles) and 30-day hospital readmission, controlling for several patient-, anaesthetist-, and case-specific factors...
May 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29630034/effective-dose-of-intravenous-dexmedetomidine-to-prolong-the-analgesic-duration-of-interscalene-brachial-plexus-block-a-single-center-prospective-double-blind-randomized-controlled-trial
#3
RyungA Kang, Ji Seon Jeong, Jae Chul Yoo, Ju Hyun Lee, Soo Joo Choi, Mi Sook Gwak, Tae Soo Hahm, Jin Huh, Justin Sangwook Ko
BACKGROUND AND OBJECTIVES: Intravenous (IV) dexmedetomidine (DEX) is reported to prolong the analgesic duration after single-shot interscalene brachial plexus block (ISBPB). However, the effective analgesic dose of IV DEX remains undetermined. Therefore, we aimed to elucidate the clinically relevant dose of IV DEX to prolong the analgesic duration of ISBPB. METHODS: Seventy-two patients scheduled for arthroscopic shoulder surgery received ISBPB with 15 mL of 0.5% ropivacaine with 1:200,000 epinephrine and were randomly assigned to 1 of 4 groups (n = 18, each): (1) IV normal saline (control), (2) IV DEX 0...
April 6, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29626650/rewarding-and-reinforcing-effects-of-4-chloro-2-5-dimethoxyamphetamine-and-ah-7921-in-rodents
#4
Hye Jin Cha, Seo Young Jeon, Hwa Jin Jang, Jisoon Shin, Young-Hoon Kim, Soo Kyung Suh
New psychoactive substances (NPSs), i.e., newly designed substances with chemical residues that are slightly different from those of known psychoactive substances, have been emerging since the late 2000s, and social problems related to the use of these substances are increasing globally. Two such NPSs are 4-chloro-2,5-dimethoxyamphetamine (DOC), a psychedelic substance that is structurally related to amphetamine, and AH-7921, an opioid analgesic that is used for recreational purposes and has a potency similar to that of morphine...
April 4, 2018: Neuroscience Letters
https://www.readbyqxmd.com/read/29626143/opioid-analgesia-on-the-battlefield-a-retrospective-review-of-data-from-operation-herrick
#5
Pip Lewis, C Wright, C Hooper
BACKGROUND: Acute pain secondary to trauma is commonly encountered on the battlefield. The use of morphine to manage pain during combat has been well established since the 19th century. Despite this, there is relatively little research on analgesia use in this environment. This study aims to review the use and complications of morphine and other opioids during Operation HERRICK. METHODS: A database search of the Joint Theatre Trauma Registry was completed looking for all incidences of morphine, fentanyl or naloxone use from February 2007 to September 2014...
April 6, 2018: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/29624535/comparison-of-intraoperative-sedation-with-dexmedetomidine-versus-propofol-on-acute-postoperative-pain-in-total-knee-arthroplasty-under-spinal-anesthesia-a-randomized-trial
#6
Hyun-Jung Shin, Sang-Hwan Do, Jae-Sung Lee, Tae-Kyun Kim, Hyo-Seok Na
BACKGROUND: In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with propofol. METHODS: Forty-eight patients were enrolled and randomly assigned to either a dexmedetomidine group (n = 24), which received a loading dose of 1 μg/kg dexmedetomidine over 10 minutes, followed by a continuous infusion of 0...
April 5, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29560596/review-of-case-narratives-from-fatal-overdoses-associated-with-injectable-naltrexone-for-opioid-dependence
#7
Roxanne Saucier, Daniel Wolfe, Nabarun Dasgupta
INTRODUCTION: An extended-release injectable naltrexone suspension (Vivitrol® ) was approved in USA in 2010 for the prevention of relapse to opioid dependence. Concerns, raised at the time of approval, about rebound overdose risk following the last dose, have not been adequately studied. We sought to determine the time period of concern for fatal overdose associated with Vivitrol. METHODS: We performed a retrospective case review of Vivitrol spontaneous reports (October 2010-March 2016) in the US Food and Drug Administration Adverse Event Reporting System via the Freedom of Information Act...
March 20, 2018: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
https://www.readbyqxmd.com/read/29535156/opioid-dose-and-route-dependent-efficacy-of-oxycodone-and-heroin-vaccines-in-rats
#8
Michael D Raleigh, Megan Laudenbach, Federico Baruffaldi, Samantha J Peterson, Michaela J Roslawski, Angela K Birnbaum, Frank I Carroll, Scott P Runyon, Scott Winston, Paul R Pentel, Marco Pravetoni
Heroin and oxycodone abuse occurs over a wide range of drug doses and by various routes of administration characterized by differing rates of drug absorption. The current study addressed the efficacy of a heroin vaccine (M-KLH) or oxycodone vaccine (OXY-KLH) for reducing drug distribution to brain after i.v. heroin or oxycodone, or s.c. oxycodone. Rats immunized with M-KLH or KLH control received an i.v. bolus dose of 0.26 or 2.6 mg/kg heroin. Vaccination with M-KLH increased retention of heroin and its active metabolites 6-acetylmorphine (6-AM) and morphine in plasma compared to KLH controls, and reduced total opioid (heroin + 6-AM + morphine) distribution to brain but only at the lower heroin dose...
March 13, 2018: Journal of Pharmacology and Experimental Therapeutics
https://www.readbyqxmd.com/read/29521421/the-pharmacokinetics-and-analgesic-effects-of-extended-release-buprenorphine-administered-subcutaneously-in-healthy-dogs
#9
M Barletta, S M Ostenkamp, A C Taylor, J Quandt, B D X Lascelles, K M Messenger
Buprenorphine is a partial μ agonist opioid used for analgesia in dogs. An extended-release formulation (ER-buprenorphine) has been shown to provide effective analgesia for 72 hr in rats and mice. Six healthy mongrel dogs were enrolled in a randomized, blinded crossover design to describe and compare the pharmacokinetics and pharmacodynamics of ER-buprenorphine administered subcutaneous at 0.2 mg/kg (ER-B) and commercially available buprenorphine for injection intravenously at 0.02 mg/kg (IV-B). After drug administration, serial blood samples were collected to measure plasma buprenorphine concentrations using liquid chromatography/mass spectrometry detection...
March 9, 2018: Journal of Veterinary Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29514333/buprenorphine-maintenance-subjects-are-hyperalgesic-and-have-no-antinociceptive-response-to-a-very-high-morphine-dose
#10
Peter Athanasos, Walter Ling, Felix Bochner, Jason M White, Andrew A Somogyi
Objective: Acute pain management in opioid-dependent persons is complicated because of tolerance and opioid-induced hyperalgesia. Very high doses of morphine are ineffective in overcoming opioid-induced hyperalgesia and providing antinociception to methadone-maintained patients in an experimental setting. Whether the same occurs in buprenorphine-maintained subjects is unknown. Design: Randomized double-blind placebo-controlled. Subjects were tested on two occasions, at least five days apart, once with intravenous morphine and once with intravenous saline...
March 5, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29509558/transferring-patients-from-methadone-to-buprenorphine-the-feasibility-and-evaluation-of-practice-guidelines
#11
Nicholas Lintzeris, Lauren A Monds, Consuelo Rivas, Stefanie Leung, Adrian Dunlop, David Newcombe, Carina Walters, Susanna Galea, Nancy White, Mark Montebello, Apo Demirkol, Nicola Swanson, Robert Ali
INTRODUCTION AND AIMS: Transfer from methadone to buprenorphine is problematic for many opioid-dependent patients, with limited documented evidence or practical clinical guidance, particularly for the range of methadone doses routinely prescribed for most patients (>50 mg). This study aimed to implement and evaluate recent national Australian guidelines for transferring patients from methadone to buprenorphine. DESIGN AND METHODS: A multisite prospective cohort study...
March 5, 2018: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/29505772/effect-of-ibuprofen-versus-acetaminophen-on-postpartum-hypertension-in-preeclampsia-with-severe-features-a-double-masked-randomized-controlled-trial
#12
Nathan R Blue, Cristina Murray-Krezan, Shana Drake-Lavelle, Daniel Weinberg, Bradley D Holbrook, Vivek R Katukuri, Lawrence Leeman, Ellen L Mozurkewich
BACKGROUND: Non-steroidal anti-inflammatory drug use has been shown to increase blood pressure in non-pregnant adults. Because of this, the American College of Obstetricians and Gynecologists suggests avoiding their use in women with postpartum hypertension; however, evidence to support this recommendation is lacking. OBJECTIVES: Our goal was to test the hypothesis that non-steroidal anti-inflammatory drugs, such as ibuprofen, adversely affect postpartum blood pressure control in women with preeclampsia with severe features...
March 2, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29476778/changes-in-brain-oxygen-and-glucose-induced-by-oxycodone-relationships-with-brain-temperature-and-peripheral-vascular-tone
#13
Ernesto Solis, Anum Afzal, Eugene A Kiyatkin
Oxycodone is a semi-synthetic opioid drug that is used to alleviate acute and chronic pain. However, oxycodone is often abused and, when taken at high doses, can induce powerful CNS depression that manifests in respiratory abnormalities, hypotension, coma, and death. Here, we employed several measurement techniques to examine the effects of intravenous oxycodone at a wide range of doses on various metabolism-related parameters in awake, freely-moving rats. High-speed amperometry was used to assess how oxycodone affects oxygen and glucose levels in the nucleus accumbens (NAc)...
February 21, 2018: Neuropharmacology
https://www.readbyqxmd.com/read/29472863/%C3%AE-2-adrenergic-receptor-activation-suppresses-the-rat-phenethylamine-hallucinogen-induced-head-twitch-response-hallucinogen-induced-excitatory-post-synaptic-potentials-as-a-potential-substrate
#14
Gerard J Marek, Brian P Ramos
5-Hydroxytryptamine2A (5-HT2A ) receptors are enriched in layers I and Va of the rat prefrontal cortex and neocortex and their activation increases the frequency of glutamatergic excitatory post-synaptic potentials/currents (EPSP/Cs) onto layer V pyramidal cells. A number of other G-protein coupled receptors (GPCRs) are also enriched in cortical layers I and Va and either induce (α1 -adrenergic and orexin2 ) or suppress (metabotropic glutamate2 [mGlu2 ], adenosine A1 , μ-opioid) both 5-HT-induced EPSCs and head twitches or head shakes induced by the phenethylamine hallucinogen 2,5-dimethoxy-4-iodoamphetamine (DOI)...
2018: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/29460670/opioid-prescribing-patterns-among-otolaryngologists
#15
Marissa A Schwartz, James G Naples, Chia-Ling Kuo, Todd E Falcone
Objectives To evaluate national trends in opioid prescribing patterns by otolaryngologists for postoperative pain control after common otolaryngologic procedures. Study Design Cross-sectional; survey. Subjects and Methods A survey to determine opioid prescribing patterns for the treatment of postoperative pain following common otolaryngologic procedures was distributed to all members of the American Academy of Otolaryngology-Head and Neck Surgery. Results The most common pain medication prescribed for adults postoperatively was hydrocodone-acetaminophen (73%), followed by oxycodone-acetaminophen (39%)...
February 1, 2018: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29440926/local-anesthetics-for-brain-tumor-resection-current-perspectives
#16
REVIEW
Jan-Willem Potters, Markus Klimek
This review summarizes the added value of local anesthetics in patients undergoing craniotomy for brain tumor resection, which is a procedure that is carried out frequently in neurosurgical practice. The procedure can be carried out under general anesthesia, sedation with local anesthesia or under local anesthesia only. Literature shows a large variation in the postoperative pain intensity ranging from no postoperative analgesia requirement in two-thirds of the patients up to a rate of 96% of the patients suffering from severe postoperative pain...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/29416859/applying-realistic-medicine-to-intrathecal-opioid-utilisation-in-scotland-do-we-have-a-standardised-approach
#17
Robert Hart, Gordon Burns, Susan Smith
Intrathecal opioids (ITOs) are commonly administered as part of a multimodal anaesthetic strategy for a variety of surgical procedures. The evolution of laparoscopic surgical techniques has seen the popularity of ITOs increase as they are effective, well tolerated and lack the cardiovascular side effects associated with epidural infusions. The risk of delayed respiratory depression remains a concern; therefore, high-quality post-operative monitoring is vital. The evidence regarding the practicalities of ITO administration such as opioid dose, type, side effect prevalence and ideal post-operative care arrangements are sparse...
February 2018: British Journal of Pain
https://www.readbyqxmd.com/read/29412458/oliceridine-trv130-a-novel-g-protein-biased-ligand-at-the-%C3%AE-opioid-receptor-demonstrates-a-predictable-relationship-between-plasma-concentrations-and-pain-relief-i-development-of-a-pharmacokinetic-pharmacodynamic-model
#18
Michael J Fossler, Brian M Sadler, Colm Farrell, David A Burt, Maria Pitsiu, Franck Skobieranda, David G Soergel
Conventional opioids bind to μ-opioid receptors and activate 2 downstream signaling pathways: G-protein coupling, linked to analgesia, and β-arrestin recruitment, linked to opioid-related adverse effects and limiting efficacy. Oliceridine (TRV130) is a novel G protein-biased ligand at the μ-opioid receptor that differentially activates G-protein coupling while mitigating β-arrestin recruitment. Using data derived from both phase 1 studies in healthy volunteers as well as data from a phase 2 study examining the efficacy of oliceridine for the treatment of postbunionectomy pain, we have developed a population pharmacokinetic/pharmacodynamic model linking the pharmacokinetics of oliceridine to its effect on pain, as measured by the Numeric Pain Rating Scale score...
February 7, 2018: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29402712/patients-at-risk-preoperative-opioid-use-affects-opioid-prescribing-refills-and-outcomes-after-total-knee-arthroplasty
#19
Nicholas M Hernandez, Joshua A Parry, Tad M Mabry, Michael J Taunton
BACKGROUND: The purpose of this study was to evaluate the effect of preoperative opioid use on opioid prescriptions, refills, and clinical outcomes after total knee arthroplasty (TKA). METHODS: A retrospective review identified 53 patients on preoperative opioids who were matched 1:2 to 106 opioid-naive patients undergoing primary TKA with at least 2-year follow-up. Opioid refills, Knee Society Score (preoperative and follow-up), morphine equivalent dose (MED) prescribed, and persistent opioid use were compared between groups...
January 16, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29392214/the-opioid-epidemic-and-national-guidelines-for-opioid-therapy-for-chronic-noncancer-pain-a-perspective-from-different-continents
#20
Winfried Häuser, Stephan Schug, Andrea D Furlan
Introduction: A marked rise in opioid prescriptions for patients with chronic noncancer pain (CNCP) with a parallel increase in opioid abuse/misuse, and resulting deaths was noted in the Unites states in the past decade (opioid epidemic). In response, the US Center of Diseases Control (CDC) developed a guideline for prescribing of opioids for patients with CNCP. Objectives: To assess (1) if there is an opioid epidemic in Australia, Canada, and Germany (2) to compare Australian, Canadian, German, and Center of Diseases Control guidelines recommendations for long-term opioid therapy for CNCP...
May 2017: Pain Reports (Baltimore, Md.)
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