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Opioid dosing guidelines

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https://www.readbyqxmd.com/read/29777388/a-retrospective-study-of-opioid-prescribing-patterns-at-hospital-discharge-in-surgical-patients-with-obstructive-sleep-apnea
#1
Samir M Kendale, Jing Wang, Jeanna D Blitz, Steven Calvino, Germaine Cuff, Nicholas Barone, Andrew D Rosenberg, Lisa Doan
PURPOSE: Obstructive sleep apnea (OSA) is a risk factor for complications with postoperative opioid use, and in those patients with known or suspected OSA, minimization of postoperative opioids is recommended. We hypothesize that despite these recommendations, surgical patients with known or suspected OSA are prescribed postoperative opioids at hospital discharge at similar doses to those without OSA. METHODS: This was a retrospective analysis of the electronic health records of surgical patients from 1 November 2016 to 30 April 2017 at a single academic institution...
May 18, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29756393/opioid-prescribing-practices-in-patients-undergoing-surgery-for-oral-cavity-cancer
#2
John Pang, Kathryn R Tringale, Viridiana J Tapia, Bharat A Panuganti, Jesse R Qualliotine, Aria Jafari, Sunny J Haft, Lawrence S Friedman, Timothy Furnish, Kevin T Brumund, Joseph A Califano, Charles S Coffey
OBJECTIVES: Opioids have been overprescribed after general and orthopedic surgeries, but prescribing patterns have not been reported for head and neck surgery. The objectives of this retrospective review are to describe postoperative opioid prescriptions after oral cancer surgery and determine which patients receive higher amounts. METHODS: A single institution retrospective review was performed for 81 adults with oral cavity tumors undergoing surgery. Opioid prescriptions upon discharge were reported in daily oral morphine equivalents (OME)...
May 14, 2018: Laryngoscope
https://www.readbyqxmd.com/read/29754987/a-statewide-effort-to-reduce-high-dose-opioid-prescribing-through-coordinated-care-organizations
#3
Daniel M Hartung, Lindsey Alley, Gillian Leichtling, P Todd Korthuis, Christi Hildebran
BACKGROUND: Oregon's Medicaid program is delivered through 16 Coordinated Care Organizations (CCOs) participating in a statewide performance improvement program to reduce high-dose opioid prescribing. CCOs were allowed flexibility to develop their own dose targets and any policies, trainings, guidelines, and/or materials to meet these targets. In this study, we characterize CCO strategies to reduce high-dose opioid prescribing across the 16 CCOs. METHODS: We reviewed relevant CCO documents and conducted semi-structured interviews with CCO administrators to acquire opioid-related policies, practices, timelines and contextual factors...
May 1, 2018: Addictive Behaviors
https://www.readbyqxmd.com/read/29742789/-case-report-opioid-therapy-for-chronic-low-back-pain
#4
Alexander Schnabel, Roland Haaga, Heike L Rittner
Within this case report we describe and discuss the treatment of a patient with chronic low back pain complaining about severe pain, reduced functionality and symptoms of depression, who was treated with long-term opioids (480 mg morphine equivalents). According to the recommendation of current guidelines we successfully reduced the opioid daily dose and discharged the patient with 28 mg morphine equivalents, improved physical functionality and reduced chronic pain intensity following a specific interdisciplinary pain rehabilitation programme for seniors...
April 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29733096/does-familiarity-with-cdc-guidelines-continuing-education-and-provider-characteristics-influence-adherence-to-chronic-pain-management-practices-and-opioid-prescribing
#5
Jean C McCalmont, Kim D Jones, Robert M Bennett, Ronald Friend
OBJECTIVES: (1) To assess providers' experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers' utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations. METHODS: A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (≥11) hours of training...
March 2018: Journal of Opioid Management
https://www.readbyqxmd.com/read/29719401/a-restrictive-dose-of-crystalloids-in-patients-during-laparoscopic-cholecystectomy-is-safe-and-cost-effective-prospective-two-arm-parallel-randomized-controlled-trial
#6
Matija Belavić, Vlatka Sotošek Tokmadžić, Antonija Brozović Krijan, Ines Kvaternik, Kristina Matijaš, Nedjeljko Strikić, Josip Žunić
Purpose: There are no evidence-based guidelines for volume replacement during surgical procedures such as laparoscopic cholecystectomy. However, the administration of a restrictive volume of crystalloids could be more cost-effective and safe. This trial aimed to determine the effectiveness and safety of a restrictive regimen of crystalloids in patients during laparoscopic cholecystectomy by analyzing its cost-effectiveness and 1-year morbidity rate. Patients and methods: In this randomized, prospective study, patients were assigned to one of three groups based on the volume of fluid administered: the restrictive group received 1 mL/kg/hr, the low liberal group received 5 mL/kg/hr, and the high liberal group received 15 mL/kg/hr of Ringer's solution intraoperatively...
2018: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29692634/chronic-pain-during-pregnancy-a-review-of-the-literature
#7
REVIEW
Shona L Ray-Griffith, Michael P Wendel, Zachary N Stowe, Everett F Magann
Background and purpose: The majority of the reviews and studies on chronic pain in pregnancy have primarily focused on the pharmacological and non-pharmacological treatment options. The purpose of our review was to identify evidence-based clinical research for the evaluation and management of preexisting chronic pain in pregnancy, chronic pain associated with pregnancy, and chronic pain in relation to mode of delivery. Methods: A literature search was undertaken using the search engines PubMed, CINAHL, EBSCOhost, and Web of Science...
2018: International Journal of Women's Health
https://www.readbyqxmd.com/read/29676050/part-2-current-prescribing-trends-of-dental-non-antibacterial-medicines-in-australia-from-2013-to-2016
#8
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/29674340/opioid-analgesics-and-adverse-outcomes-among-hemodialysis-patients
#9
Julie H Ishida, Charles E McCulloch, Michael A Steinman, Barbara A Grimes, Kirsten L Johansen
BACKGROUND AND OBJECTIVES: Patients on hemodialysis frequently experience pain and may be particularly vulnerable to opioid-related complications. However, data evaluating the risks of opioid use in patients on hemodialysis are limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, we conducted a cohort study evaluating the association between opioid use (modeled as a time-varying exposure and expressed in standardized oral morphine equivalents) and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011...
April 19, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29644468/-pharmacological-treatment-of-osteoarthritis-related-pain
#10
REVIEW
T A Nees, M Schiltenwolf
Joint pain due to osteoarthritis (OA) is often severe and disabling and affects a large proportion of the aging population impairing daily living and quality of life. Numerous pharmacological treatment approaches are available. Including major OA guidelines this review presents the current evidence of pharmacological therapies in OA-related pain and covers topical, oral and intraarticular treatment approaches. In patients with mild OA topical nonsteroidal antiinflammatory drugs (NSAIDs) can be recommended...
April 11, 2018: Der Schmerz
https://www.readbyqxmd.com/read/29624188/safe-opioid-prescribing-for-acute-noncancer-pain-in-hospitalized-adults-a-systematic-review-of-existing-guidelines
#11
Shoshana J Herzig, Susan L Calcaterra, Hilary J Mosher, Matthew V Ronan, Nicole Van Groningen, Lili Shek, Anthony Loffredo, Michelle Keller, Anupam B Jena, Teryl K Nuckols
BACKGROUND: Pain is common among hospitalized patients. Inpatient prescribing of opioids is not without risk. Acute pain management guidelines could inform safe prescribing of opioids in the hospital and limit associated unintended consequences. PURPOSE: To evaluate the quality and content of existing guidelines for acute, noncancer pain management. DATA SOURCES: The National Guideline Clearinghouse, MEDLINE via PubMed, websites of relevant specialty societies and other organizations, and selected international search engines...
April 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29595631/the-efficacy-of-dexamethasone-on-pain-and-recovery-after-total-hip-arthroplasty-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#12
REVIEW
Zheng-Rui Fan, Jianxiong Ma, Xin-Long Ma, Ying Wang, Lei Sun, Yan Wang, Ben-Chao Dong
BACKGROUND: Total hip arthroplasty (THA) perioperative dexamethasone treatment is still a controversial subject. We write this systematic review and meta-analysis to evaluate the efficacy of dexamethasone on pain and recovery after THA. METHODS: Two researchers searched the relevant studies from Pubmed, Cochrane, and Embase. The research was reported according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Randomized controlled trials (RCTs) were included in our meta-analysis...
March 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29563006/opioid-rotation-in-cancer-pain-treatment
#13
Michael Schuster, Oliver Bayer, Florian Heid, Rita Laufenberg-Feldmann
BACKGROUND: Rotating several different WHO level III opioid drugs is a therapeutic option for patients with chronic cancer-related pain who suffer from inadequate analgesia and/or intolerable side effects. The evidence favoring opioid rotation is controversial, and the current guidelines in Germany and other countries contain only weak recommendations for it. METHODS: This review is based on pertinent publications retrieved by a systematic review of the literature on opioid rotation for adult patients with chronic cancerrelated pain who are regularly taking WHO level III opioids by the oral or trans - dermal route...
March 2, 2018: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/29542370/role-of-primary-care-physicians-in-intrathecal-pain-management-a-narrative-review-of-the-literature
#14
Gladstone C McDowell, Joseph Winchell
OBJECTIVES: The majority of patients seeking medical care for chronic pain consult a primary care physician (PCP). Because systemic opioids are commonly prescribed to patients with chronic pain, PCPs are attempting to balance the competing priorities of providing adequate pain relief while reducing risks for opioid misuse and overdose. It is important for PCPs to be aware of pain management strategies other than systemic opioid dose escalation when patients with chronic pain fail to respond to conservative therapies and to initiate a multimodal treatment plan...
March 28, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29509558/transferring-patients-from-methadone-to-buprenorphine-the-feasibility-and-evaluation-of-practice-guidelines
#15
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/29505669/multicentre-emergency-department-study-found-that-paracetamol-and-ibuprofen-were-inappropriately-used-in-83-and-63-of-paediatric-cases
#16
Franca Benini, Emanuele Castagno, Egidio Barbi, Sabrina Congedi, Antonio Urbino, Paolo Biban, Lucia Calistri, Rossella Letizia Mancusi
AIM: The Pain Practice in Italian Paediatric Emergency Departments assessed how appropriately analgesic drugs were being used by Italian clinicians, based on national paediatric pain guidelines. METHODS: This was a retrospective study that involved 17 Italian members of the Pain In Pediatric Emergency Rooms group. It comprised patients up to the age of 14 years who came to hospital emergency departments with pain and were treated with paracetamol, ibuprofen or opioids, such as codeine, tramadol and morphine...
March 5, 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29505419/depression-effects-on-long-term-prescription-opioid-use-abuse-and-addiction
#17
Mark Sullivan
OBJECTIVES: Treatment guidelines discourage long-term opioid treatment for patients with chronic pain and major depression, but this treatment occurs commonly, producing higher daily doses, longer duration, and more adverse events. METHODS: Review of prospective cohort, retrospective cohort, and other observational studies of the relation between depression and opioid use, abuse, and addiction. RESULTS: Depressed patients initiate opioid therapy slightly more often than non-depressed patients, but are twice as likely to transition to long-term use...
March 2, 2018: Clinical Journal of Pain
https://www.readbyqxmd.com/read/29490325/suboptimal-opioid-prescribing-a-practice-change-project
#18
Linda S Young, Robert S Crausman, John P Fulton
In the U.S. in 2015, the proportion of people dependent on opioids approached one percent, and opioid overdose rivaled auto accidents as the leading cause of accidental death. The literature suggests a credible link between increased opioid prescribing and increased opioid addiction. Accordingly, some have suggested that limiting the number of opioid prescriptions (and the number of doses per prescription) might be effective in reducing the number of opioid-related deaths. Toward this end, we designed and piloted an evidence-based quality-improvement project in four urgent care clinics...
March 1, 2018: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/29481989/the-efficacy-of-dexamethasone-reducing-postoperative-pain-and-emesis-after-total-knee-arthroplasty-a-systematic-review-and-meta-analysis
#19
REVIEW
Zhengrui Fan, Jianxiong Ma, Mingjie Kuang, Lukai Zhang, Biao Han, Baocheng Yang, Ying Wang, Xinlong Ma
BACKGROUND: Total knee arthroplasty (TKA) is gradually emerging as the treatment of choice for end-stage osteoarthritis. In the past, Perioperative dexamethasone treatment is still a controversial subject in total knee arthroplasty. Therefore, we write this systematic review and meta-analysis to evaluate the efficacy of dexamethasone on pain and recovery after Total knee Arthroplasty. MATERIALS AND METHODS: Embase, Pubmed, and Cochrane Library were comprehensively searched...
April 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29467148/controlling-postoperative-use-of-i-v-acetaminophen-at-an-academic-medical-center
#20
William R Vincent, Paul Huiras, Jennifer Empfield, Kevin J Horbowicz, Keith Lewis, David McAneny, David Twitchell
PURPOSE: Results of an interprofessional formulary initiative to decrease postoperative prescribing of i.v. acetaminophen are reported. SUMMARY: After a medical center added i.v. acetaminophen to its formulary, increased prescribing of the i.v. formulation and a 3-fold price increase resulted in monthly spending of more than $40,000, prompting an organizationwide effort to curtail that cost while maintaining effective pain management. The surgery, anesthesia, and pharmacy departments applied the Institute for Healthcare Improvement's Model for Improvement to implement (1) pharmacist-led enforcement of prescribing restrictions, (2) retrospective evaluation of i...
April 15, 2018: American Journal of Health-system Pharmacy: AJHP
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