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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
Adrian Groh, Kirsten Jahn, Alexandra Burkert, Alexandra Neyazi, Laura Schares, Eva Janke, Marie Rehme, Rilana Schuster, Thomas Hillemacher, Stefan Bleich, Helge Frieling, Annemarie Heberlein
AIMS: The nerve growth factor (NGF) and the vascular endothelial growth factor-A (VEGF-A) may be of importance for psychiatric diseases including substance use disorders. The aim of the study was to identify differences in the regulation of both neuropeptides via the DNA-methylation status of the promotor regions of NGF and VEGF-A in different forms of maintenance therapy for opioid dependence and the related stress regulation via the hypothalamic-pituitary-adrenal axis. METHODS: We compared methylation levels of opioid-dependent patients receiving treatment with diamorphine (n = 28) or levomethadone (n = 54) and similar levels in a healthy control group (n = 72)...
2017: European Addiction Research
Ahmed Halawa, Stephen Rowe, Fleur Roberts, Chidambaram Nathan, Ahmed Hassan, Avneesh Kumar, Branislav Suvakov, Ben Edwards, Cavin Gray
OBJECTIVES: Our aim was to apply the principles of enhanced recovery in renal transplant recipients and to assess the changes in the quality of patient care and patient satisfaction. MATERIALS AND METHODS: Our study included 286 consecutive renal transplant patients. Of these, 135 patients went through the enhanced recovery program and 151 patients had traditional recovery. Patient education and discharge planning were commenced on admission. For enhanced recovery, prolonged preoperative fasting was avoided by carbohydrate loading...
August 24, 2017: Experimental and Clinical Transplantation
Kristian Jansen, Dagny F Haugen, Lisa Pont, Sabine Ruths
CONTEXT: Dying patients commonly experience potentially distressing symptoms. Palliative care guidelines recommend opioids, anticholinergics, antipsychotics, and benzodiazepines for symptom relief. OBJECTIVES: The objective of this study was to systematically review the effectiveness and safety of palliative drug treatment in the last days of life of adult patients, focusing on the management of pain, dyspnea, anxiety, restlessness, and death rattle. METHODS: A systematic search of the literature was published before December 2016 in PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Cochrane, ClinicalTrials...
February 2018: Journal of Pain and Symptom Management
James Bell, Rob van der Waal, John Strang
BACKGROUND: Six recent randomised control trials (RCTs) have suggested that supervised injectable heroin (SIH) can be effective in patients who persist in street heroin use during methadone treatment. However, short-term randomised control trials have limitations in assessing the effectiveness of treatments for addictive disorders, which are chronic and relapsing disorders of motivation. These RCTs particularly fail to capture the process of the SIH treatment and the diversity of influence and change over time...
July 2017: Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
Daniela Krause, Diana Plörer, Gabriele Koller, Gabi Martin, Catja Winter, Roland Adam, Minavere Canolli, Jori Al-Iassin, Rainer Musselmann, Stephan Walcher, Frank Schäfer, Oliver Pogarell
BACKGROUND: Concomitant opioid misuse is an increasing problem in opioid maintenance treatment as it interferes with treatment success. OBJECTIVE: Therefore, the rates of concomitant fentanyl misuse in opioid maintained patients were investigated. METHODS: We conducted a cross-sectional study which consisted in collecting data via urine samples and questionnaires in Germany. Urine samples of patients on opioid maintenance treatment were gathered and fentanyl concentrations were measured from 2008 to 2012...
April 16, 2017: Substance Use & Misuse
Michael David, Elizabeth Arthur, Raveena Dhuck, Ellie Hemmings, David Dunlop
BACKGROUND: Postoperative urinary retention (POUR) occurs frequently following hip replacement. METHODS: 94 consecutive primary hip arthroplasty patients were assessed prospectively for POUR. 80 patients followed our anaesthesia protocol with combined general and spinal anaesthesia using bupivacaine and intrathecal diamorphine. RESULTS: 29 instances of POUR with higher rates in men and younger patients (under-50s), independent of either pre-existing renal impairment or opiate strength...
December 2015: Journal of Orthopaedics
Mandy Roy, Stefan Bleich, Thomas Hillemacher
After a long lead time the substitution with diamorphine was taken into the German catalogue of statutory health insurance in 2010. Currently about 570 patients are treated this way in 9 ambulances in Germany. The study phase as well as the clinical practice are showing the success of this therapy concerning physical and mental health of patients and their circumstances of social life. Thereby substitution with diamorphine is underlying very strict admission criteria regarding patients on the one hand and particular organizational requirements of the medical institution on the other hand...
March 2016: Fortschritte der Neurologie-Psychiatrie
S Handley, M X Patel, R J Flanagan
CONTEXT: Use of second generation antipsychotics in England and Wales has increased in recent years whilst prescription of first generation antipsychotics has decreased. METHODS: To evaluate the impact of this change and of the withdrawal of thioridazine in 2000 on antipsychotic-related fatal poisoning, we reviewed all such deaths in England and Wales 1993-2013 recorded on the Office for National Statistics drug poisoning deaths database. We also reviewed antipsychotic prescribing in the community, England and Wales, 2001-2013...
July 2016: Clinical Toxicology
Rilana Schuster, Alexandra Kleimann, Marie-Kathrin Rehme, Leonie Taschner, Alexander Glahn, Adrian Groh, Helge Frieling, Ralf Lichtinghagen, Thomas Hillemacher, Stefan Bleich, Annemarie Heberlein
Brain-derived neurotrophic factor (BDNF) appears to play a crucial role in the reward response to drugs such as heroin. The primary objective of the present study was to examine epigenetic changes and serum levels of BDNF in patients undergoing different opiate-based maintenance treatments. We compared patients receiving treatment with either levomethadone (n = 55) or diamorphine (n = 28) with a healthy control group (n = 51). When comparing all subjects (patients and controls), BDNF serum levels showed a negative correlation with the BDNF IV promoter methylation rate (r = -0...
February 2017: European Archives of Psychiatry and Clinical Neuroscience
Jan van Amsterdam, Lawrence Phillips, Graeme Henderson, James Bell, Owen Bowden-Jones, Richard Hammersley, John Ramsey, Polly Taylor, Annette Dale-Perera, Jan Melichar, Wim van den Brink, David Nutt
A panel of nine experts applied multi-criteria decision analysis (MCDA) to determine the relative overall harm to users and harms to others of street heroin (injected and smoked) and eleven non-medically used prescription opioids. The experts assessed harm scores for each of the 13 opioids on each of 20 harm criteria, weighted the criteria and explored the resulting weighted harm scores for each opioid. Both forms of heroin scored very high: overall harm score of 99 for injected heroin and 72 for smoked heroin on a scale of 0-100...
December 2015: Regulatory Toxicology and Pharmacology: RTP
Susan Millerchip
Repeated annual audit cycles revealed an unacceptable failure rate of 38%-46% in epidural analgesia for surgical patients in our organisation. Reasons for failure included unilateral block, missed segments and catheter migration. In spite of interventions to remedy the situation, the success rate could not be improved. The aim of the initiative outlined in this article was to improve the efficacy of epidural analgesia and to reduce the failure rate. We found that following the appropriate training and assessment, nurse-administered diamorphine top-ups are a safe and effective way to improve the efficacy of epidural analgesia and can be integrated into acute pain team practice...
May 6, 2015: Nursing Times
John Strang, Teodora Groshkova, Ambros Uchtenhagen, Wim van den Brink, Christian Haasen, Martin T Schechter, Nick Lintzeris, James Bell, Alessandro Pirona, Eugenia Oviedo-Joekes, Roland Simon, Nicola Metrebian
BACKGROUND: Supervised injectable heroin (SIH) treatment has emerged over the past 15 years as an intensive treatment for entrenched heroin users who have not responded to standard treatments such as oral methadone maintenance treatment (MMT) or residential rehabilitation. AIMS: To synthesise published findings for treatment with SIH for refractory heroin-dependence through systematic review and meta-analysis, and to examine the political and scientific response to these findings...
July 2015: British Journal of Psychiatry: the Journal of Mental Science
(no author information available yet)
Intranasal diamorphine spray is an effective analgesia for children with severe pain. However, when the pharmacovigilance trial discussed in this article took place, the drug was unlicenced for intranasal use in children.
June 8, 2015: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
Amanda E Perry, Matthew Neilson, Marrissa Martyn-St James, Julie M Glanville, Rebecca Woodhouse, Christine Godfrey, Catherine Hewitt
BACKGROUND: The review represents one in a family of four reviews focusing on a range of different interventions for drug-using offenders. This specific review considers pharmacological interventions aimed at reducing drug use or criminal activity, or both, for illicit drug-using offenders. OBJECTIVES: To assess the effectiveness of pharmacological interventions for drug-using offenders in reducing criminal activity or drug use, or both. SEARCH METHODS: We searched Fourteen electronic bibliographic databases up to May 2014 and five additional Web resources (between 2004 and November 2011)...
2015: Cochrane Database of Systematic Reviews
Richard Brown, Robert Howard, Bridget Candy, Elizabeth L Sampson
BACKGROUND: Agitation is a common experience for people living with dementia, particularly as day-to-day function and cognition start to decline more. At the present time there are limited pharmacological options for relieving agitation and little is known about the safety and efficacy of opioid drugs in this setting. OBJECTIVES: To determine the clinical efficacy and safety of opioids for agitation in people with dementia. SEARCH METHODS: We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register, on 13 June 2014 using the terms: narcotic OR opioid OR opium OR morphine OR buprenorphine OR codeine OR dextromoramide OR diphenoxylate OR dipipanone OR dextropropoxyphene OR propoxyphene OR diamorphine OR dihydrocodeine OR alfentanil OR fentanyl OR remifentanil OR meptazinol OR methadone OR nalbuphine OR oxycodone OR papaveretum OR pentazocine OR meperidine OR pethidine OR phenazocine OR hydrocodone OR hydromorphone OR levorphanol OR oxymorphone OR butorphanol OR dezocine OR sufentanil OR ketobemidone...
May 14, 2015: Cochrane Database of Systematic Reviews
Muhammad Faisal Jafar, Priyakam Chowdhry
A case of accidental administration of high dose intrathecal diamorphine is reported in a patient who underwent total knee replacement. Initially a regional technique was planned for this patient, but due to inadvertent administration of three milligrams of diamorphine intrathecally, it was decided to convert the patient to have a general anaesthetic. Postoperatively, she was monitored in high dependency unit for 48 hours. Apart from two episodes of nausea and mild drowsiness, she did not develop any serious side effects and did not require naloxone...
November 2014: JPMA. the Journal of the Pakistan Medical Association
Borja Mugabure Bujedo
BACKGROUND: Spinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose-limiting side effects to improve postoperative analgesia. Therefore, physicians must better identify either specific opioids or adequate doses and routes of administration that result in a mainly spinal site of action rather than a cerebral analgesic one. METHODS: The purpose of this topical review is to describe current available clinical evidence to determine what opioids reach high enough concentrations to produce spinally selective analgesia when given by epidural or intrathecal routes and also to make recommendations regarding their rational and safety use for the best management of postoperative pain...
July 2014: Korean Journal of Pain
Daniel Yeomanson, Osman Chohan, Anton Mayer
Methylnaltrexone, a peripheral opioid μ-receptor antagonist is licensed for subcutaneous administration for the treatment of severe opioid-induced constipation in adults. We describe the use of intravenous methylnaltrexone in a 3-year-old boy receiving a subcutaneous diamorphine infusion for palliation from widely metastatic alveolar rhabdomyosarcoma. The patient, who had not opened his bowels for 3 weeks despite use of regular conventional laxatives, was given a 150 mcg/kg dose via indwelling central venous catheter...
March 2013: BMJ Supportive & Palliative Care
Jason W Boland, Gemma A Foulds, Sam H Ahmedzai, A Graham Pockley
BACKGROUND: Studies have demonstrated that whereas some opioids have little effect on immunity (eg, buprenorphine), others can be immunosuppressive (eg, morphine) or immunostimulatory (eg, tramadol). However, a variety of approaches have been used, especially in vitro and animal models, and the findings are variable. We hypothesised that opioids have differential effects on immunity via direct actions on neutrophils, monocytes, natural killer (NK) and T cells, and this is the first study to systematically evaluate the influence of eight opioids on neutrophil and monocyte phagocytosis and oxidative burst responses, NK cell cytotoxicity and T cell responsiveness in vitro...
December 2014: BMJ Supportive & Palliative Care
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