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Under dosing of pain medication in emergency

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https://www.readbyqxmd.com/read/27349628/liposomal-bupivacaine-incisional-injection-in-single-level-lumbar-spine-surgery
#1
Ross C Puffer, Kevin Tou, Rose E Winkel, Mohamad Bydon, Bradford Currier, Brett A Freedman
BACKGROUND CONTEXT: Postsurgical pain control is important in spine surgery as it can lead to earlier mobilization, decreased length of stay, decreased side effects from narcotic medications, and improved patient satisfaction. Liposomal bupivacaine (LB) is an injectable formulation of bupivacaine, providing prolonged local anesthesia, up to 72 hours postinjection. Although, LB has been used with increasing frequency following other musculoskeletal procedures, specifically total joint replacements, its pre-emptive analgesic effect following lumbar microdiskectomy has hitherto not been reported...
June 24, 2016: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/27181451/derivation-of-an-occupational-exposure-limit-for-an-inhalation-analgesic-methoxyflurane-penthrox-%C3%A2
#2
John Frangos, Antti Mikkonen, Christin Down
Methoxyflurane (MOF) a haloether, is an inhalation analgesic agent for emergency relief of pain by self administration in conscious patients with trauma and associated pain. It is administered under supervision of personnel trained in its use. As a consequence of supervised use, intermittent occupational exposure can occur. An occupational exposure limit has not been established for methoxyflurane. Human clinical and toxicity data have been reviewed and used to derive an occupational exposure limit (referred to as a maximum exposure level, MEL) according to modern principles...
October 2016: Regulatory Toxicology and Pharmacology: RTP
https://www.readbyqxmd.com/read/27153360/fulranumab-in-patients-with-pain-associated-with-postherpetic-neuralgia-and-postraumatic-neuropathy-efficacy-safety-and-tolerability-results-from-a-randomized-double-blind-placebo-controlled-phase-2-study
#3
Hao Wang, Gary Romano, Margaret Fedgchin, Lucille Russell, Panna Sanga, Kathleen M Kelly, Mary Ellen Frustaci, John Thipphawong
OBJECTIVE: Fulranumab is an antibody that specifically neutralizes the biologic activity of human nerve growth factor. This multicenter, phase-2, randomized, double-blind (DB), placebo-controlled study evaluated the analgesic efficacy and safety of fulranumab in postherpetic neuralgia (PHN) and posttraumatic neuropathy (PTN) patients. METHODS: Patients (18-80 y) with inadequately controlled moderate-to-severe pain received study medication (subcutaneous injection) every 4 weeks...
May 6, 2016: Clinical Journal of Pain
https://www.readbyqxmd.com/read/26334607/guidelines-for-the-management-of-a-pregnant-trauma-patient
#4
Venu Jain, Radha Chari, Sharon Maslovitz, Dan Farine, Emmanuel Bujold, Robert Gagnon, Melanie Basso, Hayley Bos, Richard Brown, Stephanie Cooper, Katy Gouin, N Lynne McLeod, Savas Menticoglou, William Mundle, Christy Pylypjuk, Anne Roggensack, Frank Sanderson
OBJECTIVE: Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. OUTCOMES: Significant health and economic outcomes considered in comparing alternative practices...
June 2015: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/25309825/transcranial-direct-current-stimulation-in-neuropathic-pain
#5
Niran Ngernyam, Mark P Jensen, Narong Auvichayapat, Wiyada Punjaruk, Paradee Auvichayapat
Neuropathic pain (NP) is one of the most common problems contributing to suffering and disability worldwide. Unfortunately, NP is also largely refractory to treatments, with a large number of patients continuing to report significant pain even when they are receiving recommended medications and physical therapy. Thus, there remains an urgent need for additional effective treatments. In recent years, nonpharmacologic brain stimulation techniques have emerged as potential therapeutic options. Many of these techniques and procedures - such as transcranial magnetic stimulation, spinal cord stimulation, deep brain stimulation, and motor cortical stimulation - have very limited availability, particularly in developing countries...
April 21, 2013: Journal of Pain & Relief
https://www.readbyqxmd.com/read/24381692/sedative-dosing-of-propofol-for-treatment-of-migraine-headache-in-the-emergency-department-a-case-series
#6
Jarrod Mosier, Grant Roper, Daniel Hays, John Guisto
INTRODUCTION: Migraine headaches requiring an emergency department visit due to failed outpatient rescue therapy present a significant challenge in terms of length of stay (LOS) and financial costs. Propofol therapy may be effective at pain reduction and reduce that length of stay given its pharmacokinetic properties as a short acting intravenous sedative anesthetic and pharmacodynamics on GABA mediated chloride flux. METHODS: Case series of 4 patients presenting to an urban academic medical center with migraine headache failing outpatient therapy...
November 2013: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/24182946/intravenous-magnesium-as-acute-treatment-for-headaches-a-pediatric-case-series
#7
Emily Gertsch, Sheila Loharuka, Kristine Wolter-Warmerdam, Suhong Tong, Allison Kempe, Sita Kedia
BACKGROUND: Acute i.v. treatment for pediatric headache varies widely. OBJECTIVES: Our aim was to describe our experience with i.v. magnesium for acute treatment of pediatric headache. METHODS: We reviewed the electronic medical records of all patients ages 5 to 18 years old treated with a standard dose of i.v. magnesium for headache at our institution from January 2008 to July 2010. Charts were assessed for headache diagnosis, prior medications given, side effects, tolerability, and response to treatment...
February 2014: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/23835024/patients-knowledge-about-paracetamol-acetaminophen-a-study-in-a-french-hospital-emergency-department
#8
Y Boudjemai, P Mbida, V Potinet-Pagliaroli, F Géffard, G Leboucher, J-L Brazier, B Allenet, B Charpiat
UNLABELLED: Paracetamol is the most widely used analgesic and antipyretic drug. In France, little is known concerning patients' knowledge and beliefs about paracetamol. OBJECTIVE: To determine how much outpatients attending an emergency department know about paracetamol. METHOD: A semi-structured questionnaire was applied to patients consulting for non-severe medical or traumatic conditions. RESULTS: Thirty-three (45%) of 73 participating patients knew that paracetamol was the active ingredient of the medication they used to reduce pain and/or fever...
July 2013: Annales Pharmaceutiques Françaises
https://www.readbyqxmd.com/read/22595625/-low-dose-ketamine-for-pediatric-procedure-related-pain
#9
D Annequin
For painful procedures in children, national recommendations are now available in France. When sedation-analgesia with nitrous oxide/oxygen mixture fails, in order to perform a painful procedure under good conditions, low dose ketamine (IV bolus titration 0.5 mg/kg but not more than 2 mg/kg) is the only drug potentially used by a trained physician, without the presence of an anaesthesiologist (Grade A). With these dosages without drug combination, the highest level of security depends largely on the quality of the hospital environment (Grade A)...
July 2012: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/22428485/prospective-randomized-study-to-assess-the-role-of-dexmedetomidine-in-patients-with-supratentorial-tumors-undergoing-craniotomy-under-general-anaesthesia
#10
RANDOMIZED CONTROLLED TRIAL
Rabie Nasr Soliman, Amira Refaie Hassan, Amr Madih Rashwan, Ahmed Mohamed Omar
BACKGROUND: Preliminary data on the perioperative use of dexmedetomidine in patients undergoing craniotomy for brain tumor under general anaesthesia indicate that the intraoperative administration of dexmedetomidine is opioid-sparing, results in less need for antihypertensive medication, and may offer greater hemodynamic stability at incision and emergence. Dexmedetomidine, alpha 2 adrenoceptor agonist used as adjuvant to anaesthetic agents. Relatively recent studies have shown that dexmedetomidine is able to decrease circulating plasma norepinephrine and epinephrine concentration in approximately 50%, decreases brain blood flow by directly acting on post-synaptic alpha 2 receptors, decreases CSF pressure without ischemic suffering and effectively decrease brain metabolism and intracranial pressure and also, able to decrease injury caused by focal ischemia...
October 2011: Middle East Journal of Anesthesiology
https://www.readbyqxmd.com/read/22420908/fixed-dose-combinations-for-emerging-treatment-of-pain
#11
REVIEW
Robert B Raffa, Ronald J Tallarida, Robert Taylor, Joseph V Pergolizzi
INTRODUCTION: Pain is a large and growing medical need that is not currently being fully met, primarily due to the shortcomings of existing analgesics (insufficient efficacy or limiting side-effects). Better outcomes might be achieved using a combination of analgesics. The ratio of the combinations matters and should therefore be evaluated using rigorous quantitative and well-documented analysis. AREAS COVERED: Advances have been made in understanding the normal physiology of pain processing, including the pathways and neurotransmitters involved...
June 2012: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/22177370/comparison-of-murraya-koenigii-and-tribulus-terrestris-based-oral-formulation-versus-tamsulosin-in-the-treatment-of-benign-prostatic-hyperplasia-in-men-aged-50-years-a-double-blind-double-dummy-randomized-controlled-trial
#12
RANDOMIZED CONTROLLED TRIAL
Gairik Sengupta, Avijit Hazra, Anup Kundu, Anirban Ghosh
BACKGROUND: Drug treatment can defer surgical intervention in benign prostatic hyperplasia (BPH), a common disorder in elderly men, and is widely practiced. Various herbal formulations have been used for the treatment of BPH, but few have been compared with established modern medicines in head-to-head clinical trials. OBJECTIVE: We compared the effectiveness and tolerability of an oral formulation, comprising standardized extracts of Murraya koenigii and Tribulus terrestris leaves being marketed in India under Ayurvedic license, versus tamsulosin in the treatment of symptomatic BPH...
December 2011: Clinical Therapeutics
https://www.readbyqxmd.com/read/21721594/pharmacokinetics-of-diazepam-administered-intramuscularly-by-autoinjector-versus-rectal-gel-in-healthy-subjects-a-phase-i-randomized-open-label-single-dose-crossover-single-centre-study
#13
RANDOMIZED CONTROLLED TRIAL
Michael J Lamson, Diane Sitki-Green, Gerald L Wannarka, Michael Mesa, Paul Andrews, John Pellock
BACKGROUND AND OBJECTIVE: Acute repetitive seizures (ARS) are a debilitating part of episodic seizure activity that can sometimes progress to status epilepticus. Currently approved treatment that can be administered by non-medical personnel to patients with ARS is a diazepam rectal gel. While effective, rectal administration can be difficult, inconvenient and objectionable. A diazepam autoinjector has been developed to deliver diazepam via an intramuscular (IM) injection. This study evaluated the dose proportionality of the diazepam autoinjector and the consequent diazepam bioavailability relative to an equivalent dose of diazepam administered rectally as a commercial gel...
2011: Clinical Drug Investigation
https://www.readbyqxmd.com/read/21629146/is-there-a-role-for-intravenous-acetaminophen-in-pediatric-emergency-departments
#14
COMPARATIVE STUDY
Franz E Babl, Theane Theophilos, Greta M Palmer
BACKGROUND: As a nonopioid parenteral analgesic intravenous (IV) acetaminophen is potentially attractive for emergency department (ED) use. However, there is little experience with its use in the pediatric ED setting. We introduced the agent into a pediatric ED with a preliminary restrictive prescribing regimen and describe its use. METHODS: This is a retrospective record review of all patients who had received IV acetaminophen over 12 months. Prescribing indications were for analgesia only (not for fever management) in patients at risk of opioid-related adverse events...
June 2011: Pediatric Emergency Care
https://www.readbyqxmd.com/read/21562412/efficacy-and-safety-of-lumbar-epidural-dexamethasone-versus-methylprednisolone-in-the-treatment-of-lumbar-radiculopathy-a-comparison-of-soluble-versus-particulate-steroids
#15
RANDOMIZED CONTROLLED TRIAL
David Kim, James Brown
INTRODUCTION: The literature is limited in the comparative efficacy and safety of dexamethasone phosphate (DP) compared with methylprednisolone acetate (MPA) in the treatment of lumbar radiculopathy by epidural injection. This study attempts to test the hypothesis that 2 corticosteroids are equivalent in efficacy and side effects. METHODS: Patients with lumbar radicular symptoms for at least 6 months were randomized to equipotent doses of MPA 80 mg or DP 15 mg by lumbar translaminar epidurals administered under fluoroscopy...
July 2011: Clinical Journal of Pain
https://www.readbyqxmd.com/read/21448767/anesthetic-management-of-a-patient-with-narcolepsy
#16
Yasuhiro Morimoto, Yuko Nogami, Kaori Harada, Hiroko Shiramoto, Takayo Moguchi
We report the anesthetic management of a narcoleptic patient performed using sevoflurane-remifentanil with bispectral index (BIS) monitoring. A 22-year-old man, who was diagnosed with narcolepsy at the age of 17, requested endoscopic sinus surgery, under general anesthesia, for chronic allergic rhinitis. On the morning of the day of operation, he took his daily dose of modafinil, used to control narcolepsy. Anesthesia was induced by 5% sevoflurane and maintained with sevoflurane and continuous infusion of remifentanil and 60% oxygen in conjunction with BIS monitoring...
June 2011: Journal of Anesthesia
https://www.readbyqxmd.com/read/21353105/a-randomized-double-blind-placebo-controlled-multicenter-repeat-dose-study-of-two-intravenous-acetaminophen-dosing-regimens-for-the-treatment-of-pain-after-abdominal-laparoscopic-surgery
#17
RANDOMIZED CONTROLLED TRIAL
Steven J Wininger, Howard Miller, Harold S Minkowitz, Mike A Royal, Robert Y Ang, James B Breitmeyer, Neil K Singla
BACKGROUND: Intravenous acetaminophen has been approved in Europe and elsewhere for the treatment of acute pain and fever, and was recently approved by the US Food and Drug Administration (FDA) for the management of mild to moderate pain, the management of moderate to severe pain with adjunctive opioid analgesics, and the reduction of fever. OBJECTIVE: The aim of this work was to evaluate the analgesic efficacy and safety of repeated doses of 2 dosing regimens of intravenous acetaminophen compared with placebo over 24 hours in subjects with moderate to severe pain after abdominal laparoscopic surgery...
December 2010: Clinical Therapeutics
https://www.readbyqxmd.com/read/21134123/safety-of-multiple-dose-intravenous-acetaminophen-in-adult-inpatients
#18
RANDOMIZED CONTROLLED TRIAL
Keith A Candiotti, Sergio D Bergese, Eugene R Viscusi, Sonia K Singla, Mike A Royal, Neil Kumar Singla
BACKGROUND: Intravenous (IV) acetaminophen provides rapid and effective analgesia in the postoperative and inpatient settings. The utility and efficacy of acetaminophen is well established; however, due to chronic excessive dosing of over-the-counter acetaminophen products and prescription opioid combination products resulting in the potential for hepatic toxicity, concerns remain about acetaminophen safety. In order to evaluate the safety of IV acetaminophen 1,000mg q6h or 650mg q4h with repeated dosing for 5 days, a randomized, open-label study assessed the safety and tolerability of repeated doses used to treat acute pain or fever in 213 adult inpatients was conducted...
December 2010: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/20648202/respiratory-failure-following-delayed-intrathecal-morphine-pump-refill-a-valuable-but-costly-lesson
#19
Xiulu Ruan, J Patrick Couch, HaiNan Liu, Rinoo V Shah, Frank Wang, Srinivas Chiravuri
BACKGROUND: Spinal analgesia, mediated by opioid receptors, requires only a fraction of the opioid dose that is needed systemically. By infusing a small amount of opioid into the cerebrospinal fluid in close proximity to the receptor sites in the spinal cord, profound analgesia may be achieved while sparing some of the side effects due to systemic opioids. Intraspinal drug delivery (IDD) has been increasingly used in patients with intractable chronic pain, when these patients have developed untoward side effects with systemic opioid usage...
July 2010: Pain Physician
https://www.readbyqxmd.com/read/20642488/a-multicenter-randomized-double-blind-placebo-controlled-trial-of-intravenous-ibuprofen-i-v-ibuprofen-in-the-management-of-postoperative-pain-following-abdominal-hysterectomy
#20
RANDOMIZED CONTROLLED TRIAL
Peter B Kroll, Laura Meadows, Amy Rock, Leo Pavliv
BACKGROUND: Ibuprofen and other nonsteroidal anti-inflammatory drugs are widely used to block pain and inflammation in a variety of settings. Contrarily, opioid analgesia does not block the inflammatory component of pain and the use of these agents can be accompanied by serious side effects. We conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate the safety and efficacy of intravenous ibuprofen (i.v.-ibuprofen) as a postoperative analgesic. METHODS: A total of 319 patients were randomly assigned in a 1:1 ratio to receive 800 i...
January 2011: Pain Practice: the Official Journal of World Institute of Pain
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