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By Xander Zuidema MD, pharmD, Anesthesiologist, intensivist, pain specialist
https://www.readbyqxmd.com/read/23121635/the-analgesic-efficacy-and-safety-of-neuraxial-magnesium-sulphate-a-quantitative-review
#1
REVIEW
E Albrecht, K R Kirkham, S S Liu, R Brull
Eighteen published trials have examined the use of neuraxial magnesium as a peri-operative adjunctive analgesic since 2002, with encouraging results. However, concurrent animal studies have reported clinical and histological evidence of neurological complications with similar weight-adjusted doses. The objectives of this quantitative systematic review were to assess both the analgesic efficacy and the safety of neuraxial magnesium. Eighteen trials comparing magnesium with placebo were identified. The time to first analgesic request increased by 11...
February 2013: Anaesthesia
https://www.readbyqxmd.com/read/22500909/comparison-of-postoperative-analgesic-effect-of-intrathecal-magnesium-and-fentanyl-added-to-bupivacaine-in-patients-undergoing-lower-limb-orthopedic-surgery
#2
RANDOMIZED CONTROLLED TRIAL
Marzieh-Beigom Khezri, Siamak Yaghobi, Mahsa Hajikhani, Saeid Asefzadeh
OBJECTIVE: To compare the analgesic efficacy and side effects of magnesium and fentanyl as an additive to intrathecal bupivacaine. METHODS: Ninety adult patients scheduled for femur surgery under spinal anesthesia were randomly allocated to one of the following three groups to receive intrathecally: bupivacaine 15 mg combined with 0.5 mL magnesium 10%; bupivacaine 15 mg combined with 0.5 mL fentanyl; or bupivacaine 15 mg combined with 0.5 mL distilled water (control)...
March 2012: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
https://www.readbyqxmd.com/read/28042914/the-polyanalgesic-consensus-conference-pacc-recommendations-for-intrathecal-drug-delivery-guidance-for-improving-safety-and-mitigating-risks
#3
REVIEW
Timothy R Deer, Jason E Pope, Salim M Hayek, Tim J Lamer, Ilir Elias Veizi, Michael Erdek, Mark S Wallace, Jay S Grider, Robert M Levy, Joshua Prager, Steven M Rosen, Michael Saulino, Tony L Yaksh, Jose A De Andrés, David Abejon Gonzalez, Jan Vesper, Stefan Schu, Brian Simpson, Nagy Mekhail
INTRODUCTION: Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. METHODS: A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts...
January 2, 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/28042906/the-polyanalgesic-consensus-conference-pacc-recommendations-for-trialing-of-intrathecal-drug-delivery-infusion-therapy
#4
REVIEW
Timothy R Deer, Salim M Hayek, Jason E Pope, Tim J Lamer, Maged Hamza, Jay S Grider, Steven M Rosen, Samir Narouze, Christophe Perruchoud, Simon Thomson, Marc Russo, Eric Grigsby, Daniel M Doleys, Marilyn S Jacobs, Michael Saulino, Paul Christo, Philip Kim, Elliot Marc Huntoon, Elliot Krames, Nagy Mekhail
INTRODUCTION: Intrathecal (IT) drug infusion is an appropriate and necessary tool in the algorithm to treat refractory cancer and noncancer pain. The decision-making steps/methodology for selecting appropriate patients for implanted targeted drug delivery systems is controversial and complicated. Therefore, a consensus on best practices for determining appropriate use of IT drug infusion may involve testing/trialing this therapy before implantation. METHODS: This current Polyanalgesic Consensus Conference (PACC) update was designed to address the deficiencies and emerging innovations since the previous PACC convened in 2012...
February 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/28042904/the-polyanalgesic-consensus-conference-pacc-recommendations-on-intrathecal-drug-infusion-systems-best-practices-and-guidelines
#5
REVIEW
Timothy R Deer, Jason E Pope, Salim M Hayek, Anjum Bux, Eric Buchser, Sam Eldabe, Jose A De Andrés, Michael Erdek, Dennis Patin, Jay S Grider, Daniel M Doleys, Marilyn S Jacobs, Tony L Yaksh, Lawrence Poree, Mark S Wallace, Joshua Prager, Richard Rauck, Oscar DeLeon, Sudhir Diwan, Steven M Falowski, Helena M Gazelka, Philip Kim, Michael Leong, Robert M Levy, Gladstone McDowell Ii, Porter McRoberts, Ramana Naidu, Samir Narouze, Christophe Perruchoud, Steven M Rosen, William S Rosenberg, Michael Saulino, Peter Staats, Lisa J Stearns, Dean Willis, Elliot Krames, Marc Huntoon, Nagy Mekhail
INTRODUCTION: Pain treatment is best performed when a patient-centric, safety-based philosophy is used to determine an algorithmic process to guide care. Since 2007, the International Neuromodulation Society has organized a group of experts to evaluate evidence and create a Polyanalgesic Consensus Conference (PACC) to guide practice. METHODS: The current PACC update was designed to address the deficiencies and innovations emerging since the previous PACC publication of 2012...
January 2, 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/27885425/intrathecal-morphine-versus-intravenous-opioid-administration-to-impact-postoperative-analgesia-in-hepato-pancreatic-surgery-a-randomized-controlled-trial
#6
Sara Dichtwald, Menahem Ben-Haim, Laila Papismedov, Shoshana Hazan, Anat Cattan, Idit Matot
PURPOSE: Inadequate analgesia following abdominal surgery may affect outcome. Data in patients undergoing liver surgery suggested that postoperative coagulopathy might delay epidural catheter removal. Thus, alternative analgesic techniques should be evaluated. METHODS: We compared the analgesic efficacy of intraoperative intrathecal morphine [single injection 4 µg/kg before skin incision (ITM group, n = 23)] to intravenous opioids [iv remifentanil infusion during surgery followed by i...
November 24, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/12351602/randomized-clinical-trial-of-an-implantable-drug-delivery-system-compared-with-comprehensive-medical-management-for-refractory-cancer-pain-impact-on-pain-drug-related-toxicity-and-survival
#7
RANDOMIZED CONTROLLED TRIAL
Thomas J Smith, Peter S Staats, Timothy Deer, Lisa J Stearns, Richard L Rauck, Richard L Boortz-Marx, Eric Buchser, Elena Català, David A Bryce, Patrick J Coyne, George E Pool
PURPOSE: Implantable intrathecal drug delivery systems (IDDSs) have been used to manage refractory cancer pain, but there are no randomized clinical trial (RCT) data comparing them with comprehensive medical management (CMM). PATIENTS AND METHODS: We enrolled 202 patients on an RCT of CMM versus IDDS plus CMM. Entry criteria included unrelieved pain (visual analog scale [VAS] pain scores >/= 5 on a 0 to 10 scale). Clinical success was defined as >/= 20% reduction in VAS scores, or equal scores with >/= 20% reduction in toxicity...
October 1, 2002: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/18305080/comparison-of-high-and-low-dose-intrathecal-morphine-for-spinal-fusion-in-children
#8
RANDOMIZED CONTROLLED TRIAL
S Eschertzhuber, M Hohlrieder, C Keller, E Oswald, G Kuehbacher, P Innerhofer
BACKGROUND: The purpose of this prospective study was to assess the blood-sparing effect, the quality of analgesia, and the incidence of side-effects of a low-dose regime of intrathecal opioids (ITO) when compared with those of a high-dose regime in scoliosis surgery in children. METHODS: Forty-six children were randomly included into one of the three groups to receive morphine 5 microg kg(-1) plus sufentanil 1 microg kg(-1) [low-dose intrathecal opioid (LITO)], morphine 15 microg kg(-1) plus sufentanil 1 microg kg(-1) [high-dose intrathecal opioid (HITO)] intrathecally, or no intrathecal opioid...
April 2008: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/22845187/prospective-study-of-3-year-follow-up-of-low-dose-intrathecal-opioids-in-the-management-of-chronic-nonmalignant-pain
#9
Maged Hamza, Daniel Doleys, Mary Wells, Jackie Weisbein, Jeremy Hoff, Michelle Martin, Costa Soteropoulos, Jose Barreto, Steven Deschner, Jessica Ketchum
OBJECTIVE:   Long-term follow-up with the use of low-dose opioids in intrathecal (IT) drug delivery system (DDS) for the treatment of intractable, severe chronic nonmalignant pain. DESIGN:   This is a prospective, cohort long-term outcome study. Intervention.  The intervention was the implantation of DDS. METHOD AND PATIENTS:   A total of 61 consecutive patients (60% females, 40% males) with a mean age of 59.2 years and a mean duration of symptoms prior to implant of 6...
October 2012: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27730704/intrathecal-drug-delivery-systems-idds-the-implantable-systems-performance-registry-ispr
#10
Peter E Konrad, John M Huffman, Lisa M Stearns, Robert J Plunkett, Eric J Grigsby, E K Stromberg, Mollie P Roediger, Michelle D Wells, Todd W Weaver
OBJECTIVES: The ISPR was initially created to monitor the product performance of Medtronic implanted intrathecal drug infusion and spinal cord systems available in the United States. MATERIALS AND METHODS: Data were collected from 50 representative sites implanting and following patients with intrathecal drug delivery systems across the United States between August 7, 2003 and January 31, 2014. Device performance over time was estimated using life table survival methods...
December 2016: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/27651513/comparison-of-the-effects-of-intermittent-boluses-to-simple-continuous-infusion-on-patients-global-perceived-effect-in-intrathecal-therapy-for-pain-a-randomized-double-blind-crossover-study
#11
Sam Eldabe, Rui V Duarte, Grace Madzinga, Alan M Batterham, Morag E Brookes, Ashish P Gulve, Christophe Perruchoud, Jon H Raphael, David Lorenzana, Eric Buchser
OBJECTIVE:  Intrathecal drug delivery (ITDD) is commonly used for intractable pain management. A paucity of good-quality studies in chronic noncancer patients and concerns over increased dosages have focused interest on different modes of administration. The aim of this international multicenter randomized double-blind crossover trial was to compare the efficacy of the same daily dose of drugs administered by intermittent boluses vs simple continuous infusion. METHODS:  Eligible patients implanted with a programmable ITDD device were randomized to receive two weeks of either intermittent boluses or a simple continuous flow in period 1, followed by a crossover to the alternative mode of administration...
September 19, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27550951/surgical-site-infections-in-cancer-patients-with-intrathecal-drug-delivery-devices
#12
Maura M Scanlon, Halena M Gazelka, Susan M Moeschler, Bryan C Hoelzer, W Michael Hooten, Markus A Bendel, Tim J Lamer
OBJECTIVES:  Our purpose was to determine the incidence of surgical site infection (SSI) in cancer patients receiving an intrathecal drug delivery system (IDDS) and compare that rate with the incidence of SSI in the general population receiving an IDDS or spinal cord stimulator. We attempted to describe risk factors for SSIs in cancer patients treated with IDDS in terms of exposure to cancer treatments. DESIGN:  Retrospective review. SETTING:  Large tertiary care center...
August 22, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27492135/use-of-low-dose-ziconotide-as-first-line-intrathecal-monotherapy
#13
Julia Prusik, Charles Argoff, Sophia Peng, Julie G Pilitsis
BACKGROUND: Ziconotide use in intrathecal drug therapy (IDT) has been limited by dosing related side effects. We examine our experience with ziconotide as a first line IDT monotherapy in patients with chronic pain and present our low and slow dosing algorithm aimed at reducing these patient experienced side effects while adequately managing pain. METHODS: We retrospectively reviewed demographics, dosing, and outcomes of 15 consecutive patients with complete three-month data sets implanted with intrathecal pain pumps more than three years utilizing ziconotide as a first-line monotherapy...
August 5, 2016: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/27505059/primary-hydromorphone-related-intrathecal-catheter-tip-granulomas-is-there-a-role-for-dose-and-concentration
#14
I Elias Veizi, Salim M Hayek, Michael Hanes, Ryan Galica, Sivakanth Katta, Tony Yaksh
BACKGROUND: Intrathecal drug delivery therapy has been used effectively in treating patients with intractable chronic pain. The development of an intrathecal catheter tip granuloma (ICTG) related to delivery of intrathecal opiates is a relatively infrequent, but potentially devastating complication. While there are many morphine-related ICTG cases described, reports of hydromorphone-related ICTG are limited. In addition, studies suggest a strong correlation between the use of higher doses and concentrations of intrathecal opiates and ICTG formation...
October 2016: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/27388670/upper-antero-medial-thigh-as-an-alternative-site-for-implantation-of-intrathecal-pumps-a-case-series
#15
Sanjeet Narang, Suresh K Srinivasan, Nantthasorn Zinboonyahgoon, Christian E Sampson
INTRODUCTION: Neuraxial drug delivery via intrathecal drug delivery systems (IDDS) is becoming an increasingly common mode of treating intractable cancer-related pain, chronic pain, or severe spasticity. An implanted infusion pump delivers medication into the intrathecal (subarachnoid) space via a thin catheter. These pumps are commonly placed in the anterior abdominal wall. Certain conditions may render it difficult or unsafe for an IDDS to be implanted at the traditional site; thus, alternative sites have been explored...
August 2016: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/27272672/intrathecal-catheterization-and-drug-delivery-in-guinea-pigs-a-small-animal-model-for-morphine-evoked-granuloma-formation
#16
Kelly A Eddinger, Eric S Rondon, Veronica I Shubayev, Marjorie R Grafe, Miriam Scadeng, Keith R Hildebrand, Linda M Page, Shelle A Malkmus, Joanne J Steinauer, Tony L Yaksh
BACKGROUND: Intrathecal infusion of opioids in dogs, sheep, and humans produces local space-occupying masses. To develop a small-animal model, the authors examined effects of intrathecal catheterization and morphine infusion in guinea pigs. METHODS: Under isoflurane, polyethylene or polyurethane catheters were advanced from the cisterna magna to the lumbar enlargement. Drugs were delivered as a bolus through the externalized catheter or continuously by subcutaneous minipumps...
August 2016: Anesthesiology
https://www.readbyqxmd.com/read/27125288/intrathecal-therapy-for-cancer-related-pain
#17
REVIEW
Brian M Bruel, Allen W Burton
OBJECTIVE: The increasing incidence of cancer survivorship has shifted treatment of cancer-related pain from short-term analgesia to long-term chronic pain management. As a result, alternatives to oral analgesics, such as intrathecal therapy, may be beneficial for patients with cancer-related pain. The authors review the use of intrathecal therapy in the management of cancer-related pain. METHODS: The Medline database was searched for English-language articles that included "ziconotide" or "morphine" AND ("cancer" OR "malignant") AND "intrathecal" in title or abstract...
April 28, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27023424/therapeutic-potential-of-rq-00311651-a-novel-t-type-ca2-channel-blocker-in-distinct-rodent-models-for-neuropathic-and-visceral-pain
#18
Fumiko Sekiguchi, Yuma Kawara, Maho Tsubota, Eri Kawakami, Tomoka Ozaki, Yudai Kawaishi, Shiori Tomita, Daiki Kanaoka, Shigeru Yoshida, Tsuyako Ohkubo, Atsufumi Kawabata
T-type Ca channels (T channels), particularly Cav3.2 among the 3 isoforms, play a role in neuropathic and visceral pain. We thus characterized the effects of RQ-00311651 (RQ), a novel T-channel blocker, in HEK293 cells transfected with human Cav3.1 or Cav3.2 by electrophysiological and fluorescent Ca signaling assays, and also evaluated the antiallodynic/antihyperalgesic activity of RQ in somatic, visceral, and neuropathic pain models in rodents. RQ-00311651 strongly suppressed T currents when tested at holding potentials of -65 ∼ -60 mV, but not -80 mV, in the Cav3...
August 2016: Pain
https://www.readbyqxmd.com/read/26974022/intrathecal-hydromorphone-and-morphine-for-postcesarean-delivery-analgesia-determination-of-the-ed90-using-a-sequential-allocation-biased-coin-method
#19
Hans P Sviggum, Katherine W Arendt, Adam K Jacob, Adam D Niesen, Rebecca L Johnson, Darrell R Schroeder, Michael Tien, Carlos B Mantilla
BACKGROUND: Intrathecal (IT) morphine is considered the "gold standard" for analgesia after cesarean delivery under spinal anesthesia, most commonly administered at a dose of 100 to 200 μg. There is less experience with IT hydromorphone for postcesarean analgesia and limited information on its optimal analgesic dose. We conducted this study to determine the effective analgesic dose for 90% patients (ED90) of IT hydromorphone that provides effective analgesia for women undergoing elective cesarean delivery and its potency ratio to IT morphine...
September 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26893118/pain-modulation-and-autonomic-function-the-effect-of-clonidine
#20
Hadas Nahman-Averbuch, Lior Dayan, Elliot Sprecher, Uri Hochberg, Silviu Brill, David Yarnitsky, Giris Jacob
OBJECTIVE: . The α2-agonist clonidine is an analgesic agent, whose yet uncertain action may involve either increase in pain modulation efficiency, change in autonomic function, and/or decrease in anxiety level. The present study aimed to examine the effect of oral clonidine on pain perception in healthy subjects in order to reveal its mode of action. DESIGN: . Randomized, double-blind, placebo-controlled study. SUBJECTS: . Forty healthy subjects...
February 18, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
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