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[PMID]:27779367
[Au] Autor:Livingstone MJ; Groenewald CB; Rabbitts JA; Palermo TM
[Ad] Endereço:Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
[Ti] Título:Codeine use among children in the United States: a nationally representative study from 1996 to 2013.
[So] Source:Paediatr Anaesth;27(1):19-27, 2017 Jan.
[Is] ISSN:1460-9592
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Concerns regarding the safety of codeine have been raised. Cases of life-threatening respiratory depression and death in children have been attributed to codeine's polymorphic metabolic pathway. International health agencies recommend restricted use of codeine in children. Despite these recommendations, the epidemiology of codeine use among children remains unknown. AIMS: Our objective was to examine patterns of codeine use in the US among children. METHODS: A cross-sectional analysis of children of age 0-17 years from 1996 to 2013 in the US was performed. Data were extracted from MEPS, a nationally representative set of health care surveys. Prevalence rates of codeine use between 1996 and 2013 were examined. Multivariable logistic regression examined relationships between codeine use and patient demographics. RESULTS: Codeine use remained largely unchanged from 1996 to 2013 (1.08 vs 1.03 million children, respectively). Odds of codeine use was higher in ages 12-17 (OR, 1.40; [1.21-1.61]), outside of the Northeastern US, and among those with poor physical health status (OR, 3.29 [1.79-6.03]). Codeine use was lower in children whose ethnicity was not white and those uninsured (OR, 0.47 [0.34-0.63]). Codeine was most frequently prescribed by emergency physicians (18%) and dentists (14%). The most common condition associated with codeine use was trauma-related pain. CONCLUSIONS: Pediatric codeine use has declined since 1996; however, more than 1 million children still used codeine in 2013. Health care providers must be made aware of guidelines advising against the use of codeine in children. Codeine is potentially hazardous and safer alternatives to treat children's pain are available.
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Codeína/uso terapêutico
Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Distribuição por Idade
Criança
Pré-Escolar
Estudos Transversais
Feminino
Seres Humanos
Lactente
Masculino
Padrões de Prática Médica/estatística & dados numéricos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); Q830PW7520 (Codeine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180101
[Lr] Data última revisão:
180101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1111/pan.13033


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[PMID]:29049655
[Au] Autor:Jin J
[Ti] Título:Risks of Codeine and Tramadol in Children.
[So] Source:JAMA;318(15):1514, 2017 10 17.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Analgésicos Opioides/efeitos adversos
Codeína/efeitos adversos
Tosse/tratamento farmacológico
Tramadol/efeitos adversos
[Mh] Termos MeSH secundário: Acetaminofen/uso terapêutico
Adolescente
Analgésicos não Entorpecentes/uso terapêutico
Criança
Pré-Escolar
Seres Humanos
Lactente
Uso Indevido de Medicamentos sob Prescrição
Transtornos do Sono-Vigília/induzido quimicamente
Estados Unidos
United States Food and Drug Administration
[Pt] Tipo de publicação:PATIENT EDUCATION HANDOUT
[Nm] Nome de substância:
0 (Analgesics, Non-Narcotic); 0 (Analgesics, Opioid); 362O9ITL9D (Acetaminophen); 39J1LGJ30J (Tramadol); Q830PW7520 (Codeine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.13534


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[PMID]:28708940
[Au] Autor:Soares JX; Alves EA; Silva AMN; de Figueiredo NG; Neves JF; Cravo SM; Rangel M; Netto ADP; Carvalho F; Dinis-Oliveira RJ; Afonso CM
[Ad] Endereço:LAQV, REQUIMTE, Department of Chemical Sciences, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto , José Viterbo Ferreira Street No. 228, 4050-313 Porto, Portugal.
[Ti] Título:Street-Like Synthesis of Krokodil Results in the Formation of an Enlarged Cluster of Known and New Morphinans.
[So] Source:Chem Res Toxicol;30(8):1609-1621, 2017 Aug 21.
[Is] ISSN:1520-5010
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:"Krokodil" is the street name for a homemade injectable drug that has been used as a cheap substitute for heroin. Codeine is the opioid starting material for krokodil synthesis, and desomorphine is claimed to be the main opioid of krokodil and the main component responsible for its addictive and psychoactive characteristics. However, due to its peculiar manufacture, using cheap raw materials, krokodil is composed of a large and complex mixture of different substances. In order to shed some light upon the chemical complexity of krokodil, its profiling was conducted by reverse phase high performance liquid chromatography coupled to a photodiode array detector (RP-HPLC-DAD) and by liquid chromatography coupled to high resolution tandem mass spectrometry (LC-ESI-IT-Orbitrap-MS). Besides desomorphine, codeine, and morphine, profiting from the high resolution mass spectrometry (HRMS) data, an endeavor to study the morphinans content in krokodil was set for the first time. Considering codeine as the only morphinan precursor and the possible chemical transformations that can occur during krokodil synthesis, the morphinan chemical space was designed, and 95 compounds were defined. By making use of the morphinan chemical space in krokodil, the exact masses featured by HRMS, and the morphinan mass fragmentations patterns, a targeted identification approach was designed and implemented.The proposed 95 morphinans were searched using the full scan chromatogram of krokodil, and findings were validated by mass fragmentation of the correspondent precursor ions (MS spectra). Following this effort, a total of 54 morphinans were detected, highlighting the fact that these additional morphinans may contribute to the psychotropic effects of krokodil.
[Mh] Termos MeSH primário: Cromatografia Líquida de Alta Pressão
Codeína/análogos & derivados
Morfinanos/análise
Espectrometria de Massas em Tandem
[Mh] Termos MeSH secundário: Cromatografia de Fase Reversa
Codeína/análise
Codeína/síntese química
Morfina/análise
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Morphinans); 76I7G6D29C (Morphine); 7OP86J5E33 (desomorphine); Q830PW7520 (Codeine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE
[do] DOI:10.1021/acs.chemrestox.7b00126


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[PMID]:28683172
[Au] Autor:Wiffen PJ; Wee B; Derry S; Bell RF; Moore RA
[Ad] Endereço:Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Pain Research Unit, Churchill Hospital, Oxford, Oxfordshire, UK, OX3 7LE.
[Ti] Título:Opioids for cancer pain - an overview of Cochrane reviews.
[So] Source:Cochrane Database Syst Rev;7:CD012592, 2017 07 06.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pain is a common symptom with cancer, and 30% to 50% of all people with cancer will experience moderate to severe pain that can have a major negative impact on their quality of life. Opioid (morphine-like) drugs are commonly used to treat moderate or severe cancer pain, and are recommended for this purpose in the World Health Organization (WHO) pain treatment ladder. The most commonly-used opioid drugs are buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, tramadol, and tapentadol. OBJECTIVES: To provide an overview of the analgesic efficacy of opioids in cancer pain, and to report on adverse events associated with their use. METHODS: We identified systematic reviews examining any opioid for cancer pain published to 4 May 2017 in the Cochrane Database of Systematic Reviews in the Cochrane Library. The primary outcomes were no or mild pain within 14 days of starting treatment, withdrawals due to adverse events, and serious adverse events. MAIN RESULTS: We included nine reviews with 152 included studies and 13,524 participants, but because some studies appeared in more than one review the number of unique studies and participants was smaller than this. Most participants had moderate or severe pain associated with a range of different types of cancer. Studies in the reviews typically compared one type of opioid or formulation with either a different formulation of the same opioid, or a different opioid; few included a placebo control. Typically the reviews titrated dose to effect, a balance between pain relief and adverse events. Various routes of administration of opioids were considered in the reviews; oral with most opioids, but transdermal administration with fentanyl, and buprenorphine. No review included studies of subcutaneous opioid administration. Pain outcomes reported were varied and inconsistent. The average size of included studies varied considerably between reviews: studies of older opioids, such as codeine, morphine, and methadone, had low average study sizes while those involving newer drugs tended to have larger study sizes.Six reviews reported a GRADE assessment (buprenorphine, codeine, hydromorphone, methadone, oxycodone, and tramadol), but not necessarily for all comparisons or outcomes. No comparative analyses were possible because there was no consistent placebo or active control. Cohort outcomes for opioids are therefore reported, as absolute numbers or percentages, or both.Reviews on buprenorphine, codeine with or without paracetamol, hydromorphone, methadone, tramadol with or without paracetamol, tapentadol, and oxycodone did not have information about the primary outcome of mild or no pain at 14 days, although that on oxycodone indicated that average pain scores were within that range. Two reviews, on oral morphine and transdermal fentanyl, reported that 96% of 850 participants achieved that goal.Adverse event withdrawal was reported by five reviews, at rates of between 6% and 19%. Participants with at least one adverse event were reported by three reviews, at rates of between 11% and 77%.Our GRADE assessment of evidence quality was very low for all outcomes, because many studies in the reviews were at high risk of bias from several sources, including small study size. AUTHORS' CONCLUSIONS: The amount and quality of evidence around the use of opioids for treating cancer pain is disappointingly low, although the evidence we have indicates that around 19 out of 20 people with moderate or severe pain who are given opioids and can tolerate them should have that pain reduced to mild or no pain within 14 days. This accords with the clinical experience in treating many people with cancer pain, but overstates to some extent the effectiveness found for the WHO pain ladder. Most people will experience adverse events, and help may be needed to manage the more common undesirable adverse effects such as constipation and nausea. Perhaps between 1 in 10 and 2 in 10 people treated with opioids will find these adverse events intolerable, leading to a change in treatment.
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Dor do Câncer/tratamento farmacológico
Literatura de Revisão como Assunto
[Mh] Termos MeSH secundário: Acetaminofen/administração & dosagem
Acetaminofen/uso terapêutico
Administração Cutânea
Administração Oral
Analgésicos Opioides/administração & dosagem
Analgésicos Opioides/efeitos adversos
Buprenorfina/administração & dosagem
Buprenorfina/uso terapêutico
Codeína/administração & dosagem
Codeína/uso terapêutico
Fentanila/administração & dosagem
Fentanila/uso terapêutico
Seres Humanos
Hidromorfona/administração & dosagem
Hidromorfona/uso terapêutico
Metadona/administração & dosagem
Metadona/uso terapêutico
Oxicodona/administração & dosagem
Oxicodona/uso terapêutico
Fenóis/administração & dosagem
Fenóis/uso terapêutico
Tramadol/administração & dosagem
Tramadol/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Phenols); 362O9ITL9D (Acetaminophen); 39J1LGJ30J (Tramadol); 40D3SCR4GZ (Buprenorphine); CD35PMG570 (Oxycodone); H8A007M585 (tapentadol); Q812464R06 (Hydromorphone); Q830PW7520 (Codeine); UC6VBE7V1Z (Methadone); UF599785JZ (Fentanyl)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012592.pub2


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[PMID]:28651217
[Au] Autor:McCall AK; Palmitessa R; Blumensaat F; Morgenroth E; Ort C
[Ad] Endereço:Eawag, Swiss Federal Institute of Aquatic Science and Technology, CH 8600, Dübendorf, Switzerland.
[Ti] Título:Modeling in-sewer transformations at catchment scale - implications on drug consumption estimates in wastewater-based epidemiology.
[So] Source:Water Res;122:655-668, 2017 Oct 01.
[Is] ISSN:1879-2448
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:To which extent illicit drugs are transformed during in-sewer transport, depends on a number of factors: i) substance-specific transformation rates, ii) environmental conditions, iii) point of discharge (location of drug user) and iv) sewer network properties, primarily hydraulic residence time (HRT) and the ratio of biofilm contact area to wastewater volume (A/V ). Assessing associated uncertainties typically requires numerous simulations. Therefore, we propose a new two-step modeling framework: 1) Quantify hydrodynamic conditions. This computationally demanding step was performed once in SWMM to derive HRT and A/V for each potential point of discharge (node) in three catchments of different size. 2) Estimate biomarker loss. In this step, Monte Carlo simulations were performed for defined scenarios. Depending on assumptions about drug user distribution and prevalence, a number of nodes was sampled. For each node an empirical first-order transformation model was applied with flow-path-corresponding HRT and A/V from step 1. Biotic and abiotic transformation rates were sampled from distributions combining variability of different biofilms. In our modeling study, median losses were >30% for amphetamine, 6-monoacetylmorphine and 6-acetylcodeine in all three catchments with high uncertainty (5%-100% loss), which would imply a systematic underestimation of consumption when neglecting in-sewer processes. Median losses for 21 other investigated biomarkers were <10% with different uncertainty ranges - "no substantial transformation" was confirmed for nine substances in a real sewer segment with a 2-h residence time. Transferability of these results must be tested for other catchments. To further reduce uncertainty, mainly additional knowledge on transformation rates, particularly in biofilm, and their distribution across a sewer network is needed to update model input objectively. Our approach allows efficient testing and, furthermore, can be expanded for many other human biomarkers. Accounting for biomarker stability during in-sewer transport will avoid biased estimates and further improve wastewater-based epidemiology.
[Mh] Termos MeSH primário: Esgotos/química
Águas Residuais
Poluentes Químicos da Água/química
[Mh] Termos MeSH secundário: Anfetamina/química
Codeína/análogos & derivados
Codeína/química
Derivados da Morfina/química
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Morphine Derivatives); 0 (Sewage); 0 (Waste Water); 0 (Water Pollutants, Chemical); 6703-27-1 (acetylcodeine); CK833KGX7E (Amphetamine); M5E47P1ZCH (6-O-monoacetylmorphine); Q830PW7520 (Codeine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170627
[St] Status:MEDLINE


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[PMID]:28586638
[Au] Autor:Best AD; De Silva RK; Thomson WM; Tong DC; Cameron CM; De Silva HL
[Ad] Endereço:Former Oral and Maxillofacial Surgery Registrar, University of Otago, Dunedin, New Zealand. Electronic address: adrianucx@gmail.com.
[Ti] Título:Efficacy of Codeine When Added to Paracetamol (Acetaminophen) and Ibuprofen for Relief of Postoperative Pain After Surgical Removal of Impacted Third Molars: A Double-Blinded Randomized Control Trial.
[So] Source:J Oral Maxillofac Surg;75(10):2063-2069, 2017 Oct.
[Is] ISSN:1531-5053
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The use of opioids in combination with nonopioids is common practice for acute pain management after third molar surgery. One such combination is paracetamol, ibuprofen, and codeine. The authors assessed the efficacy of codeine when added to a regimen of paracetamol and ibuprofen for pain relief after third molar surgery. MATERIALS AND METHODS: This study was a randomized, double-blinded, placebo-controlled trial conducted in patients undergoing the surgical removal of at least 1 impacted mandibular third molar requiring bone removal. Participants were randomly allocated to a control group (paracetamol 1,000 mg and ibuprofen 400 mg) or an intervention group (paracetamol 1,000 mg, ibuprofen 400 mg, and codeine 60 mg). All participants were treated under intravenous sedation and using identical surgical conditions and technique. Postoperative pain was assessed using the visual analog scale (VAS) every 3 hours (while awake) for the first 48 hours after surgery. Pain was globally assessed using a questionnaire on day 3 after surgery. RESULTS: There were 131 participants (36% men; control group, n = 67; intervention group, n = 64). Baseline characteristics were similar for the 2 groups. Data were analyzed using a modified intention-to-treat analysis and, for this, a linear mixed model was used. The model showed that the baseline VAS score was associated with subsequent VAS scores and that, with each 3-hour period, the VAS score increased by an average of 0.08. The treatment effect was not statistically meaningful, indicating there was no difference in recorded pain levels between the 2 groups during the first 48 hours after mandibular third molar surgery. Similarly, the 2 groups did not differ in their global ratings of postoperative pain. CONCLUSION: Codeine 60 mg added to a regimen of paracetamol 1,000 mg and ibuprofen 400 mg does not improve analgesia after third molar surgery.
[Mh] Termos MeSH primário: Acetaminofen/administração & dosagem
Analgésicos não Entorpecentes/administração & dosagem
Analgésicos Opioides/administração & dosagem
Codeína/administração & dosagem
Ibuprofeno/administração & dosagem
Dente Serotino/cirurgia
Manejo da Dor/métodos
Dor Pós-Operatória/tratamento farmacológico
Extração Dentária
Dente Impactado/cirurgia
[Mh] Termos MeSH secundário: Método Duplo-Cego
Quimioterapia Combinada
Feminino
Seres Humanos
Masculino
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Non-Narcotic); 0 (Analgesics, Opioid); 362O9ITL9D (Acetaminophen); Q830PW7520 (Codeine); WK2XYI10QM (Ibuprofen)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; D; IM
[Da] Data de entrada para processamento:170607
[St] Status:MEDLINE


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[PMID]:28369523
[Au] Autor:Winborn J; Kerrigan S
[Ad] Endereço:Department of Forensic Science, Sam Houston State University, Box 2525, 1003 Bowers Blvd, Huntsville, TX 77341, USA.
[Ti] Título:Desomorphine Screening Using Commercial Enzyme-Linked Immunosorbent Assays.
[So] Source:J Anal Toxicol;41(5):455-460, 2017 Jun 01.
[Is] ISSN:1945-2403
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Desomorphine ("Krokodil") is a semi-synthetic opioid that has drawn attention as a recreational drug, particularly in Russia, neighboring former Soviet Republics, Eastern and Central Europe. It has no accepted medicinal uses and is currently a schedule I drug in the United States. In clandestine environments, desomorphine is synthesized from codeine using red phosphorous, hydroiodic acid and gasoline. Residual starting materials in illicit preparations have been associated with severe dermatological effects and extensive tissue necrosis. Desomorphine is not well studied, and there are limited reports concerning its pharmacology or detection in biological matrices. Immunoassays are widely relied upon for both antemortem and postmortem toxicology screening. Although desomorphine is an opioid of the phenanthrene-type, its ability to bind to conventional opioid antibodies has not been described. In this report we describe the cross-reactivity of desomorphine using six commercially available enzyme-linked immunosorbent assays (Immunalysis Opiates Direct ELISA, Immunalysis Oxycodone/Oxymorphone Direct ELISA, Randox Opiate ELISA, OraSure Technologies OTI Opiate Micro-plate EIA, Neogen Opiate Group ELISA and Neogen Oxycodone/Oxymorphone ELISA). Cross-reactivites were highly variable between assays, ranging from 77 to <2.5%. In general, assays directed towards morphine produced greater cross-reactivity with desomorphine than those directed towards oxycodone. The Immunalysis Opiates Direct ELISA produced the greatest cross-reactivity, although several of the assays evaluated produced cross-reactivity of a sufficient magnitude to be effective for desomorphine screening.
[Mh] Termos MeSH primário: Codeína/análogos & derivados
Ensaio de Imunoadsorção Enzimática
Drogas Ilícitas/análise
Detecção do Abuso de Substâncias/métodos
[Mh] Termos MeSH secundário: Analgésicos Opioides
Codeína/análise
Seres Humanos
Oxicodona
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Street Drugs); 7OP86J5E33 (desomorphine); CD35PMG570 (Oxycodone); Q830PW7520 (Codeine)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170404
[St] Status:MEDLINE
[do] DOI:10.1093/jat/bkx024


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[PMID]:28328759
[Au] Autor:Tolska HK; Takala A; Blomgren K; Hamunen K; Kontinen V
[Ad] Endereço:From the *Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, †Division of Otorhinolaryngology, Department of Head and Neck Surgery, and ‡Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
[Ti] Título:Topical Ropivacaine in Prevention of Post-Tonsillectomy Pain in Adults.
[So] Source:Anesth Analg;124(5):1459-1466, 2017 May.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Post-tonsillectomy pain is 1 of the most intense postoperative pain conditions. However, optimal and sufficient postoperative analgesic treatment remains unclear. We investigated the effect of topical ropivacaine for post-tonsillectomy pain in 160 adult outpatient surgery patients over 2 postoperative weeks. METHODS: At the end of tonsillectomy, 2 swabs soaked in either 1% ropivacaine or saline were packed into the tonsillar beds for 5 minutes. We used ibuprofen and a combination of acetaminophen (500 mg)-codeine (30 mg) tablets as postoperative analgesics for 2 weeks. The primary outcome was pain intensity on swallowing measured on a numeric rating scale (NRSs) during the first postoperative week expressed as area under curve (AUC). The secondary endpoints included the worst pain experienced during the 2-hour follow-up in the postanesthesia care unit, pain intensity during the second postoperative week, and the number of ibuprofen and acetaminophen-codeine tablets consumed during the 2 postoperative weeks. RESULTS: During the first postoperative week, 120 patients out of 160 (75%) provided complete results, including data on their use of analgesics according to the instructions as well as completed and returned a questionnaire daily. A total of 101 patients (63%) did the same during the second postoperative week.Median (interquartile range [IQR]) of the primary outcome NRSs (AUC) was 38 (19) for the ropivacaine group and 37 (24) for the control group during the first postoperative week (P = .77, -1.0 estimated difference; 95% confidence interval [CI] for the difference, -7.0 to 5.0); no difference was found. Median (IQR) of NRS at rest (NRSr) (AUC) was 24.5 (19) for the ropivacaine group and 24 (22) for the control group during the first postoperative week (P = .96, 0.0 estimated difference; 95% CI for the difference, -5.0 to 5.0); no difference was found. Median (IQR) of the worst pain intensity values (NRSs or NRSr) (AUC) was 5 (3) for the ropivacaine group and 5 (3) for the control group (P = .44, 0.0 estimated difference; 95% CI for the difference, -1.0 to 0.5); no difference was found. During the second postoperative week, median (IQR) of the NRSs (AUC) was 17 (13) for the ropivacaine group and 21 (23) for the control group (P = .05, -4.0 estimated difference; 95% CI for the difference, -9.0 to 0.0) and median (IQR) of the NRSr (AUC) 10.5 (10) for ropivacaine group and 11 (13) for the control group (P = .42, -1.0 estimated difference; 95% CI for the difference, -5.0 to 2.0); no difference was found.The number of rescue analgesics (acetaminophen-codeine tablets) consumed during the second postoperative week was lower in the ropivacaine group than in the control group (median [IQR] of the consumption [AUC] was 10 [12] for the ropivacaine group and 16 [12] for the control group; P = .0008, -7.0 estimated difference; 95% CI of difference, -10 to -3.0). The groups showed no differences in overall risk for post-tonsillectomy bleeding. However, bleeding requiring hemostasis under local anesthesia was more common in the ropivacaine group (18% vs 8%, P = .048, 10% estimated difference; 95% CI for the difference, 0%-21%). CONCLUSIONS: Topical ropivacaine failed to reduce pain intensity during the first postoperative week. We observed no major adverse effects.
[Mh] Termos MeSH primário: Amidas/administração & dosagem
Amidas/uso terapêutico
Anestésicos Locais/administração & dosagem
Anestésicos Locais/uso terapêutico
Dor Pós-Operatória/prevenção & controle
Tonsilectomia/efeitos adversos
[Mh] Termos MeSH secundário: Acetaminofen/uso terapêutico
Adolescente
Adulto
Procedimentos Cirúrgicos Ambulatórios
Analgésicos não Entorpecentes/uso terapêutico
Analgésicos Opioides/uso terapêutico
Anti-Inflamatórios não Esteroides/uso terapêutico
Codeína/uso terapêutico
Combinação de Medicamentos
Feminino
Seres Humanos
Ibuprofeno/uso terapêutico
Masculino
Meia-Idade
Medição da Dor/efeitos dos fármacos
Hemorragia Pós-Operatória/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amides); 0 (Analgesics, Non-Narcotic); 0 (Analgesics, Opioid); 0 (Anesthetics, Local); 0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Drug Combinations); 0 (acetaminophen, codeine drug combination); 362O9ITL9D (Acetaminophen); 7IO5LYA57N (ropivacaine); Q830PW7520 (Codeine); WK2XYI10QM (Ibuprofen)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170323
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002015


  9 / 3761 MEDLINE  
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[PMID]:28253826
[Au] Autor:Wang S; Dong Y; Su K; Zhang J; Wang L; Han A; Wen C; Wang X; He Y
[Ad] Endereço:a The Laboratory of Clinical Pharmacy , The People's Hospital of Lishui , Lishui , China.
[Ti] Título:Effect of codeine on CYP450 isoform activity of rats.
[So] Source:Pharm Biol;55(1):1223-1227, 2017 Dec.
[Is] ISSN:1744-5116
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:CONTEXT: Codeine, also known as 3-methylmorphine, is an opiate used to treat pain, as a cough medicine and for diarrhoea. No study on the effects of codeine on the metabolic capacity of CYP enzyme is reported. OBJECTIVE: In order to investigate the effects of codeine on the metabolic capacity of cytochrome P450 (CYP) enzymes, a cocktail method was employed to evaluate the activities of CYP2B1, CYP2D1, CYP1A2, CYP3A2 and CYP2C11. MATERIALS AND METHODS: Sprague-Dawley rats were randomly divided into codeine group (low, medium, high) and control group. The codeine group rats were given 4, 8, 16 mg/kg (low, medium, high) codeine by continuous intragastric administration for 14 days. Five probe drugs bupropion, metroprolol, phenacetin, midazolam and tolbutamide were given to rats through intragastric administration, and the plasma concentrations were determined by UPLC-MS/MS. RESULTS AND CONCLUSION: The pharmacokinetic parameters of bupropion and metroprolol experienced obvious change with AUC , C increased and CL decreased for bupropion in medium dosage group and midazolam low dosage group. This result indicates that the 14 day-intragastric administration of codeine may inhibit the metabolism of bupropion (CYP2B1) and midazolam (CYP3A2) in rat. Additional, there are no statistical differences for albumin (ALB), alkaline phosphatase (ALP), creatinine (Cr) after 14 intragastric administration of codeine, while alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA) increased compared to control group. The biomedical test results show continuous 14 day-intragastric administration of codeine would cause liver damage.
[Mh] Termos MeSH primário: Codeína/metabolismo
Codeína/farmacologia
Sistema Enzimático do Citocromo P-450/metabolismo
[Mh] Termos MeSH secundário: Animais
Bupropiona/metabolismo
Relação Dose-Resposta a Droga
Interações Medicamentosas/fisiologia
Ativação Enzimática/efeitos dos fármacos
Ativação Enzimática/fisiologia
Isoenzimas/metabolismo
Masculino
Distribuição Aleatória
Ratos
Ratos Sprague-Dawley
Tolbutamida/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Isoenzymes); 01ZG3TPX31 (Bupropion); 9035-51-2 (Cytochrome P-450 Enzyme System); 982XCM1FOI (Tolbutamide); Q830PW7520 (Codeine)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170313
[Lr] Data última revisão:
170313
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170304
[St] Status:MEDLINE
[do] DOI:10.1080/13880209.2017.1297466


  10 / 3761 MEDLINE  
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[PMID]:28226338
[Au] Autor:Karaman H; Tufek A; Karaman E; Tokgoz O
[Ad] Endereço:Dept. of Pain Management Center, Dicle University.
[Ti] Título:Opioids Inhibit Angiogenesis in a Chorioallantoic Membrane Model.
[So] Source:Pain Physician;20(2S):SE11-SE21, 2017 Feb.
[Is] ISSN:2150-1149
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Angiogenesis is an important characteristic of cancer. Switching from the avascular phase to the vascular phase is a necessary process for tumor growth. Therefore, research in cancer treatment has focused on angiogenesis as a drug target. Despite the widespread use of opioids to treat pain in patients with cancer, little is known about the effect of these drugs on vascular endothelium and angiogenesis. OBJECTIVES: We aimed to investigate the efficacies of morphine, codeine, and tramadol in 3 different concentrations on angiogenesis in hens' eggs. STUDY DESIGN: This is a prospective, observational, controlled, in-vivo animal study. SETTING: Single academic medical center. METHODS: This study was conducted on the chorioallantoic membrane (CAM) of fertilized hens' eggs. The efficacies of morphine, codeine, and tramadol in 3 different concentrations were evaluated on angiogenesis in a total of 165 hens' eggs. RESULTS: Statistically significant differences were found between drug-free agarose used as a negative control and concentrations of morphine of 10 µM and 1 µM, a concentration of tramadol of 10 µM, and concentrations of codeine of 10 µM and 1 µM. Concentrations of morphine of 10 µM and 1 µM showed strong antiangiogenic effects. While codeine had strong antiangiogenic effects at high concentrations, at 0.1 µM it was shown to have weak antiangiogenic effects. However, tramadol at a concentration of 10 µM had only weak antiangiogenic effects. LIMITATIONS: This is just a CAM model study. CONCLUSION: In this study, we tested the effects of 3 different opioid drugs on angiogenesis in 3 different concentrations, and we observed that morphine was a good anti-angiogenic agent, but tramadol and codeine only had anti-angiogenic effects at high doses.Key Words: Morphine, codeine, tramadol, opioid, bevacizumab, chorioallantoic membrane (CAM), angiogenesis.
[Mh] Termos MeSH primário: Analgésicos Opioides/farmacologia
Membrana Corioalantoide/irrigação sanguínea
Neovascularização Patológica/tratamento farmacológico
[Mh] Termos MeSH secundário: Animais
Galinhas
Codeína/farmacologia
Feminino
Seres Humanos
Estudos Prospectivos
Tramadol/farmacologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 39J1LGJ30J (Tramadol); Q830PW7520 (Codeine)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170223
[St] Status:MEDLINE



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