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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]:28655025
[Au] Autor:Walsh SL; Comer SD; Lofwall MR; Vince B; Levy-Cooperman N; Kelsh D; Coe MA; Jones JD; Nuzzo PA; Tiberg F; Sheldon B; Kim S
[Ad] Endereço:Center on Drug and Alcohol Research, University of Kentucky, Lexington.
[Ti] Título:Effect of Buprenorphine Weekly Depot (CAM2038) and Hydromorphone Blockade in Individuals With Opioid Use Disorder: A Randomized Clinical Trial.
[So] Source:JAMA Psychiatry;74(9):894-902, 2017 Sep 01.
[Is] ISSN:2168-6238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Buprenorphine is an efficacious, widely used treatment for opioid use disorder (OUD). Daily oral transmucosal formulations can be associated with misuse, diversion, and nonadherence; these limitations may be obviated by a sustained release formulation. Objective: To evaluate the ability of a novel, weekly, subcutaneous buprenorphine depot formulation, CAM2038, to block euphorigenic opioid effects and suppress opioid withdrawal in non-treatment-seeking individuals with OUD. Design, Setting, and Participants: This multisite, double-blind, randomized within-patient study was conducted at 3 controlled inpatient research facilities. It involved 47 adults with DSM-V moderate-to-severe OUD. The study was conducted from October 12, 2015 (first patient enrolled), to April 21, 2016 (last patient visit). Interventions: A total of five 3-day test sessions evaluated the response to hydromorphone (0, 6, and 18 mg intramuscular in random order; 1 dose/session/day). After the first 3-day session (ie, qualification phase), participants were randomized to either CAM2038 weekly at 24 mg (n = 22) or 32 mg (n = 25); the assigned CAM2038 dose was given twice, 1 week apart (day 0 and 7). Four sets of sessions were conducted after randomization (days 1-3, 4-6, 8-10, and 11-13). Main Outcomes and Measures: The primary end point was maximum rating on the visual analog scale for drug liking. Secondary end points included other visual analog scale (eg, high and desire to use), opioid withdrawal scales, and physiological and pharmacokinetic outcomes. Results: A total of 46 of 47 randomized participants (mean [SD] age, 35.5 [9] years; 76% male [n = 35]) completed the study. Both weekly CAM2038 doses produced immediate and sustained blockade of hydromorphone effects (liking maximum effect, CAM2038, 24 mg: effect size, 0.813; P < .001, and CAM2038, 32 mg: effect size, 0.753; P < .001) and suppression of withdrawal (Clinical Opiate Withdrawal Scale, CAM2038, 24 mg: effect size, 0.617; P < .001, and CAM2038, 32 mg: effect size, 0.751; P < .001). CAM2038 produces a rapid initial rise of buprenorphine in plasma with maximum concentration around 24 hours, with an apparent half-life of 4 to 5 days and approximately 50% accumulation of trough concentration from first to second dose (trough concentration = 0.822 and 1.23 ng/mL for weeks 1 and 2, respectively, with 24 mg; trough concentration = 0.993 and 1.47 ng/mL for weeks 1 and 2, respectively, with 32 mg). Conclusions and Relevance: CAM2038 weekly, 24 and 32 mg, was safely tolerated and produced immediate and sustained opioid blockade and withdrawal suppression. The results support the use of this depot formulation for treatment initiation and stabilization of patients with OUD, with the further benefit of obviating the risk for misuse and diversion of daily buprenorphine while retaining its therapeutic benefits. Trial Registration: Clinicaltrials.gov Identifier: NCT02611752.
[Mh] Termos MeSH primário: Buprenorfina/uso terapêutico
Hidromorfona/antagonistas & inibidores
Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Analgésicos Opioides/antagonistas & inibidores
Buprenorfina/efeitos adversos
Buprenorfina/farmacocinética
Preparações de Ação Retardada/uso terapêutico
Método Duplo-Cego
Feminino
Seres Humanos
Masculino
Meia-Idade
Antagonistas de Entorpecentes/uso terapêutico
Síndrome de Abstinência a Substâncias/tratamento farmacológico
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Delayed-Action Preparations); 0 (Narcotic Antagonists); 40D3SCR4GZ (Buprenorphine); Q812464R06 (Hydromorphone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170628
[St] Status:MEDLINE
[do] DOI:10.1001/jamapsychiatry.2017.1874


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[PMID]:28606595
[Au] Autor:Davis C; Geik C; Arthur K; Fuller J; Johnston E; Levitt F; Leung E; McCart G; McMichael D; Painter J; Staublin T; Walroth T
[Ad] Endereço:Eskenazi Health, Indianapolis, Indiana. Electronic address: christina.davis@eskenazihealth.edu.
[Ti] Título:A Multisite Retrospective Study Evaluating the Implementation of the Pasero Opioid-Induced Sedation Scale (POSS) and Its Effect on Patient Safety Outcomes.
[So] Source:Pain Manag Nurs;18(4):193-201, 2017 Aug.
[Is] ISSN:1532-8635
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The Joint Commission recommended the Pasero Opioid-induced Sedation Scale (POSS) to minimize opioid-induced respiratory depression. However, there is a paucity of data describing its impact on patient safety. This study assessed the impact of POSS implementation or reeducation on naloxone use in patients receiving hydromorphone. This retrospective, Institutional Review Board-approved study performed with the Indianapolis Coalition for Patient Safety was conducted in two phases, 3 months before and after intervention. The intervention was POSS implementation or reeducation at six sites in a variety of practice settings. A total of 212 patients were evaluated. For the primary endpoint, naloxone use occurred in 1.9% of patients in each group and occurred in 3.1 versus 3.5 patients per 1,000 patient days pre- versus postintervention (p = .902). For secondary endpoints, POSS documentation increased post- versus preintervention, 78.1% versus 26.4% (p < .001). More patients experienced unintended sedation based on the Richmond Agitation and Sedation Scale or POSS post- versus preintervention, 12.2% versus 3.8% (p = .04). When the POSS was used, unintended sedation was likely detected before respiratory depression occurred and before naloxone was required. The lack of change in naloxone use and increased sedation postintervention may reflect that a POSS score 3 or 4 is a better marker of unintended sedation and should be considered as an endpoint instead of naloxone in future studies. The implementation or reeducation of the POSS at six area health-systems resulted in increased documentation of POSS and opioid-induced unintended sedation detection with no change in naloxone use.
[Mh] Termos MeSH primário: Hidromorfona/efeitos adversos
Hipnóticos e Sedativos/análise
Avaliação de Resultados (Cuidados de Saúde)
Segurança do Paciente/normas
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Hidromorfona/uso terapêutico
Hipnóticos e Sedativos/efeitos adversos
Hipnóticos e Sedativos/uso terapêutico
Masculino
Meia-Idade
Naloxona/farmacologia
Naloxona/uso terapêutico
Antagonistas de Entorpecentes/farmacologia
Antagonistas de Entorpecentes/uso terapêutico
Manejo da Dor/efeitos adversos
Manejo da Dor/métodos
Manejo da Dor/estatística & dados numéricos
Segurança do Paciente/estatística & dados numéricos
Insuficiência Respiratória/tratamento farmacológico
Insuficiência Respiratória/prevenção & controle
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); 0 (Narcotic Antagonists); 36B82AMQ7N (Naloxone); Q812464R06 (Hydromorphone)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE


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[PMID]:28405945
[Au] Autor:Swart LM; van der Zanden V; Spies PE; de Rooij SE; van Munster BC
[Ad] Endereço:Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. l.m.swart@amc.uva.nl.
[Ti] Título:The Comparative Risk of Delirium with Different Opioids: A Systematic Review.
[So] Source:Drugs Aging;34(6):437-443, 2017 Jun.
[Is] ISSN:1179-1969
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: There is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the various opioids remains controversial. In this systematic review, we evaluate and discuss possible differences in the risk of delirium from the use of various types of opioids in older patients. METHODS: We performed a search in MEDLINE by combining search terms on delirium and opioids. A specific search filter for use in geriatric medicine was used. Quality was scored according to the quality assessment for cohort studies of the Dutch Cochrane Institute. RESULTS: Six studies were included, all performed in surgical departments and all observational. No study was rated high quality, one was rated moderate quality, and five were rated low quality. Information about dose, route, and timing of administration of the opioid was frequently missing. Pain and other important risk factors of delirium were often not taken into account. Use of tramadol or meperidine was associated with an increased risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and codeine were not, when compared with no opioid. Meperidine was also associated with an increased risk of delirium compared with other opioids, whereas tramadol was not. The risk of delirium appeared to be lower with hydromorphone or fentanyl, compared with other opioids. Numbers used for comparisons were small. CONCLUSION: Some data suggest that meperidine may lead to a higher perioperative risk for delirium; however, high-quality studies that compare different opioids are lacking. Further comparative research is needed.
[Mh] Termos MeSH primário: Analgésicos Opioides/efeitos adversos
Delírio/induzido quimicamente
Medição da Dor/métodos
Dor/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Analgésicos Opioides/uso terapêutico
Seres Humanos
Hidromorfona/efeitos adversos
Hidromorfona/uso terapêutico
Meperidina/efeitos adversos
Meperidina/uso terapêutico
Morfina/efeitos adversos
Morfina/uso terapêutico
Oxicodona/efeitos adversos
Oxicodona/uso terapêutico
Fatores de Risco
Tramadol/efeitos adversos
Tramadol/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); 39J1LGJ30J (Tramadol); 76I7G6D29C (Morphine); 9E338QE28F (Meperidine); CD35PMG570 (Oxycodone); Q812464R06 (Hydromorphone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170915
[Lr] Data última revisão:
170915
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170414
[St] Status:MEDLINE
[do] DOI:10.1007/s40266-017-0455-9


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[PMID]:28287363
[Au] Autor:Wahler RG; Smith DB; Mulcahy KB
[Ti] Título:Nebulized Fentanyl for Dyspnea in a Hospice Patient with True Allergy to Morphine and Hydromorphone.
[So] Source:J Pain Palliat Care Pharmacother;31(1):38-42, 2017 Mar.
[Is] ISSN:1536-0539
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:An 86-year-old white female was admitted to hospice care with lung cancer. Even with optimal medical management, she suffered from dyspnea and required opioid therapy. However, the patient had a true morphine and hydromorphone allergy. She was administered nebulized fentanyl for symptomatic relief of dyspnea with good effect and she did not experience any allergic response.
[Mh] Termos MeSH primário: Hipersensibilidade a Drogas
Dispneia/tratamento farmacológico
Fentanila/uso terapêutico
Cuidados Paliativos na Terminalidade da Vida
[Mh] Termos MeSH secundário: Administração por Inalação
Idoso de 80 Anos ou mais
Feminino
Fentanila/administração & dosagem
Seres Humanos
Hidromorfona/efeitos adversos
Morfina/efeitos adversos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
76I7G6D29C (Morphine); Q812464R06 (Hydromorphone); UF599785JZ (Fentanyl)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170314
[St] Status:MEDLINE
[do] DOI:10.1080/15360288.2017.1279499


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[PMID]:28143397
[Au] Autor:Naik BI; Tsang S; Knisely A; Yerra S; Durieux ME
[Ad] Endereço:Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA. bin4n@virginia.edu.
[Ti] Título:Retrospective case-control non-inferiority analysis of intravenous lidocaine in a colorectal surgery enhanced recovery program.
[So] Source:BMC Anesthesiol;17(1):16, 2017 Jan 31.
[Is] ISSN:1471-2253
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Enhanced recovery after surgery (ERAS) programs typically utilizes multi-modal analgesia to reduce perioperative opioid consumption. Systemic lidocaine is used in several of these ERAS algorithms and has been shown to reduce opioid use after colorectal surgery. However it is unclear how much the other components of an ERAS protocol contribute to the final outcome. Using a noninferiority analysis we sought to assess the role of perioperative lidocaine in an ERAS program for colorectal surgery, using pain and opioid consumption as outcomes. METHODS: We conducted a retrospective review of patients who had received intravenous lidocaine perioperatively during colorectal surgery. We matched them with patients who were managed using a multi-component ERAS protocol, which included perioperative lidocaine. We tested a joint hypothesis of noninferiority of lidocaine infusion to ERAS protocol in postoperative pain scores and opioid consumption. We assigned a noninferiority margin of 1 point (on an 11-point numerical rating scale) difference in pain and a ratio [mean (lidocaine) / mean (ERAS)] of 1.2 in opioid consumption, respectively. RESULTS: Fifty-two patients in the lidocaine group were matched with patients in the ERAS group. With regards to opioid consumption, in the overall [1.68 (1.43-1.98)] [odds ratio (95% confidence interval)] analysis and on postoperative day (POD) 1 [2.38 (1.74-3.31)] lidocaine alone was inferior to multi-modal analgesia. On POD 2 and beyond, although the mean odds ratio for opioid consumption was 1.43 [1.43 (1.17-1.73)], the lower limit extended beyond the pre-defined cut-off of 1.2, rendering the outcome inconclusive. For pain scores lidocaine is non-inferior to ERAS [-0.17 (-1.08-0.74)] on POD 2 and beyond. Pain scores on POD 1 and in the overall cohort were inconclusive based on the noninferiority analysis. CONCLUSIONS: The addition of a multi-component ERAS protocol to intravenous lidocaine incrementally reduces opioid consumption, most evident on POD 1. For pain scores the data is inconclusive on POD 1, however on POD 2 and beyond lidocaine alone is non-inferior to an ERAS program with lidocaine. Opioid-related complications, including return of bowel function, were not different between the groups despite reduced opioid use in the ERAS group.
[Mh] Termos MeSH primário: Anestésicos Locais/administração & dosagem
Procedimentos Cirúrgicos do Sistema Digestório
Lidocaína/administração & dosagem
Dor Pós-Operatória/prevenção & controle
[Mh] Termos MeSH secundário: Analgesia Controlada pelo Paciente
Analgésicos Opioides/administração & dosagem
Estudos de Casos e Controles
Deambulação Precoce
Feminino
Seres Humanos
Hidromorfona/administração & dosagem
Infusões Intravenosas
Período Intraoperatório
Tempo de Internação
Masculino
Meia-Idade
Medição da Dor
Melhoria de Qualidade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Anesthetics, Local); 98PI200987 (Lidocaine); Q812464R06 (Hydromorphone)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170202
[St] Status:MEDLINE
[do] DOI:10.1186/s12871-017-0306-6


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[PMID]:28012310
[Au] Autor:Mazák K; Hosztafi S; Kraszni M; Noszál B
[Ad] Endereço:Semmelweis University, Department of Pharmaceutical Chemistry, Research Group of Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences, Hogyes E. u. 9., H-1092 Budapest, Hungary. Electronic address: mazak.karoly@pharma.semmelweis-univ.hu.
[Ti] Título:Physico-chemical profiling of semisynthetic opioids.
[So] Source:J Pharm Biomed Anal;135:97-105, 2017 Feb 20.
[Is] ISSN:1873-264X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Species-specific acid-base and partition equilibrium constants were experimentally determined for the therapeutically important semisynthetic opioid receptor agonist hydromorphone, dihydromorphine, and mixed agonist-antagonist nalorphine and nalbuphine. The acid-base microequilibria were characterized by combining pH-potentiometry and deductive methods using synthesized auxiliary compounds. Independent of the pH, there are approximately 4.8 times as many zwitterionic microspecies than non-charged ones in nalbuphine solutions, while for nalorphine it is the non-charged form that predominates by the same ratio. The non-charged microspecies is the dominant one also in the case of hydromorphone, although its concentration exceeds only 1.3 times that of its zwitterionic protonation isomer. The pH-independent partition coefficients of the individual microspecies were determined by a combination of experimentally measured, pH-dependent, conditional distribution constants and a custom-tailored evaluation method, using highly similar auxiliary compounds. The pH-independent contribution of the zwitterionic microspecies to the distribution constant is 1380, 1070, 3160 and 72,440 times smaller than that of the inherently more lipophilic non-charged one for hydromorphone, dihydromorphine, nalbuphine and nalorphine, respectively.
[Mh] Termos MeSH primário: Analgésicos Opioides/química
Fenômenos Químicos
Di-Hidromorfina/química
Hidromorfona/química
Nalbufina/química
Nalorfina/química
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); C3S5FRP6JW (Dihydromorphine); L2T84IQI2K (Nalbuphine); Q812464R06 (Hydromorphone); U59WB2WRY2 (Nalorphine)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170524
[Lr] Data última revisão:
170524
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161225
[St] Status:MEDLINE


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[PMID]:27878902
[Au] Autor:Hong RA; Gibbons KM; Li GY; Holman A; Voepel-Lewis T
[Ad] Endereço:Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
[Ti] Título:A retrospective comparison of intrathecal morphine and epidural hydromorphone for analgesia following posterior spinal fusion in adolescents with idiopathic scoliosis.
[So] Source:Paediatr Anaesth;27(1):91-97, 2017 Jan.
[Is] ISSN:1460-9592
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Posterior spinal fusion to correct idiopathic scoliosis is associated with severe postoperative pain. Intrathecal morphine is commonly used for analgesia after adolescent posterior spinal fusion; however, anticipating and managing the increase in pain scores after resolution of analgesic effect of intrathecal morphine analgesia is challenging. In 2014, we developed a clinical protocol detailing both the administration of intrathecal morphine intraoperatively and the transition to routine, scheduled oral analgesics at 18 h postoperatively. The goal of our study was to examine the efficacy of our intrathecal morphine protocol vs epidural hydromorphone for postoperative analgesia after posterior spinal fusion. METHODS: Following IRB approval, we retrospectively identified developmentally intact children of ages 10-20 years in our electronic database with a diagnosis of idiopathic scoliosis who had undergone elective posterior spinal fusion surgery from June 2014 to April 2015. For the intrathecal morphine group, intrathecal morphine was administered in a dose of 12 µg·kg (max 1000 µg) prior to incision. Postoperatively, all children in the intrathecal morphine group had an order to receive oral oxycodone (0.1 mg·kg , max 5 mg) starting at 18 h postintrathecal morphine injection. For the epidural hydromorphone group, catheters were placed by the surgeon and bolused with 5 µg·kg hydromorphone (max 200 µg) and 1 µg·kg fentanyl (max 50 µg), followed by a continuous infusion of 40-60 µg·h , and patient-controlled bolus doses of 5 µg with a lockout interval of 30 min. All patients in both groups had postoperative orders for acetaminophen, diazepam, and ketorolac. RESULTS: During the study time period, 20 patients received intrathecal morphine and were successfully matched with 20 patients who received epidural hydromorphone. All patients in the intrathecal morphine group were transitioned to oral analgesics on the first postoperative day, without need for intravenous opioids after discharge from the postanesthesia care unit. Compared to the epidural hydromorphone group, the intrathecal morphine group reported lower pain scores in the postanesthesia care unit (difference in means -4.26 [95% CI -6.56, -1.96], P = 0.001) and first 8 h after surgery (difference in means -1.88 [95% CI -3.84, 0.082, P = 0.060) and higher pain scores on the 2nd postoperative day (difference in means 1.60 [95% CI 0.10, 3.10], P = 0.037). The documented time to ambulation and time of Foley catheter removal were statistically earlier in the intrathecal morphine group, and the hospital length of stay was significantly shorter (3.0 ± 0.5 days vs 3.5 ± 0.7 days; P = 0.03). Adverse events did not significantly differ between the groups. CONCLUSION: The efficacy of intraoperative intrathecal morphine for postoperative analgesia in the posterior spinal fusion patient population has been shown previously; however, the pain and analgesic trajectory, including transition to other analgesics, has not previously been studied. Our findings suggest that for many patients, use of intrathecal morphine in addition to routine administration of nonopioid medications facilitates direct transition to oral analgesics in the early postoperative period and earlier routine ambulation and discharge of posterior spinal fusion patients.
[Mh] Termos MeSH primário: Analgesia Epidural/métodos
Hidromorfona/uso terapêutico
Morfina/uso terapêutico
Dor Pós-Operatória/tratamento farmacológico
Escoliose/cirurgia
Fusão Vertebral
[Mh] Termos MeSH secundário: Adolescente
Adulto
Analgésicos Opioides/uso terapêutico
Criança
Feminino
Seres Humanos
Injeções Espinhais
Masculino
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 76I7G6D29C (Morphine); Q812464R06 (Hydromorphone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161124
[St] Status:MEDLINE
[do] DOI:10.1111/pan.13037


  9 / 1061 MEDLINE  
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[PMID]:27839957
[Au] Autor:Politi JR; Davis RL; Matrka AK
[Ad] Endereço:Department of Orthopedic Surgery, Mount Carmel Health, Orthopedic One, Columbus, Ohio.
[Ti] Título:Randomized Prospective Trial Comparing the Use of Intravenous versus Oral Acetaminophen in Total Joint Arthroplasty.
[So] Source:J Arthroplasty;32(4):1125-1127, 2017 Apr.
[Is] ISSN:1532-8406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Multimodal pain management has had a significant effect on improving total joint arthroplasty recovery and patient satisfaction. There is literature supporting that intravenous (IV) acetaminophen reduces postoperative pain and narcotic use in the total joint population. However, there are no studies comparing the effectiveness of IV vs oral (PO) acetaminophen as part of a standard multimodal perioperative pain regimen. METHODS: One hundred twenty patients undergoing hip and knee arthroplasty surgeries performed by one joint arthroplasty surgeon were prospectively randomized into 2 groups. Group 1 (63 patients) received IV and group 2 (57 patients) received PO acetaminophen in addition to a standard multimodal perioperative pain regimen. Each group received 1 gram of acetaminophen preoperatively and then every 6 hours for 24 hours. Total narcotic use and visual analog scale (VAS) scores were collected every 4 hours postoperatively. RESULTS: The 24-hour average hydromorphone equivalents given were not different between groups (3.71 vs 3.48) at 24 hours (P = .76), or at any of the individual 4-hour intervals. The 24-hour average visual analog scale scores in group 1 (IV) was 3.00 and in group 2 (PO) was 3.40 (P = .06). None of the 4-hour intervals were significantly different except the first interval (0-4 hour postoperatively), which favored the IV group (P = .03). CONCLUSION: The use of IV acetaminophen may have a role when given intraoperatively to reduce the immediate pain after surgery. Following that, it does not provide a significant benefit in reducing pain or narcotic use when compared with the much less expensive PO form.
[Mh] Termos MeSH primário: Acetaminofen/administração & dosagem
Analgésicos não Entorpecentes/administração & dosagem
Artroplastia de Substituição
Dor Pós-Operatória/tratamento farmacológico
[Mh] Termos MeSH secundário: Administração Intravenosa
Administração Oral
Analgésicos Opioides/administração & dosagem
Quimioterapia Combinada
Seres Humanos
Hidromorfona/administração & dosagem
Medição da Dor
Estudos Prospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Non-Narcotic); 0 (Analgesics, Opioid); 362O9ITL9D (Acetaminophen); Q812464R06 (Hydromorphone)
[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:161115
[St] Status:MEDLINE


  10 / 1061 MEDLINE  
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[PMID]:27810148
[Au] Autor:Bryskin RB; Robie DK; Mansfield FM; Freid EB; Sukumvanich S
[Ad] Endereço:Department of Anesthesiology, Nemours Children's Clinic, Jacksonville, FL, USA,. Electronic address: RBryskin@Nemours.org.
[Ti] Título:Introduction of a novel ultrasound-guided extrathoracic sub-paraspinal block for control of perioperative pain in Nuss procedure patients.
[So] Source:J Pediatr Surg;52(3):484-491, 2017 Mar.
[Is] ISSN:1531-5037
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A safe and effective method of multilevel thoracic pain control remains an elusive goal in patients undergoing the Nuss procedure. The aim of our study was to develop a nonopioid centered approach using a novel regional technique as part of a quality improvement initiative. METHODS: The proposed ultrasound-guided technique positions multi-perforated soaker catheter deep to the paraspinal muscles from T2 to T11. The project was conducted in two phases. First, a cadaveric dissection was performed to establish the pathway of spread of local anesthetic in vivo. Second, a pilot double blind randomized control project was conducted to evaluate effectiveness of the technique in ten patients and to derive parameters necessary for the definitive future study. Outcomes were evaluated based on the narcotic requirement, pain scores and functional measures. RESULTS: Placement of the catheters in two cadavers demonstrated reliable positioning in the subparaspinal tissue plane, and multilevel dye spread along the intercostal nerve path. In addition, a potential route of spread toward the paravertebral space along the canal accommodating dorsal ramus of the thoracic nerve was demonstrated. The pilot trial demonstrated a trend in decreased cumulative hydromorphone requirement in comparison to the control group at both 24h (0.19±0.09mg/kg vs. 0.13±0.08mg/kg p=0.72) and 48h (0.37±0.2mg/kg vs. 0.3±0.12mg/kg p=0.37). Functional performance ability was higher in the treatment group on both POD#1 (6.7±1.8 vs. 4.8±1 p=0.0495) and POD#2 (8.9±0.8 vs. 6.5±1.2 p=0.04). Pain scores were similar among the two groups (p=0.96). CONCLUSIONS: We describe a new technique to treat multilevel thoracic pain following the Nuss procedure that is reproducible, safe, allows diminished opioid use and enhances functional recovery.
[Mh] Termos MeSH primário: Tórax em Funil/cirurgia
Bloqueio Nervoso/métodos
Manejo da Dor/métodos
Medição da Dor/métodos
Dor Pós-Operatória/prevenção & controle
Ultrassonografia de Intervenção/métodos
[Mh] Termos MeSH secundário: Adolescente
Analgésicos Opioides/administração & dosagem
Cadáver
Cateteres
Método Duplo-Cego
Feminino
Seres Humanos
Hidromorfona/administração & dosagem
Músculos Intercostais/anatomia & histologia
Músculos Intercostais/diagnóstico por imagem
Nervos Intercostais
Masculino
Projetos Piloto
Tórax/anatomia & histologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); Q812464R06 (Hydromorphone)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170426
[Lr] Data última revisão:
170426
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161105
[St] Status:MEDLINE



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