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[PMID]:29363349
[Au] Autor:Van Donge T; Mian P; Tibboel D; Van Den Anker J; Allegaert K
[Ad] Endereço:a Intensive Care and Department of Paediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands.
[Ti] Título:Drug metabolism in early infancy: opioids as an illustration.
[So] Source:Expert Opin Drug Metab Toxicol;14(3):287-301, 2018 Mar.
[Is] ISSN:1744-7607
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Drug dosing in infants frequently depends on body weight as a crude indicator for maturation. Fentanyl (metabolized by Cytochrome P450 3A4) and morphine (glucuronidated by UDP-glucuronosyltransferase-2B7) served as model drugs to provide insight in maturation patterns of these enzymes and provide understanding of the impact of non-maturational factors to optimize dosing in infants. Areas covered: Systematic searches on metabolism and population pharmacokinetic (Pop-PK) models for fentanyl and morphine were performed. Pre- and post-model selection criteria were applied to assess and evaluate the validity of these models. It was observed that maturational changes have been rather well investigated, be it with variability in the maturational function estimates. The same holds true for Pop-PK models, where non-maturational covariates have also been reported (pharmacogenetics, disease state or external influences), although less incorporated in the PK models and with limited knowledge on mechanisms involved. Expert opinion: PK models for fentanyl and morphine are currently available. Consequently, we suggest that researchers should not continue to develop new models, but should investigate whether collected data fit in already existing models and provide additional value concerning the impact of (non)-maturational factors like drug-drug interactions or pharmacogenetics.
[Mh] Termos MeSH primário: Analgésicos Opioides/administração & dosagem
Fentanila/administração & dosagem
Morfina/administração & dosagem
[Mh] Termos MeSH secundário: Fatores Etários
Analgésicos Opioides/farmacocinética
Peso Corporal
Citocromo P-450 CYP3A/metabolismo
Relação Dose-Resposta a Droga
Fentanila/farmacocinética
Glucuronosiltransferase/metabolismo
Seres Humanos
Lactente
Modelos Biológicos
Morfina/farmacocinética
Farmacogenética
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); 76I7G6D29C (Morphine); EC 1.14.13.67 (CYP3A4 protein, human); EC 1.14.14.1 (Cytochrome P-450 CYP3A); EC 2.4.1.- (UGT2B7 protein, human); EC 2.4.1.17 (Glucuronosyltransferase); UF599785JZ (Fentanyl)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1080/17425255.2018.1432595


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[PMID]:28463863
[Au] Autor:Howard PK; Gisness CM
[Ad] Endereço:Emergency Services, University of Kentucky HealthCare, Lexington (Dr Kunz Howard); and Department of Emergency Medicine at Grady Hospital, Emory University, Atlanta, Georgia (Ms Gisness).
[Ti] Título:Is Subdissociative Ketamine As Safe and Effective As Morphine for Pain Management in the Emergency Department?
[So] Source:Adv Emerg Nurs J;39(2):81-85, 2017 Apr/Jun.
[Is] ISSN:1931-4493
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:: Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial." This prospective, randomized controlled inquiry enrolled 90 patients into 2 groups (ketamine vs. morphine) for patients seeking care in an emergency department with acute pain. Data regarding pain scores were collected at baseline, 15, 30, 60, 90, and 120 min. Study subjects reporting persistent pain could receive rescue analgesia with fentanyl. Initial pain scores for the subjects in each of the groups were comparable (ketamine: 8.6; morphine: 8.5). Pain management for the 2 groups revealed similar average doses (ketamine: 21.8 mg; morphine: 7.7 mg). Although subjects in both groups reported reduction in pain scores at 15 and 30 min, no clinical significance was found. Subjects experienced greater pain relief (pain score = 0) in the ketamine group at 15 min (percentage difference 31%; 95% confidence interval [13, 49]), yet this was not sustained at the 30-min interval. There were no serious or life-threatening adverse effects in either group. This study highlights the important role of the APN in providing quality care, communication about pain management, and related follow-up care.
[Mh] Termos MeSH primário: Ketamina/administração & dosagem
Morfina/administração & dosagem
Manejo da Dor/métodos
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Ketamina/efeitos adversos
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
690G0D6V8H (Ketamine); 76I7G6D29C (Morphine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1097/TME.0000000000000145


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[PMID]:29386447
[Au] Autor:Mori T; Sawaguchi T
[Ad] Endereço:Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences.
[Ti] Título:[Underlying Mechanisms of Methamphetamine-Induced Self-Injurious Behavior and Lethal Effects in Mice].
[So] Source:Nihon Eiseigaku Zasshi;73(1):51-56, 2018.
[Is] ISSN:1882-6482
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:Relatively high doses of psychostimulants induce neurotoxicity on the dopaminergic system and self-injurious behavior (SIB) in rodents. However the underlying neuronal mechanisms of SIB remains unclear. Dopamine receptor antagonists, N-methyl-D-aspartic acid (NMDA) receptor antagonists, Nitric Oxide Synthase (NOS) inhibitors and free radical scavengers significantly attenuate methamphetamine-induced SIB. These findings indicate that activation of dopamine as well as NMDA receptors followed by radical formation and oxidative stress, especially when mediated by NOS activation, is associated with methamphetamine-induced SIB. On the other hand, an increase in the incidence of polydrug abuse is a major problem worldwide. Coadministered methamphetamine and morphine induced lethality in more than 80% in mice, accompanied by an increase in the number of poly (ADP-ribose) polymerase (PARP)-immunoreactive cells in the heart, kidney and liver. The lethal effect and the increase in the incidence of rupture or PARP-immunoreactive cells induced by the coadministration of methamphetamine and morphine were significantly attenuated by pretreatment with a phospholipase A2 inhibitor or a radical scavenger, or by cooling of body from 30 to 90 min after drug administration. These results suggest that free radicals play an important role in the increased lethality induced by the coadministration of methamphetamine and morphine. Therefore, free radical scavengers and cooling are beneficial for preventing death that is induced by the coadministration of methamphetamine and morphine. These findings may help us better understand for masochistic behavior, which is a clinical phenomenon on SIB, as well as polydrug-abuse-induced acute toxicity.
[Mh] Termos MeSH primário: Estimulantes do Sistema Nervoso Central/efeitos adversos
Estimulantes do Sistema Nervoso Central/toxicidade
Metanfetamina/efeitos adversos
Metanfetamina/toxicidade
Comportamento Autodestrutivo/induzido quimicamente
[Mh] Termos MeSH secundário: Animais
Antagonistas de Dopamina/farmacologia
Antagonistas de Dopamina/uso terapêutico
Neurônios Dopaminérgicos/efeitos dos fármacos
Relação Dose-Resposta a Droga
Interações Medicamentosas
Depuradores de Radicais Livres/farmacologia
Depuradores de Radicais Livres/uso terapêutico
Radicais Livres/efeitos adversos
Radicais Livres/toxicidade
Seres Humanos
Dose Letal Mediana
Metanfetamina/administração & dosagem
Morfina/administração & dosagem
Morfina/efeitos adversos
Morfina/toxicidade
Receptores de N-Metil-D-Aspartato/antagonistas & inibidores
Comportamento Autodestrutivo/etiologia
Transtornos Relacionados ao Uso de Substâncias
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Central Nervous System Stimulants); 0 (Dopamine Antagonists); 0 (Free Radical Scavengers); 0 (Free Radicals); 0 (Receptors, N-Methyl-D-Aspartate); 44RAL3456C (Methamphetamine); 76I7G6D29C (Morphine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180202
[St] Status:MEDLINE
[do] DOI:10.1265/jjh.73.51


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[PMID]:29265141
[Au] Autor:Sader S; Anant K; Wu C
[Ad] Endereço:College of Science and Mathematics, Rowan University, Glassboro, NJ 08028, USA. wuc@rowan.edu.
[Ti] Título:To probe interaction of morphine and IBNtxA with 7TM and 6TM variants of the human µ-opioid receptor using all-atom molecular dynamics simulations with an explicit membrane.
[So] Source:Phys Chem Chem Phys;20(3):1724-1741, 2018 Jan 17.
[Is] ISSN:1463-9084
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:IBNtxA, a morphine derivative, is 10-fold more potent and has a better safety profile than morphine. Animal studies indicate that the analgesic effect of IBNtxA appears to be mediated by the activation of truncated splice variants (6TM) of the Mu opioid receptor (MOR-1) where transmembrane helix 1 (TM1) is removed. Interestingly, morphine is unable to activate 6TM variants. To date, a high resolution structure of 6TM variants is missing, and the interaction of 6TM variants with IBNtxA and morphine remains elusive. In this study we used homology modeling, docking and molecular dynamics (MD) simulations to study a representative 6TM variant (G1) and a full-length 7TM variant of human MOR-1 in complex with IBNtxA and morphine respectively. The structural models of human G1 and 7TM were obtained by homology modeling using the X-ray solved crystal structure of the active mouse 7TM bound to an agonist BU72 (PDB id: ) as the template. Our 6000 ns MD data show that either TM1 truncation (i.e. from 7TM to 6TM) or ligand modification (i.e. from morphine to IBNtxA) alone causes the loss of key morphine-7TM interactions that are well-known to be required for MOR-1 activation. Receptor disruptions are mainly located at TMs 2, 3, 6 and 7 in comparison with the active crystal complex. However, when both perturbations occur in the 6TM-IBNtxA complex, the key ligand-receptor interactions and the receptor conformation are recovered to resemble those in the active 7TM-morphine complex. Our molecular switch analysis further explains well why morphine is not able to activate 6TM variants. The close resemblance between 6TM-IBTtxA and 7TM in complex with PZM21, a G-protein biased 7TM agonist, suggests the possible biased agonism of IBNtxA on G1, which is consistent with its reduced side effects.
[Mh] Termos MeSH primário: Simulação de Dinâmica Molecular
Morfina/metabolismo
Naltrexona/análogos & derivados
Receptores Opioides mu/metabolismo
[Mh] Termos MeSH secundário: Sequência de Aminoácidos
Animais
Sítios de Ligação
Seres Humanos
Ligantes
Camundongos
Morfina/química
Mutagênese
Naltrexona/química
Naltrexona/metabolismo
Domínios Proteicos
Receptores Opioides mu/química
Receptores Opioides mu/genética
Alinhamento de Sequência
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Ligands); 0 (Receptors, Opioid, mu); 0 (iodobenzoylnaltrexamide); 5S6W795CQM (Naltrexone); 76I7G6D29C (Morphine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1039/c7cp06745c


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[PMID]:29381983
[Au] Autor:Yang Q; Zhang Z; Xin W; Li A
[Ti] Título:Preoperative intravenous glucocorticoids can decrease acute pain and postoperative nausea and vomiting after total hip arthroplasty: A PRISMA-compliant meta-analysis.
[So] Source:Medicine (Baltimore);96(47):e8804, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A systematic review and meta-analysis of published randomized controlled trials (RCTs) were performed to assess the efficacy and safety of preoperative intravenous glucocorticoids versus controls for the prevention of postoperative acute pain and postoperative nausea and vomiting (PONV) after primary total hip arthroplasty (THA). METHODS: A computer literature search of electronic databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), and China Wanfang database, was conducted to identify the relevant RCTs comparing preoperative intravenous glucocorticoids versus placebos for reducing acute pain and PONV in THA patients. The primary outcomes included the use of the visual analog scale (VAS) with rest or mobilization at 6, 24, 48, and 72 hours and the occurrence of PONV. The secondary outcome was total morphine consumption. We calculated the risk ratio (RR) with a 95% confidence interval (95% CI) for dichotomous outcomes, and the weighted mean difference (WMD) with a 95% CI for continuous outcomes. RESULTS: Pooled data from 7 RCTs (411 THAs) favored preoperative intravenous glucocorticoids against acute pain intensity at 4, 24, and 48 hours (P < .05). There was no significant difference between the VAS with rest or mobilization at 72 hours (P > .05). Subsequently, preoperative intravenous glucocorticoids provided a total morphine-sparing effect of 9.36 mg (WMD = -9.36, 95% CI = -12.33 to -6.38, P = .000). In addition, preoperative intravenous glucocorticoids were associated with a significant reduction of the occurrence of PONV (RR = 0.41, 95% CI = 0.30-0.57, P = .000). CONCLUSION: Intravenous glucocorticoids can decrease early pain intensity and PONV after THA. However, the low number of studies and variation in dosing regimens limits the evidence for its use. Thus, more high-quality RCTs are still needed to identify the optimal drug and the safety of intravenous glucocorticoids.
[Mh] Termos MeSH primário: Artroplastia de Quadril/efeitos adversos
Glucocorticoides/administração & dosagem
Dor Pós-Operatória/tratamento farmacológico
Náusea e Vômito Pós-Operatório/tratamento farmacológico
Cuidados Pré-Operatórios/métodos
[Mh] Termos MeSH secundário: Administração Intravenosa
Idoso
Analgésicos Opioides/administração & dosagem
Artroplastia de Quadril/métodos
Feminino
Seres Humanos
Masculino
Meia-Idade
Morfina/administração & dosagem
Medição da Dor
Dor Pós-Operatória/etiologia
Náusea e Vômito Pós-Operatório/etiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Glucocorticoids); 76I7G6D29C (Morphine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008804


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[PMID]:29369202
[Au] Autor:Ju Y; Tian D; Tan Y; Fu Z
[Ad] Endereço:Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Shandong China.
[Ti] Título:Palliative care with cervical intrathecal infusion and external pump for a late-stage cancer patient with refractory pain: A case report.
[So] Source:Medicine (Baltimore);97(4):e9714, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Intrathecal therapy, with a low complication rate, has become an alternative to standard pain management for treatment of neuropathic cancer pain. PATIENT CONCERNS: Here, we reported a late-stage cancer patient with intractable neuropathic pain in his right neck, shoulder, and upper limb. DIAGNOSES: The pain started 2 years ago when the patient was diagnosed as squamous cell carcinoma with metastasis to right supraclavicular lymph nodes. INTERVENTIONS: Cervical intrathecal infusion of morphine and bupivacaine with patient control analgesia by external pump was performed. The intrathecal catheter was located at the level of C6 vertebra. The initial concentration of bupivacaine and morphine were both 1 mg/mL with infusion rate of 0.3 mL/h and bolus of 0.3 mL. Subsequently, the concentrations increased to 2 mg/mL (bupivacaine) and 1.33 mg/mL (morphine), with infusion rate to 0.6 mL/h and bolus to 0.5 ml. OUTCOMES: The pain intensity decreased from numerical rating scale 6 to 7 to 2 to 3 at rest, and from 10 to 5 to 6 of breakthrough pain. LESSONS: In conclusion, cervical intrathecal infusion requires low concentration but high doses of bupivacaine and morphine, which is safe and effective in cancer patients with refractory pain and short life expectancy.
[Mh] Termos MeSH primário: Infusão Espinal/métodos
Neuralgia/tratamento farmacológico
Manejo da Dor/métodos
Dor Intratável/tratamento farmacológico
Cuidados Paliativos/métodos
[Mh] Termos MeSH secundário: Idoso
Analgesia Controlada pelo Paciente/métodos
Analgésicos Opioides/administração & dosagem
Anestésicos Locais/administração & dosagem
Bupivacaína/administração & dosagem
Carcinoma de Células Escamosas/complicações
Carcinoma de Células Escamosas/secundário
Vértebras Cervicais
Seres Humanos
Masculino
Morfina/administração & dosagem
Neoplasias Primárias Desconhecidas/complicações
Neuralgia/etiologia
Dor Intratável/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Anesthetics, Local); 76I7G6D29C (Morphine); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009714


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[PMID]:28464238
[Au] Autor:Wang W; Zhou L; Sun L
[Ad] Endereço:Department of Anesthesiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
[Ti] Título:Ondansetron for neuraxial morphine-induced pruritus: A meta-analysis of randomized controlled trials.
[So] Source:J Clin Pharm Ther;42(4):383-393, 2017 Aug.
[Is] ISSN:1365-2710
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:WHAT IS KNOWN AND OBJECTIVE: Pruritus is one of the most common adverse effects associated with neuraxial morphine. Ondansetron has been used to deal with the problem of neuraxial morphine-induced pruritus (NMIP). The aim of this meta-analysis was to evaluate the preventive efficacy of ondansetron on NMIP. METHODS: Online databases such as PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for eligible randomized controlled trials (RCTs). The primary outcome was the incidence of NMIP. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data. Trial sequential analysis (TSA) was performed to avoid the risk of making a spurious claim of significant effect and to calculate the sample size necessary to make a robust claim of effect. RESULTS AND DISCUSSION: Our traditional meta-analysis showed that prophylactic ondansetron could significantly reduce the incidence of NMIP in non-obstetric patients (three trials, RR=0.63, 95% CI 0.45-0.89, P=.008) with modest heterogeneity (I =47%) while it did not show the preventive efficacy of NMIP in obstetric patients (seven trials, RR=0.84, 95% CI 0.69-1.03, P=.10) with obvious heterogeneity (I  =82% ). However, TSA demonstrates that more high-quality RCTs are still needed to confirm the preventive efficacy of ondansetron on NMIP in non-obstetric populations and to study whether ondansetron prevents NMIP in obstetric patients. WHAT IS NEW AND CONCLUSION: Prophylactic ondansetron can significantly reduce the incidence of NMIP in non-obstetric patients but not in obstetric patients. However, more well-designed trials are still required to test the reliability of the results in our traditional meta-analysis.
[Mh] Termos MeSH primário: Morfina/efeitos adversos
Ondansetron/uso terapêutico
Prurido/prevenção & controle
[Mh] Termos MeSH secundário: Analgésicos Opioides/administração & dosagem
Analgésicos Opioides/efeitos adversos
Antipruriginosos/uso terapêutico
Seres Humanos
Incidência
Morfina/administração & dosagem
Prurido/induzido quimicamente
Prurido/epidemiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Antipruritics); 4AF302ESOS (Ondansetron); 76I7G6D29C (Morphine)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1111/jcpt.12539


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Registro de Ensaios Clínicos
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[PMID]:28468518
[Au] Autor:Kraft WK; Adeniyi-Jones SC; Chervoneva I; Greenspan JS; Abatemarco D; Kaltenbach K; Ehrlich ME
[Ad] Endereço:From Sidney Kimmel Medical College, Thomas Jefferson University (W.K.K., S.C.A.-J., I.C., J.S.G., D.A., K.K.), and Nemours duPont Pediatrics, Thomas Jefferson University Hospital (S.C.A.-J., J.S.G.) - both in Philadelphia; and the Departments of Neurology, Pediatrics, and Genetics and Genomic Scienc
[Ti] Título:Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome.
[So] Source:N Engl J Med;376(24):2341-2348, 2017 06 15.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Current pharmacologic treatment of the neonatal abstinence syndrome with morphine is associated with a lengthy duration of therapy and hospitalization. Buprenorphine may be more effective than morphine for this indication. METHODS: In this single-site, double-blind, double-dummy clinical trial, we randomly assigned 63 term infants (≥37 weeks of gestation) who had been exposed to opioids in utero and who had signs of the neonatal abstinence syndrome to receive either sublingual buprenorphine or oral morphine. Infants with symptoms that were not controlled with the maximum dose of opioid were treated with adjunctive phenobarbital. The primary end point was the duration of treatment for symptoms of neonatal opioid withdrawal. Secondary clinical end points were the length of hospital stay, the percentage of infants who required supplemental treatment with phenobarbital, and safety. RESULTS: The median duration of treatment was significantly shorter with buprenorphine than with morphine (15 days vs. 28 days), as was the median length of hospital stay (21 days vs. 33 days) (P<0.001 for both comparisons). Adjunctive phenobarbital was administered in 5 of 33 infants (15%) in the buprenorphine group and in 7 of 30 infants (23%) in the morphine group (P=0.36). Rates of adverse events were similar in the two groups. CONCLUSIONS: Among infants with the neonatal abstinence syndrome, treatment with sublingual buprenorphine resulted in a shorter duration of treatment and shorter length of hospital stay than treatment with oral morphine, with similar rates of adverse events. (Funded by the National Institute on Drug Abuse; BBORN ClinicalTrials.gov number, NCT01452789 .).
[Mh] Termos MeSH primário: Analgésicos Opioides/efeitos adversos
Analgésicos Opioides/uso terapêutico
Buprenorfina/uso terapêutico
Síndrome de Abstinência Neonatal/tratamento farmacológico
Tratamento de Substituição de Opiáceos
[Mh] Termos MeSH secundário: Administração Oral
Administração Sublingual
Buprenorfina/efeitos adversos
Método Duplo-Cego
Quimioterapia Combinada
Feminino
Seres Humanos
Hipnóticos e Sedativos/uso terapêutico
Recém-Nascido
Tempo de Internação
Masculino
Morfina/efeitos adversos
Morfina/uso terapêutico
Fenobarbital/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Hypnotics and Sedatives); 40D3SCR4GZ (Buprenorphine); 76I7G6D29C (Morphine); YQE403BP4D (Phenobarbital)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180121
[Lr] Data última revisão:
180121
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170505
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1614835


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[PMID]:29310376
[Au] Autor:Weigl W; Bierylo A; Wielgus M; Krzemien-Wiczynska S; Kolacz M; Dabrowski MJ
[Ad] Endereço:First Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
[Ti] Título:Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section: A randomized controlled study.
[So] Source:Medicine (Baltimore);96(48):e8892, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Intrathecal morphine is used in the postoperative management of pain after caesarean section (CS), but might not be optimal for intraoperative analgesia. We hypothesized that intrathecal fentanyl could supplement intraoperative analgesia when added to a local anesthetic and morphine without affecting management of postoperative pain. METHODS: This prospective, randomized, double-blind, parallel-group study included 60 parturients scheduled for elective CS. Spinal anesthesia consisted of bupivacaine with either morphine 100 µg (M group), or fentanyl 25 µg and morphine 100 µg (FM group). The frequency of intraoperative pain and pethidine consumption in the 24 hours postoperatively was recorded. RESULTS: Fewer patients in the FM group required additional intraoperative analgesia (P < .01, relative risk 0.06, 95% confidence interval [CI] 0.004-1.04). The FM group was noninferior to the M group for 24-hour opioid consumption (95% CI -10.0 mg to 45.7 mg, which was below the prespecified boundary of 50 mg). Pethidine consumption in postoperative hours 1 to 12 was significantly higher in the FM group (P = .02). Postoperative nausea and vomiting (PONV) were more common in the FM group (P = .01). Visual analog scale scores, effective analgesia, Apgar scores, and rates of pruritus and respiratory depression were similar between the groups. CONCLUSIONS: Intrathecal combination of fentanyl and morphine may provide better perioperative analgesia than morphine alone in CS and could be useful when the time from anesthesia to skin incision is short. However, an increase in PONV and possible acute spinal opioid tolerance after addition of intrathecal fentanyl warrants further investigation using lower doses of fentanyl.
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Raquianestesia/métodos
Cesárea
Fentanila/uso terapêutico
Morfina/uso terapêutico
Dor Pós-Operatória/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Adulto
Método Duplo-Cego
Feminino
Seres Humanos
Meia-Idade
Medição da Dor
Gravidez
Estudos Prospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); 76I7G6D29C (Morphine); UF599785JZ (Fentanyl)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008892


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[PMID]:28470102
[Au] Autor:Balyan R; Zhang X; Chidambaran V; Martin LJ; Mizuno T; Fukuda T; Vinks AA; Sadhasivam S
[Ad] Endereço:Department of Anesthesia, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA.
[Ti] Título:OCT1 genetic variants are associated with postoperative morphine-related adverse effects in children.
[So] Source:Pharmacogenomics;18(7):621-629, 2017 May.
[Is] ISSN:1744-8042
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: Large interindividual variability in morphine pharmacokinetics (PK) could contribute to variability in morphine analgesia and adverse events. Respiratory depression (RD) and postoperative nausea and vomiting (PONV) are significant adverse drug response of intravenous morphine in the perioperative setting limiting its efficacy in achieving adequate surgical pain relief. OCT1 is a transporter in the liver that transports morphine from the bloodstream into hepatocytes. Earlier we reported association of genetic polymorphisms in OCT1 with morphine PK, and lower morphine clearance in Caucasian children as compared with African-American (AA) children. The aim of this study is to identify the association between common OCT1 genotypes affecting morphine's PK and clinically important postoperative morphine-related adverse outcomes. METHODS: After obtaining institutional review board (IRB) approval and informed consents, 311 children ages 6-15 years, American Society of Anesthesiologists' physical status 1 or 2 scheduled for tonsillectomy who received standard anesthetic, surgical and postoperative care were recruited. Clinical data collected included postoperative pain scores, total opioid use, incidence of PONV and RD. Four nonsynonymous SNPs of the OCT1 gene (rs12208357, rs34130495, rs72552763 and rs34059508) in each patient were genotyped using commercially available TaqMan assays. We investigated the genetic association of OCT1 with incidences of postoperative RD and PONV. RESULTS: Caucasian and AA children differed significantly in the incidence of obstructive sleep apnea (p < 0.001) and total morphine use (p = 0.028). There were incidences of prolonged post anesthesia care unit stay in 7% of Caucasian children, while no such incidences were observed for AA children (p = 0.05). OCT1 polymorphism rs12208357 was associated with high incidences of PONV and PONV leading to prolonged post anesthesia care unit stay (p < 0.05). A significant association was also found between rs72552763 GAT deletion and high incidence of RD (p = 0.007). CONCLUSION: Children with certain OCT1 genotypes are associated with higher risk for RD and PONV following morphine administration leading to prolonged hospital stay. The OCT1 transporters' effects on morphine's PK could explain this association.
[Mh] Termos MeSH primário: Afroamericanos/genética
Grupo com Ancestrais do Continente Europeu/genética
Morfina/efeitos adversos
Fator 1 de Transcrição de Octâmero/genética
Variantes Farmacogenômicos/genética
Complicações Pós-Operatórias/genética
[Mh] Termos MeSH secundário: Adolescente
Analgésicos Opioides/administração & dosagem
Analgésicos Opioides/efeitos adversos
Criança
Feminino
Seres Humanos
Masculino
Morfina/administração & dosagem
Dor Pós-Operatória/genética
Dor Pós-Operatória/prevenção & controle
Complicações Pós-Operatórias/induzido quimicamente
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Octamer Transcription Factor-1); 0 (POU2F1 protein, human); 76I7G6D29C (Morphine)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.2217/pgs-2017-0002



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