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Opioid Analgesia (opioid + analgesia)
Selected AbstractsOpioid Analgesia: Managing Risks and Obtaining BenefitsPAIN MEDICINE, Issue 2008Rollin M. Gallagher MD No abstract is available for this article. [source] The Implementation of Intranasal Fentanyl for Children in a Mixed Adult and Pediatric Emergency Department Reduces Time to Analgesic AdministrationACADEMIC EMERGENCY MEDICINE, Issue 2 2010Anna Holdgate MBBS, FACEM ACADEMIC EMERGENCY MEDICINE 2010; 17:1,4 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to determine whether the introduction of intranasal (IN) fentanyl for children with acute pain would reduce the time to analgesic administration in a mixed adult and pediatric emergency department (ED). Methods:, A protocol for IN fentanyl (1.5 ,g/kg) for children age 1,15 years presenting with acute pain was introduced to the department. All children who received intravenous (IV) morphine in the 7 months prior to the introduction of the protocol and either IV morphine or IN fentanyl in the 7 months after the introduction of the protocol were identified from drug registers. Time to analgesic administration, time to see a doctor, and the ages of patients were compared between the periods before and after the introduction of IN fentanyl. Results:, Following implementation, 81 patients received IN fentanyl and 37 received IV morphine, compared to 63 patients receiving morphine in the previous 7 months. The median time to analgesic administration for IN fentanyl was significantly shorter than for morphine (32 minutes vs. 63 minutes, p = 0.001). Children receiving fentanyl were significantly younger than those receiving morphine (median = 8.5 years vs. 12 years, p < 0.001). Conclusions:, This study demonstrates that children treated with IN fentanyl received analgesic medication faster than those treated with IV morphine in a mixed ED. Younger children were more likely to receive opioid analgesia following the introduction of fentanyl. [source] Salivary melatonin response to acute pain stimuliJOURNAL OF PINEAL RESEARCH, Issue 4 2001F.A. Nelson Evidence for a relationship between melatonin, nociception, and analgesia in humans is based on data that are only linked by association and simultaneous occurrence. Studies have reported inverse correlation of the circadian melatonin rhythm with nociception latency and enhancement of opioid analgesia by simultaneous administration of melatonin in animals. This study examines the response of salivary melatonin to acute pain stimuli in 18 healthy subjects ranging in age from 19 to 50 years. A biphasic melatonin response following an acute pain stimulus of 36 V was observed, F(8, 8)=17.839, P<0.001. Within 5 min of the stimulus, melatonin decreased and reached a plateau of 36 pg/mL below baseline by 20 min. This decrease was followed by an increase of 5 pg/mL. Melatonin levels subsequently decreased until they had reached levels similar to those anticipated for the time of day and did not vary thereafter. The magnitude of the melatonin response was not related to age or gender. There was no association between voltage and magnitude of the melatonin responses observed at 15 min (r=0.185, P=0.51) or at 30 min (r=0.468, P=0.09). This study provides the first evidence of melatonin utilization and subsequent pineal gland synthesis following acute pain episodes in humans. [source] Effects of postoperative ketamine infusion on pain control and feeding behaviour in bitches undergoing mastectomyJOURNAL OF SMALL ANIMAL PRACTICE, Issue 12 2007S. Sarrau Objectives: To determine if ketamine administered to bitches at the end of a mastectomy, followed by a six-hour constant rate infusion (CRI), improved postoperative opioid analgesia and feeding behaviour. Methods: The bitches were randomised into three groups: the placebo group received 0·09 ml/kg isotonic saline intravenously followed by a six-hour CRI of 0·5 ml/kg/hour, the low-dose ketamine received 150 ,g/kg ketamine intravenously followed by a six-hour CRI of 2 ,g/kg/minute and the high-dose ketamine group received 700 ,g/kg ketamine intravenously followed by a six-hour CRI of 10 ,g/kg/minute. Any additional opioids given were recorded at the time of extubation and at intervals after extubation. Food intake was evaluated eight (T8) and 20 (T20) hours after extubation by measuring the per cent coverage of basal energy requirements (BER). Results: No significant difference was observed for opioid requirements between the three groups. The mean percentages of BER coverage did not differ significantly at T8 but the difference between the high-dose and low-dose ketamine groups (P=0·014), and the high-dose ketamine and placebo groups (P=0·038) was significant at T20. Clinical Significance: This study demonstrated that 700 ,g/kg ketamine given intravenously postoperatively followed by a six-hour ketamine CRI of 10 ,g/kg/minute improved patient feeding behaviour. [source] A qualitative systematic review of peri-operative dextromethorphan in post-operative painACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2006T. H. Duedahl Background:, The N -methyl- d -aspartate (NMDA) receptor antagonist, dextromethorphan (DM), has received interest as an adjunctive agent in post-operative pain management. Clinical trials have been contradictory. This systematic review aims to evaluate the available literature examining the analgesic efficacy of DM in post-operative patients. Methods:, Twenty-eight randomized, double-blind, clinical studies, with 40 comparisons, including a variety of dosing regimens comparing DM treatment with placebo, were included. Meta-analysis was intended but deemed to be inappropriate because of the substantial difference in methodology and reporting between trials. The outcome measures (pain scores at rest, time to first analgesic request and supplemental analgesic consumption) were evaluated qualitatively by significant difference (P < 0.05) as reported in the original investigations. Results:, DM did not reduce the post-operative pain score with a clinically significant magnitude. The time to first analgesic request was significantly prolonged in most comparisons with DM. Significant decreases in supplemental opioid consumption were observed in the majority of parenteral DM studies and in about one-half of the oral studies. The decreases were of questionable clinical importance in most comparisons, although a relationship between a decrease in opioid consumption and opioid-related side-effects was established in some studies. Conclusion:, Based on the studies available, DM has the potential to be a safe adjunctive agent to opioid analgesia in post-operative pain management, but the consistency of the potential opioid-sparing and pain-reducing effect must be questioned. Consequently, it is not possible to recommend dose regimens or routine clinical use of DM in post-operative pain. The route of administration may be important for the beneficial effect. [source] Sevoflurane: an ideal agent for adult day-case anesthesia?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2003S. Ghatge Sevoflurane has several properties which make it potentially useful as a day case anaesthetic. Following induction of anaesthesia with propofol, awakening from sevoflurane is faster compared to isoflurane, faster or similar compared to propofol and comparable (in the majority of studies) to desflurane. Subsequent recovery and discharge is generally similar following all agents. Sevoflurane may also be used to induce anaesthesia, which is generally well-received and causes less hypotension and apnoea compared to propofol. When used as a maintenance anaesthetic, the incidence of postoperative nausea and vomiting after sevoflurane is comparable to other inhaled anaesthetics, but this complication appears more common after inhaled inductions. The tolerability and low solubility of sevoflurane facilitate titration of anaesthesia and may reduce the need for opioid analgesia, which in turn may limit the occurrence of nausea and vomiting. [source] Nausea and Vomiting Side Effects with Opioid Analgesics during Treatment of Chronic Pain: Mechanisms, Implications, and Management OptionsPAIN MEDICINE, Issue 4 2009Frank Porreca PhD ABSTRACT Objectives., Gastrointestinal (GI) side effects such as nausea and vomiting are common following opioid analgesia and represent a significant cause of patient discomfort and treatment dissatisfaction. This review examines the mechanisms that produce these side effects, their impact on treatment outcomes in chronic pain patients, and counteractive strategies. Results., A number of mechanisms by which opioids produce nausea and vomiting have been identified. These involve both central and peripheral sites including the vomiting center, chemoreceptor trigger zones, cerebral cortex, and the vestibular apparatus of the brain, as well as the GI tract itself. Nausea and vomiting have a negative impact on treatment efficacy and successful patient management because they limit the effective analgesic dosage that can be achieved and are frequently reported as the reason for discontinuation of opioid pain medication or missed doses. While various strategies such as antiemetic agents or opioid switching can be employed to control these side effects, neither option is ideal because they are not always effective and incur additional costs and inconvenience. Opioid-sparing analgesic agents may provide a further alternative to avoid nausea and vomiting due to their reduced reliance on mu-opioid signalling pathways to induce analgesia. Conclusions., Nausea and vomiting side effects limit the analgesic efficiency of current opioid therapies. There is a clear need for the development of improved opioid-based analgesics that mitigate these intolerable effects. [source] Cancer Pain Education for Medical Students: The Development of a Short Course on CD-ROMPAIN MEDICINE, Issue 1 2002Paul A. Sloan MD Objective., The purpose of this study was to assess the educational value and acceptability of a short CD-ROM course on cancer pain management given to third-year medical students at the University of Kentucky. Methods., Thirty-six medical students were given a short-course CD-ROM on cancer pain assessment and management. The Cancer Pain CD-ROM included textual instruction as well as video clips and a 15-item interactive self-assessment examination on cancer pain management. Students were asked to evaluate the computerized course with an 18-item survey using a Likert scale (1 = strongly disagree; 5 = strongly agree). Results., Twenty-seven medical students completed the course, however, only 11 returned evaluations. In general, the medical students appreciated the CD-ROM material, with the exception of the video clips. Students agreed most strongly (mean ± standard deviation [SD]) that the educational material on the CD-ROM was presented clearly (3.9 ± 1.1), the CD-ROM format was easy to use (4.0 ± 0.8), the CD-ROM course improved knowledge of opioid use for cancer pain (4.0 ± 0.7), and the course improved understanding of opioid-related side effects (4.0 ± 0.7). The self-assessment examination on cancer pain was rated easy to use and felt to be helpful (4.0 ± 0.9) for students to identify cancer pain knowledge deficits. The authors estimate that 150 man-hours were needed to complete production of the CD-ROM without any specialized training in computer skills. Conclusions., A short-course computer format program was developed by the authors to teach the basics of cancer pain management to medical students. A minority of students evaluated the program and agreed the material was clearly presented, improved knowledge of opioid analgesia, and was easy to use. [source] Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysisANAESTHESIA, Issue 6 2009M. Gehling Summary Intrathecal morphine is often used for postoperative analgesia after surgery. We performed a meta-analysis to obtain more detailed information on the frequency of side-effects in patients receiving intrathecal morphine in combination with spinal anaesthesia compared with placebo treated patients. We clustered the analysis to patients receiving placebo, less than morphine 0.3 mg (M < 0.3), or equal to or more than morphine 0.3 mg (M , 0.3) and calculated the risk ratios of morphine vs placebo. Twenty-eight studies investigating 46 morphine groups vs placebo were included. A total of 790 patients with intrathecal morphine and 524 patients who received placebo were analysed. Compared with placebo the lower dose of morphine resulted in an increase of nausea (RR 1.4, 95% CI 1.1,1.7), vomiting (RR 3.1, 95% CI 1.5,6.4) and pruritus (RR 1.8, 95% CI 1.4,2.2). The higher dose resulted in an increased risk ratio for pruritus (RR 5.0, 95% CI 2.9,8.6), but not nausea (RR 1.2, 95% CI 0.9,1.6) or vomiting (RR 1.3, 95% CI 0.9,1.9). Overall, intrathecal morphine did not increase respiratory depression. However, the higher dose of intrathecal morphine was associated with more episodes of respiratory depression (7/80) compared with the lower dose (2/247). Intrathecal morphine is associated with a mild increase in side-effects. With a dose < 0.3 mg we found there were no more episodes of respiratory depression than in placebo patients who received systemic opioid analgesia. [source] Fetal bradycardia due to intrathecal opioids for labour analgesia: a systematic reviewBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2002Chahé Mardirosoff Objective To evaluate fetal and maternal adverse effects of intrathecal opioid analgesia during labour. Data sources A systematic search was performed, in Medline, Embase, the Cochrane Library, bibliographies, and personal contact with authors, in any language, up to February 2001. Study selection Full reports on randomised comparisons of any analgesia with intrathecal opioid (experimental group) with any non-intrathecal opioid regimen (control group) during labour. Data extraction Dichotomous data from 24 trials (3513 women). Results With intrathecal opioids, there was a significant increase in the risk of fetal bradycardia: odds ratio 1.8 (95% confidence interval 1.0 to 3.1), number-needed-to-harm 28. The risk of caesarean section due to fetal heart rate abnormalities was similar (6.0%versus 7.8%). The incidence of pruritus was significantly higher with intrathecal opioids: relative risk 29.6 (95% CI 13.6 to 64.6), number-needed-to-harm 1.7. Conclusions Intrathecal opioids for labour increase the risk of fetal bradycardia and maternal pruritus. The risk of subsequent caesarean section is not increased. [source] Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal PainACADEMIC EMERGENCY MEDICINE, Issue 5 2008Esther H. Chen MD Abstract Objectives:, Oligoanalgesia for acute abdominal pain historically has been attributed to the provider's fear of masking serious underlying pathology. The authors assessed whether a gender disparity exists in the administration of analgesia for acute abdominal pain. Methods:, This was a prospective cohort study of consecutive nonpregnant adults with acute nontraumatic abdominal pain of less than 72 hours' duration who presented to an urban emergency department (ED) from April 5, 2004, to January 4, 2005. The main outcome measures were analgesia administration and time to analgesic treatment. Standard comparative statistics were used. Results:, Of the 981 patients enrolled (mean age ± standard deviation [SD] 41 ± 17 years; 65% female), 62% received any analgesic treatment. Men and women had similar mean pain scores, but women were less likely to receive any analgesia (60% vs. 67%, difference 7%, 95% confidence interval [CI] = 1.1% to 13.6%) and less likely to receive opiates (45% vs. 56%, difference 11%, 95% CI = 4.1% to 17.1%). These differences persisted when gender-specific diagnoses were excluded (47% vs. 56%, difference 9%, 95% CI = 2.5% to 16.2%). After controlling for age, race, triage class, and pain score, women were still 13% to 25% less likely than men to receive opioid analgesia. There was no gender difference in the receipt of nonopioid analgesia. Women waited longer to receive their analgesia (median time 65 minutes vs. 49 minutes, difference 16 minutes, 95% CI = 3.5 to 33 minutes). Conclusions:, Gender bias is a possible explanation for oligoanalgesia in women who present to the ED with acute abdominal pain. Standardized protocols for analgesic administration may ameliorate this discrepancy. [source] The National Trend in Quality of Emergency Department Pain Management for Long Bone FracturesACADEMIC EMERGENCY MEDICINE, Issue 2 2007PA-C, Tamara S. Ritsema MPH Background Despite national attention, there is little evidence that the quality of emergency department (ED) pain management is improving. Objectives To compare the quality of ED pain management before and after implementation of the Joint Commission on the Accreditation of Healthcare Organizations' standards in 2001. Methods The authors performed a retrospective cohort study by using the National Hospital Ambulatory Medical Care Survey from 1998,2003. Patients who presented to the ED with a long bone fracture (femur, humerus, tibia, fibula, radius, or ulna) were compared. The authors extracted data on patient, visit, and hospital characteristics. The primary outcomes were the proportion of patients who received assessment of pain severity and who received analgesic treatment. Results There were 2,064 patients with a qualifying fracture in the study period, 834 from 1998,2000 and 1,230 from 2001,2003. Compared with the early period, a higher proportion of patients in the late period had their pain assessed (74% vs. 57%), received opiates (56% vs. 50%), and received any analgesic (76% vs. 56%). Patients in the late period had higher odds of receiving any analgesia (adjusted odds ratio [OR], 1.43) and opioid analgesia (adjusted OR, 1.27) compared with the early period. Patients in the middle age group (adjusted OR, 2.28) or those seen by physician assistants (adjusted OR, 2.05) were more likely, whereas those with Medicaid (adjusted OR, 0.58) and those in the Northeast were less likely, to receive opiates. Conclusions Although the quality of ED pain management for acute fractures appears to be improving, there is still room for further improvement. [source] | ||||||||||