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Anesthesiology and Pain Medicine Dec 2022Post-laparoscopic cholecystectomy (LC) pain control is still an issue postoperatively.
BACKGROUND
Post-laparoscopic cholecystectomy (LC) pain control is still an issue postoperatively.
OBJECTIVES
We investigated the effectiveness of the unilateral right-side ultrasound-guided erector spinae plane block (ESPB) on post-LC pain intensity and opioid consumption.
METHODS
This is a parallel-arm randomized control trial on 62 adult patients with an American Society of Anesthesiologists (ASA) physical status ≤ 2 who underwent LC. The patients were randomized into 2 groups (the block group [BG] and the control group [CG]; n = 31 per group). BG received a single-shot right-sided T7 ESPB with 20 mL of 0.2% ropivacaine at arrival time in the post-anesthesia care unit (PACU). CG) received no regional anesthesia. Both groups received patient-controlled intravenous fentanyl and rescue meperidine for analgesia. The primary outcome was the pain intensity determined using a Numerical Rating Scale (NRS) in the first 24 hours after surgery. Secondary outcomes included total fentanyl and meperidine consumption within 24 hours.
RESULTS
Median pain scores were significantly higher in CG at rest and with coughing up to 12 hours after surgery compared with BG. Pain scores were higher in CG with a cough at 24 hours compared with BG (median 1 [interquartile range (IQR) 1, 2] vs. 1 [1, 0]; P = 0.0005). Total fentanyl consumption and meperidine consumption within 24 hours were significantly lower in BG compared with CG (median 60 µg [IQR 60, 90] vs 250 µg [90, 300]; P < 0.0001 and median 20 µg [IQR 10, 20] vs 25 [20, 25]; P = 0.002, respectively).
CONCLUSIONS
A single-shot, right-sided, unilateral ESPB decreases post-LC opioid consumption and pain.
PubMed: 36938107
DOI: 10.5812/aapm-132152 -
Frontiers in Microbiology 2023Northeast China has always been an area with severe brucellosis prevalence. This study will identify in Northeast China and test its resistance to antibiotics, in order...
INTRODUCTION
Northeast China has always been an area with severe brucellosis prevalence. This study will identify in Northeast China and test its resistance to antibiotics, in order to clarify its resistance mechanism. is a widespread and highly pathogenic bacteria that poses serious threats to public health and animal husbandry.
METHODS
In this study, 61 isolates were identified by abortus-melitensis-ovis-suis polymerase chain reaction (AMOS-PCR) for biotypes and epidemic potential was clarified by multi-locus sequence analysis. Whole-genome sequencing (WGS) was performed and the antibiotic susceptibility of the strains against 13 antibiotics was detected with the use of E-test strips.
RESULTS
The results showed that all of the isolates were ST8, group CC4 with little genetic variation and obvious geographical characteristics. All 61 isolates were sensitive to doxycycline, tetracycline, minocycline, levofloxacin, ciprofloxacin, gentamicin, and streptomycin, while 24.6%, 86.9%, 65.6%, 27.9%, 3.3%, and 1.6% were resistant to rifampin, azithromycin, cefepime, cefoperazone/sulbactam, cefotaxime, and meperidine/sulfamethoxazole, respectively. This is the first report of cephalosporin-resistant in China. The WGS results indicated that about 60% of the antibiotic resistance genes were associated with efflux pumps (mainly the resistance nodulation division family).
DISCUSSION
Brucellosis is usually treated with antibiotics for several months, which can easily lead to the emergence of antibiotic resistance. To ensure the effectiveness and safety of antibiotics for treatment of brucellosis, continuous surveillance of antibiotic susceptibility is especially important.
PubMed: 37125183
DOI: 10.3389/fmicb.2023.1137932 -
Saudi Pharmaceutical Journal : SPJ :... Mar 2023The objectives of this study were to explore the wastage of narcotics and controlled medications and, their financial impact in a tertiary care setting over a one-year...
OBJECTIVE
The objectives of this study were to explore the wastage of narcotics and controlled medications and, their financial impact in a tertiary care setting over a one-year period.
METHODOLOGY
The study period was of one year, i.e., October 2020 - September 2021. The venue of study was a tertiary care hospital. The narcotic medications included Fentanyl, Tramadol, Morphine, and Meperidine. The controlled medications included Midazolam, Phenobarbital, Diazepam, Ketamine and Lorazepam. The annual consumption and wastage of the narcotic and controlled medications were documented using data report generated by narcotics and controlled medication in-charge pharmacist through the hospital's online system. Data was reported using average, minimum and maximum values. Quantities of wastage is expressed in terms of ampoules. Costs per ampoule were calculated and expressed in both Saudi Riyal (SAR) and United States Dollar (USD). The study was approved by an ethics committee.
RESULTS
The annual wastage of narcotics was 3.19 % while the same for controlled medications was 21.3 %. An annual wastage of 3.81 % was reported for narcotics and controlled medications combined. The total wastage cost of narcotics and controlled medications was 15,443.1 SAR that was equivalent to USD 4085.5. Fentanyl 500mcg formulations had the highest consumption, i.e., 28,580 ampoules followed by Morphine 10 mg formulations, i.e., 27,122 ampoules. The highest ampoule wastage was observed for Morphine 10 mg formulations, i.e., 1956 ampoules. The highest % wastage was observed for Midazolam formulations, i.e., 29.3 %.
CONCLUSION
The overall wastage was less than 5% of the total consumption, however, midazolam was observed to have the highest wastage. Shifting to prefilled syringes supplied by pharmacies, making protocols, and safely pooling costly drugs could result in significant savings.
PubMed: 37026053
DOI: 10.1016/j.jsps.2022.12.012 -
Medicine Jun 2023Dexmedetomidine is used for the sedation method in the case of endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of relieving patient anxiety. It has... (Comparative Study)
Comparative Study Randomized Controlled Trial
INTRODUCTION
Dexmedetomidine is used for the sedation method in the case of endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of relieving patient anxiety. It has been reported that CO2 accumulated during sedation causes an arousal reaction, so how to normalize CO2 during sedation can be improved by administration of the minimum necessary sedative.Nasal High Flow oxygen therapy (NHF) uses a mild positive pressure load that improves carbon dioxide washout and reduces rebreathing to improve respiratory function and therefore is widely used to prevent hypoxemia and hypercapnia. In this study, we will investigate whether the upper airway patency would be maintained and the hypercapnia and hypoxemia during sedation would be prevented, by applying NHF as a respiratory management method to patients undergoing ERCP under sedation.
METHODS/DESIGN
In a randomized comparative study of 2 groups, the NHF device use group and the nasal cannula use group, for adult patients who visited the Nagasaki University Hospital and underwent ERCP examination under sedation. For sedation, Dexmedetomidine will be used in combination with and Midazolam and evaluation by anesthesiologist. In addition, as an analgesic, pethidine hydrochloride was administered intravenously. The total dose of the analgesic pethidine hydrochloride used in combination is used as the primary endpoint. As a secondary evaluation item, the percutaneous CO2 concentration is evaluated with a TCO2 monitor to examine whether it is effective in preventing hypercapnia. Furthermore, we will evaluate the incidence of hypoxemia with a percutaneous oxygen saturation value of 90% or less, and examine whether the use of equipment is effective in preventing the occurrence of hypercapnia and hypoxemia.
DISCUSSION
The purpose of this study was to obtain evidence for the utility of NHF as a potential therapeutic device for patients undergoing an ERCP under sedation, assessed by determining if the incidence rates of hypercapnia and hypoxemia decreased in the NHF device group, compared to the control group that did not use of this device.
Topics: Adult; Humans; Carbon Dioxide; Cholangiopancreatography, Endoscopic Retrograde; Dexmedetomidine; Hypercapnia; Hypoxia; Meperidine
PubMed: 37335651
DOI: 10.1097/MD.0000000000034004 -
Veterinary Medicine and Science Jul 2022The use of combinations of α -adrenergic agonists and opioids has been published as providing superior sedation than either drug alone.
BACKGROUND
The use of combinations of α -adrenergic agonists and opioids has been published as providing superior sedation than either drug alone.
INTRODUCTION
The present study aims to compare the sedative and physiological effects of intravenous (IV) administration of medetomidine alone and in combination with methadone, morphine, tramadol, and pethidine in goats.
METHODS
Ten healthy goats aged 12 ± 3 months and weight of 22 ± 4 kg were used in an experimental, crossover (Latin square), randomized, and blinded study. The animals were assigned to five IV treatments with a minimum washout period of 8 days between treatments: medetomidine (20 μg kg ), medetomidine/methadone (0.5 mg kg ), medetomidine/morphine (0.5 mg kg ), medetomidine/tramadol (5 mg kg ), and medetomidine/pethidine (1 mg kg ).
RESULTS
Clinical adverse effects such as tremors (facial and generalized), bruxism, nystagmus, mydriasis, and vocalization were presented in all the medetomidine/opioid treatments. Clinical adverse effects were observed at 10-90 minutes in medetomidine/opioid treatments. Animals in all treatments were sedated at 5-90 minutes. Sedation was significantly higher in medetomidine/opioid treatments than in medetomidine at 15-30 minutes after administration (P < 0.05). In all treatments, heart rate and respiratory rate significantly decreased from baseline at 5-105 and 30-60 minutes, respectively. There was no significant difference in heart and respiratory rates between different treatments at any time point. Ruminal motility was decreased in medetomidine and medetomidine/opioid treatments at 10-75 and 10-105 minutes, respectively. Compared with medetomidine, ruminal motility was significantly lower in medetomidine/opioid treatments at 75-105 minutes.
CONCLUSION
The use of combinations of medetomidine/opioids would be considered for superior sedation at 15-30 minutes after administration in goats. No significant differences were detected among opioids in combination with medetomidine in goats.
Topics: Analgesics, Opioid; Animals; Goats; Hypnotics and Sedatives; Medetomidine; Meperidine; Methadone; Morphine; Tramadol
PubMed: 35353952
DOI: 10.1002/vms3.806 -
Data in Brief Apr 2021Here we describe the dataset of the first report of pharmacogenomics profiling in an outpatient spine setting with the primary aims to catalog: 1) the genes, alleles,...
Here we describe the dataset of the first report of pharmacogenomics profiling in an outpatient spine setting with the primary aims to catalog: 1) the genes, alleles, and associated rs Numbers (accession numbers for specific single-nucleotide polymorphisms) analysed and 2) the genotypes and corresponding phenotypes of the genes involved in metabolizing 37 commonly used analgesic medications. The present description applies to analgesic medication-metabolizing enzymes and may be especially valuable to investigators who are exploring strategies to optimize pharmacologic pain management (e.g., by tailoring analgesic regimens to the genetically identified sensitivities of the patient). Buccal swabs were used to acquire tissue samples of 30 adult patients who presented to an outpatient spine clinic with the chief concern of axial neck and/or back pain. Array-based assays were then used to detect the alleles of genes involved in the metabolism of pain medications, including all common (wild type) and most rare variant alleles with known clinical significance. Both CYP450 isozymes - including CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5 - and the phase II enzyme UDP-glucuronosyltransferase-2B7 (UGT2B7) were examined. Genotypes/phenotypes were then used to evaluate each patient's relative ability to metabolize 37 commonly used analgesic medications. These medications included both non-opioid analgesics (i.e., aspirin, diclofenac, nabumetone, indomethacin, meloxicam, piroxicam, tenoxicam, lornoxicam, celecoxib, ibuprofen, flurbiprofen, ketoprofen, fenoprofen, naproxen, and mefenamic acid) and opioid analgesics (i.e., morphine, codeine, dihydrocodeine, ethylmorphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, alfentanil, fentanyl, sufentanil, meperidine, ketobemidone, dextropropoxyphene, levacetylmethadol, loperamide, methadone, buprenorphine, dextromethorphan, tramadol, tapentadol, and tilidine). The genes, alleles, and associated rs Numbers that were analysed are provided. Also provided are: 1) the genotypes and corresponding phenotypes of the genes involved in metabolizing 37 commonly used analgesic medications and 2) the mechanisms of metabolism of the analgesic medications by primary and ancillary pathways. In supplemental spreadsheets, the raw and analysed pharmacogenomics data for all 30 patients evaluated in the primary research article are additionally provided. Collectively, the presented data offer significant reuse potential in future investigations of pharmacogenomics for pain management.
PubMed: 33644270
DOI: 10.1016/j.dib.2021.106832 -
Cirugia Y Cirujanos 2024The aim of this study is to evaluate the effect of erector spinae plane block (ESPB) as a rescue therapy in the recovery room.
OBJECTIVE
The aim of this study is to evaluate the effect of erector spinae plane block (ESPB) as a rescue therapy in the recovery room.
MATERIALS AND METHODS
This single-center historical cohort study included patients who received either ESPB or intravenous meperidine for pain management in the recovery room. Patients' numeric rating scale (NRS) scores and opoid consumptions were evaluated.
RESULTS
One hundred and eight patients were included in the statistical analysis. Sixty-two (57%) patients received ESPB postoperatively (pESPB) and 46 (43%) patients were managed with IV meperidine boluses only (IV). The cumulative meperidine doses administered were 0 (0-40) and 30 (10-80) mg for the pESPB and IV groups, respectively (p < 0.001). NRS scores of group pESPB were significantly lower than those of Group IV on T30 and T60.
CONCLUSION
ESPB reduces the frequency of opioid administration and the amount of opioids administered in the early post-operative period. When post-operative rescue therapy is required, it should be considered before opioids.
Topics: Humans; Male; Female; Middle Aged; Pain, Postoperative; Nerve Block; Paraspinal Muscles; Adult; Meperidine; Analgesics, Opioid; Cohort Studies; Pain Measurement; Aged; Cholecystectomy; Anesthetics, Local; Retrospective Studies
PubMed: 38782375
DOI: 10.24875/CIRU.23000062 -
Acta Medica Academica Apr 2022Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In... (Review)
Review
OBJECTIVES
Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In this retrospective observational study, we evaluated the effectiveness of 3-in-1 nerve block in patients after total knee arthroplasty compared to standard opioid treatment, and we state the reasons why this approach should still be considered.
METHODS
To evaluate the effectiveness of the 3-in-1 nerve block, we assessed the acute pain service archive and compared the values of the visual analog scale, by separating patients into two groups according to the analgesic regimen they received as per local protocols. In group A, patients received 0.25% bupivacaine through a 3 in 1 block catheter and additional meperidine IM if needed, while in group B they received meperidine every six hours.
RESULTS
Our analysis showed the statistically significant better effectiveness of 3-in-1 nerve block with bupivacaine administration in postoperative TKR pain control compared to repeated administration of meperidine.
CONCLUSION
The results of our study suggest that 3-in-1 nerve block with bupivacaine is an option that must always be considered in order to alleviate post-operative pain after TKR.
Topics: Analgesics, Opioid; Anesthetics, Local; Arthroplasty, Replacement, Knee; Bupivacaine; Femoral Nerve; Humans; Meperidine; Nerve Block; Observational Studies as Topic; Pain, Postoperative
PubMed: 35695398
DOI: 10.5644/ama2006-124.365 -
International Journal of Environmental... Nov 2021Pain relief during labor is a part of standard care in modern obstetrics. Several modalities used for pain relief have their own disadvantages and benefits in terms of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pain relief during labor is a part of standard care in modern obstetrics. Several modalities used for pain relief have their own disadvantages and benefits in terms of side effects, effectiveness, availability, and satisfaction. The objectives of this study are primarily to compare the effectiveness and patients' satisfaction for pain relief during labor between pethidine and inhaled 50% nitrous oxide (Entonox).
METHODS
Laboring women at 37-41 + 6 weeks of gestation were randomly allocated to receive pethidine (50 mg intravenously) or Entonox for reducing labor pain. Pain scores were evaluated at 0, (baseline), 30, 60, 90, and 120 min after initiation, using the visual analog scale (VAS) and also satisfaction score after delivery using the verbal rating scale (VRS). The secondary outcomes were also assessed, including APGAR scores, labor course, side effects, and cesarean section rate.
RESULTS
A total of 136 laboring women underwent randomization into two groups, but only 58 and 65 in the pethidine group and the Entonox group were available for analysis. The median pain scores at baseline, 30, 60, and 90 min were comparable between both groups (-value > 0.05); however, pain score at 120 min in the pethidine group was significantly higher (-value: 0.038). The median of satisfaction score was significantly higher in the Entonox group (4 vs. 3; -value 0.043). All of the secondary outcomes were comparable between the two groups.
CONCLUSIONS
Both have comparable effectiveness, but Entonox has a higher satisfaction score. Entonox could be an alternative to pethidine for reducing labor pain, because of its efficacy, ease for self-adjustment for satisfaction, and no serious effects on the labor course and newborns.
Topics: Analgesics, Opioid; Cesarean Section; Female; Humans; Infant, Newborn; Labor Pain; Meperidine; Nitrous Oxide; Oxygen; Pregnancy
PubMed: 34886299
DOI: 10.3390/ijerph182312571 -
Xenobiotica; the Fate of Foreign... Feb 20201. Meperidine is an opioid analgesic that undergoes demethylation to form the neurotoxic metabolite normeperidine. Previous studies indicate that meperidine...
1. Meperidine is an opioid analgesic that undergoes demethylation to form the neurotoxic metabolite normeperidine. Previous studies indicate that meperidine -demethylation is catalyzed by cytochrome P450 2B6 (CYP2B6), CYP3A4, and CYP2C19.2. The purpose of this study was to examine the relative P450 contributions to meperidine -demethylation and to evaluate the effect of polymorphism on normeperidine generation. Experiments were performed using recombinant P450 enzymes, selective chemical inhibitors, enzyme kinetic assays, and correlation analysis with individual -genotyped human liver microsomes.3. The catalytic efficiency (/) for meperidine -demethylation was similar between recombinant CYP2B6 and CYP2C19, but markedly lower by CYP3A4.4. In -genotyped human liver microsomes, normeperidine formation was significantly correlated with CYP2C19 activity (-mephenytoin 4-hydroxylation).5. CYP2C19 inhibitor (+)--3-benzylnirvanol and CYP3A inhibitor ketoconazole significantly reduced microsomal normeperidine generation by an individual donor with high CYP2C19 activity, whereas donors with lower CYP2C19 activity were sensitive to inhibition by ketoconazole but not benzylnirvanol.6. These findings demonstrate that the relative CYP3A4, CYP2B6, and CYP2C19 involvement in meperidine -demethylation depends on the enzyme activities in individual human liver microsomal samples. CYP2C19 is likely an important contributor to normeperidine generation in individuals with high CYP2C19 activity, but additional factors influence inter-individual metabolite accumulation.
Topics: Cholinesterase Inhibitors; Cytochrome P-450 CYP2C19; Cytochrome P-450 Enzyme System; Demethylation; Humans; Meperidine; Mephenytoin
PubMed: 30902024
DOI: 10.1080/00498254.2019.1599465