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American Journal of Rhinology & Allergy May 2022The literature on opiate use after endoscopic endonasal transsphenoidal surgery (EETS) is limited.
BACKGROUND
The literature on opiate use after endoscopic endonasal transsphenoidal surgery (EETS) is limited.
OBJECTIVE
To determine the risk factors for higher opiate use following EETS and the quantity of opiates used after discharge.
METHODS
A retrospective review of 144 patients undergoing EETS from July 2018 to July 2020 was conducted. Patient, tumor, and surgical factors were documented. Pain scores and medications used on postoperative days (POD) 0 and 1, and discharge prescriptions, were recorded. Opiate use was quantified using morphine milligram equivalents (MME) dose. Multiple linear regression determined risk factors independently associated with POD0 to 1 opiate use.
RESULTS
On POD 0 to 1, mean pain score was 4.9/10 (standard deviation [SD] ± 2.0). Mean acetaminophen use was 3.4 tablets (SD ± 1.6; 650 mg per tablet). Mean opiate use was 35.6 MME (SD ± 36.3), equivalent to 4.7 tablets (SD ± 4.8) of oxycodone 5 mg. Multiple linear regression showed that current smokers required an additional 37.1 MME ( = .011), and patients with grade 3 intraoperative cerebrospinal fluid leaks required an additional 36.7 MME ( = .046) on POD0 to 1. On discharge, mean opiate prescription was 117.7 MME (SD ± 102.1), equivalent to 15.7 tablets (SD ± 13.6) of oxycodone 5 mg. Thirty-nine patients (27.1%) did not require prescriptions. Only 10 patients (6.9%) required opiate refill(s) within 30 days after surgery.
CONCLUSION
Patients undergoing EETS have higher opiate needs compared to those undergoing endoscopic sinus surgery, although the overall requirements are still considered low. Independent risk factors associated with higher opiate use in the immediate postoperative period included current smokers and grade 3 intraoperative cerebrospinal fluid leaks.
Topics: Analgesics, Opioid; Cerebrospinal Fluid Leak; Endoscopy; Humans; Opiate Alkaloids; Pain, Postoperative; Retrospective Studies
PubMed: 34881667
DOI: 10.1177/19458924211061990 -
BMJ (Clinical Research Ed.) Feb 2023
Topics: Humans; Opiate Alkaloids; Opioid-Related Disorders; Self Efficacy; Personal Autonomy
PubMed: 36805854
DOI: 10.1136/bmj.p400 -
Clinical Toxicology (Philadelphia, Pa.) Sep 2022
Topics: Analgesics, Opioid; Diphenhydramine; False Positive Reactions; Humans; Immunoassay; Opiate Alkaloids; Substance Abuse Detection
PubMed: 35546100
DOI: 10.1080/15563650.2022.2071285 -
Cold Spring Harbor Perspectives in... Oct 2012Opiates are a highly addictive class of drugs that have been reported to possess both dopamine-dependent and dopamine-independent rewarding properties. The search for... (Review)
Review
Opiates are a highly addictive class of drugs that have been reported to possess both dopamine-dependent and dopamine-independent rewarding properties. The search for how, if at all, these distinct mechanisms of motivation are related is of great interest in drug addiction research. Recent electrophysiological, molecular, and behavioral work has greatly improved our understanding of this process. In particular, the signaling properties of GABA(A) receptors located on GABA neurons in the ventral tegmental area (VTA) appear to be crucial to understanding the interplay between dopamine-dependent and dopamine-independent mechanisms of opiate motivation.
Topics: Animals; Dopamine; Humans; Motivation; Opiate Alkaloids; Opioid-Related Disorders; Receptors, GABA; Signal Transduction; Ventral Tegmental Area
PubMed: 23028134
DOI: 10.1101/cshperspect.a012096 -
Nature Nov 2017
Topics: Analgesics, Opioid; Death; Humans; Opiate Alkaloids; Opioid-Related Disorders
PubMed: 29189802
DOI: 10.1038/d41586-017-07657-z -
American Journal of Respiratory and... Aug 2020
Topics: Critical Care; Humans; Intensive Care Units; Opiate Alkaloids; Patient Discharge; Respiration, Artificial
PubMed: 32464072
DOI: 10.1164/rccm.202005-1815ED -
American Journal of Surgery Oct 2023
Topics: Humans; Opium; Opiate Alkaloids; Opioid-Related Disorders
PubMed: 37336710
DOI: 10.1016/j.amjsurg.2023.06.007 -
Tijdschrift Voor Psychiatrie 2023Patients with opiate use disorder may be treated medicamentally with methadone and sublingual buprenorphine. However, also two forms of subcutaneous buprenorphine that...
BACKGROUND
Patients with opiate use disorder may be treated medicamentally with methadone and sublingual buprenorphine. However, also two forms of subcutaneous buprenorphine that can be administered weekly or monthly are available.
AIM
To describe the effectiveness and the side effects of the buprenorphine depot.
METHOD
Embase was searched and cross-references were sought in the included studies and previous reviews.
RESULTS
Nine articles were included. One randomized study (n = 428) compared buprenorphine depot to the sublingual form, with the depot being more effective after 12-24 weeks. The other randomized study (n = 504) compared the depot with placebo. The depot was found to be effective. In two comparative non-blinded studies, no significant difference in abstinence was reported between the depot and sublingual administration. Medium-term effectiveness (16-52 weeks) was confirmed in five follow-up studies, in which the depot preparation proved both effective and well tolerated.
CONCLUSION
The buprenorphine depot is described as promising in the international literature. However, there are still several uncertainties that make its prescription should be done with great caution.
Topics: Humans; Buprenorphine; Narcotic Antagonists; Opiate Alkaloids; Opioid-Related Disorders; Methadone
PubMed: 36734687
DOI: No ID Found -
American Journal of Respiratory and... Sep 2021
Topics: Analgesia; Delirium; Humans; Opiate Alkaloids; Pain; Pain Management
PubMed: 33956575
DOI: 10.1164/rccm.202104-0968ED -
Journal of Opioid Management 2023To investigate post-operative opioid use following a total hip arthroplasty (THA) in metastatic bone disease (MBD) patients and identify factors associated with...
OBJECTIVES
To investigate post-operative opioid use following a total hip arthroplasty (THA) in metastatic bone disease (MBD) patients and identify factors associated with post-operative opioid use at 6 weeks and 90 days.
BACKGROUND
MBD commonly affects the hip, and surgical intervention including THA may be indicated for pain relief or to improve function. Following THA, patients are often prescribed short courses of opioids for post-operative pain relief. No study has evaluated opiate use following THA in patients for MBD.
METHODS
This was a retrospective review of patients using opioids preoperatively who underwent primary THA for MBD at two institutions between 2009 and 2022. Preoperative and post-operative opioid usages, respectively, at 6 weeks and 90 days were quantified through calculating daily morphine milligram equivalents (MMEs) and compared using the sign test. Factors associated with post-operative opioid use at 6 weeks and 90 days were compared using χ2 test or Fisher's exact test as appropriate.
RESULTS
Nineteen THA and 11 THA with complex acetabular reconstruction were included. At 6 weeks, 26 (86.7 percent) patients were utilizing opiates, and at 90 days, 23 (76.7 percent) patients were utilizing opiates. There was a statistically significant difference between median daily preoperative MME compared to daily MME at 90 days (p < 0.001). The only statistically significant association with opioid use at 90 days was opioid use at 6 weeks.
CONCLUSION
To our knowledge, this is the first paper evaluating post-operative opioid use following primary THA in MBD patients. After THA in the setting of MBD, patients exhibit decreased post-operative opioid use. Future studies with larger cohorts should be conducted to characterize post-operative opioid use following joint arthroplasty in MBD patients.
Topics: Humans; Arthroplasty, Replacement, Hip; Analgesics, Opioid; Opiate Alkaloids; Pain, Postoperative; Opioid-Related Disorders; Retrospective Studies; Bone Diseases; Endrin
PubMed: 37968973
DOI: 10.5055/jom.0813