-
Journal of Medical Toxicology :... Apr 2022
Topics: Analgesics, Opioid; Humans; Opiate Alkaloids; Opioid-Related Disorders
PubMed: 34780053
DOI: 10.1007/s13181-021-00864-1 -
Journal of Pediatric Orthopedics Sep 2021Many children with tibial fractures are currently being managed as outpatients. It is unclear how much opiates should be prescribed to ensure adequate analgesia at home...
BACKGROUND
Many children with tibial fractures are currently being managed as outpatients. It is unclear how much opiates should be prescribed to ensure adequate analgesia at home without overprescription. This study aimed to evaluate the risk factors for requiring opiates following admission for tibial fractures and to estimate opiate requirements for children being discharged directly from the emergency department (ED).
METHODS
All children aged 4 to 16 years admitted with closed tibial fractures being treated in a molded circumferential above-knee plaster cast between October 2015 and April 2020 were included. Case notes were reviewed to identify demographics, analgesic prescriptions, and complications. Risk factors were analyzed using logistic regression.
RESULTS
A total of 75 children were included, of which 64% were males. The mean age was 9.5 (SD 3.4) years. Opiates were required by 36 (48%) children in the first 24 hours following admission. The median number of opiate doses in the first 48 hours was 0 (range: 0 to 5), with 93% of children receiving ≤3 doses. The odds of requiring opiates in the first 24 hours were unchanged for age above 10 years [odds ratio (OR)=0.85, 95% confidence interval (CI): 0.33-2.23], male sex (OR=1.58, 95% CI: 0.59-4.19), high-energy injury (OR=1.65, 95% CI: 0.45-6.04), presence of a fibula fracture (OR=2.21, 95% CI: 0.72-6.76), or need for fracture reduction in the ED (OR=0.57, 95% CI: 0.20-1.65). No children developed compartment syndrome, and the mean length of stay was 1.4 (SD 1.2) days. No children were readmitted following discharge.
CONCLUSIONS
We have found no cases of compartment syndrome or extensive requirement for opiates following closed tibial fractures treated in plaster cast. These children are candidates to be discharged directly from the ED. We have not identified any specific risk factors for the targeting of opiate analgesics. We recommend a guideline prescription of 6 doses of opiates for direct discharge from the ED to ensure adequate analgesia without overprescription.
LEVEL OF EVIDENCE
Level IV-case series.
Topics: Analgesics; Analgesics, Opioid; Child; Humans; Male; Opiate Alkaloids; Retrospective Studies; Tibial Fractures
PubMed: 34397781
DOI: 10.1097/BPO.0000000000001914 -
The Annals of Thoracic Surgery Jun 2021
Topics: Humans; Opiate Alkaloids; Postoperative Complications; Surgeons
PubMed: 33279535
DOI: 10.1016/j.athoracsur.2020.09.045 -
Reproductive Biomedicine Online Mar 2016The objectives of this study were to determine whether the main opioid receptor (OPRM1) is present on human granulosa cells and if exogenous opiates and their...
The objectives of this study were to determine whether the main opioid receptor (OPRM1) is present on human granulosa cells and if exogenous opiates and their antagonists can influence granulosa cell vascular endothelial growth factor (VEGF) production via OPRM1. Granulosa cells were isolated from women undergoing oocyte retrieval for IVF. Complementary to the primary cells, experiments were conducted using COV434, a well-characterized human granulosa cell line. Identification and localization of opiate receptor subtypes was carried out using Western blot and flow cytometry. The effect of opiate antagonist on granulosa cell VEGF secretion was assessed by enzyme-linked immunosorbent assay. For the first time, the presence of OPRM1 on human granulosa cells is reported. Blocking of opiate signalling using naloxone, a specific OPRM1 antagonist, significantly reduced granulosa cell-derived VEGF levels in both COV434 and granulosa-luteal cells (P < 0.01). The presence of opiate receptors and opiate signalling in granulosa cells suggest a possible role in VEGF production. Targeting this signalling pathway could prove promising as a new clinical option in the prevention and treatment of ovarian hyperstimulation syndrome.
Topics: Blotting, Western; Cell Line; Cellular Microenvironment; Enzyme-Linked Immunosorbent Assay; Female; Flow Cytometry; Granulosa Cells; Humans; Naloxone; Opiate Alkaloids; Receptors, Opioid, mu; Signal Transduction; Vascular Endothelial Growth Factor A
PubMed: 26803207
DOI: 10.1016/j.rbmo.2015.12.006 -
Journal of Opioid Management 2022To examine the role of Targin® (oral oxycodone:naloxone combination) in the perioperative setting. (Observational Study)
Observational Study
OBJECTIVE
To examine the role of Targin® (oral oxycodone:naloxone combination) in the perioperative setting.
DESIGN
A single center prospective observational pilot study at a regional hospital.
SETTING
Thirty-eight eligible patients undergoing major general surgical operations were recruited. Thirty-two patients completed the study.
INTERVENTIONS
Participants were given Targin twice daily from day 2 post-operatively with twice daily measures of pain scores, gut function, and mobility.
MAIN OUTCOME MEASURES
The primary end points were analgesic efficacy and the rate of ileus. Secondary end points were gastrointestinal (GI) recovery and the need for opioid requirement on discharge, at 1 week and 1 month.
RESULTS
Average pain score over 5 days at rest was one and on movement was four out of 10. All patients mobilized to a chair by day 3. Twenty-six participants (81.3 percent) experienced nausea at some point during the study, and four participants (12.5 percent) were diagnosed with a post-operative ileus (POI). There was no serious adverse event reported. Only two patients were on opioids at 1-month discharge. This was due to them having Orthopaedic surgery not related to this study.
Topics: Analgesia; Analgesics, Opioid; Humans; Ileus; Narcotic Antagonists; Opiate Alkaloids; Oxycodone; Pain; Pain, Postoperative; Prospective Studies
PubMed: 35666485
DOI: 10.5055/jom.2022.0721 -
World Neurosurgery Feb 2023Opioids are commonly prescribed for chronic pain before spinal surgery and research has shown an increased rate of postoperative adverse events in these patients.
BACKGROUND
Opioids are commonly prescribed for chronic pain before spinal surgery and research has shown an increased rate of postoperative adverse events in these patients.
OBJECTIVE
This study compared the incidence of 2-year subsequent surgical procedures and postoperative adverse events in patients undergoing lumbar fusion with or without 90-day preoperative opioid use. We hypothesized that patients using preoperative opioids would have a higher incidence of subsequent surgery and adverse outcomes.
METHODS
A retrospective cohort study was performed using the Optum Pan-Therapeutic Electronic Health Records database including adult patients who had their first lumbar fusion between 2015 and 2018. The daily average preoperative opioid dosage 90 days before fusion was determined as morphine equivalent dose and further categorized into high dose (morphine equivalent dose >100 mg/day) and low dose (1-100 mg/day). Clinical outcomes were compared after adjusting for confounders.
RESULTS
A total of 23,275 patients were included, with 2112 patients (10%) using opioids preoperatively. There was a significantly higher incidence of infection compared with nonusers (12.3% vs. 10.1%; P = 0.01). There was no association between subsequent fusion surgery (7.9% vs. 7.5%; P = 0.52) and subsequent decompression surgery (4.1% vs. 3.6%; P = 0.3) between opioid users and nonusers. Regarding postoperative infection risk, low-dose users showed significantly higher incidence (12.7% vs. 10.1%; P < 0.01), but high-dose users did not show higher incidence than nonusers (7.5% vs. 10.1%; P = 0.23).
CONCLUSIONS
Consistent with previous studies, opioid use was significantly associated with a higher incidence of 2-year postoperative infection compared with nonuse. Low-dose opioid users had higher postoperative infection rates than did nonusers.
Topics: Adult; Humans; Analgesics, Opioid; Retrospective Studies; Opiate Alkaloids; Pain, Postoperative; Postoperative Complications; Morphine; Opioid-Related Disorders
PubMed: 36396056
DOI: 10.1016/j.wneu.2022.11.044 -
Shock (Augusta, Ga.) Sep 1999The presence of opiate receptors in mammalian tissues has stimulated the search for endogenous ligands to these receptors and has led to the discovery and... (Review)
Review
The presence of opiate receptors in mammalian tissues has stimulated the search for endogenous ligands to these receptors and has led to the discovery and characterization of endogenous opioid peptides. However, recent studies have provided evidence for the presence of opiate alkaloids in mammalian tissues and for their endogenous synthesis. The study of their origin and synthetic pathway has been significantly influenced by the early classical biochemical studies performed in plants. This review is a historical account of the use and abuse of opiates, the elucidation of morphine's synthetic pathway in the poppy plant, and the subsequent characterization of its presence in mammalian tissues. Clearly, our understanding of its synthetic pathway and regulation is a reflection of observations originally made in plant biochemistry.
Topics: Alkaloids; Analgesics, Opioid; Animals; Humans; Morphine; Opioid-Related Disorders; Opium; Plants; Receptors, Opioid
PubMed: 10485593
DOI: No ID Found -
The Journal of Neuroscience : the... Jan 2022We previously found that human heroin addicts and mice chronically exposed to morphine exhibit a significant increase in the number of detected hypocretin/orexin...
We previously found that human heroin addicts and mice chronically exposed to morphine exhibit a significant increase in the number of detected hypocretin/orexin (Hcrt)-producing neurons. However, it remains unknown how this increase affects target areas of the hypocretin system involved in opioid withdrawal, including norepinephrine containing structures locus coeruleus (LC) and A1/A2 medullary regions. Using a combination of immunohistochemical, biochemical, imaging, and behavioral techniques, we now show that the increase in detected hypocretin cell number translates into a significant increase in hypocretin innervation and tyrosine hydroxylase (TH) levels in the LC without affecting norepinephrine-containing neuronal cell number. We show that the increase in TH is completely dependent on Hcrt innervation. The A1/A2 regions were unaffected by morphine treatment. Manipulation of the Hcrt system may affect opioid addiction and withdrawal. Previously, we have shown that the hypothalamic hypocretin system undergoes profound anatomic changes in human heroin addicts and in mice exposed to morphine, suggesting a role of this system in the development of addictive behaviors. The locus coeruleus plays a key role in opioid addiction. Here we report that the hypothalamic hypocretin innervation of the locus coeruleus increases dramatically with morphine administration to mice. This increase is correlated with a massive increase in tyrosine hydroxylase expression in locus coeruleus. Elimination of hypocretin neurons prevents the tyrosine hydroxylase increase in locus coeruleus and dampens the somatic and affective components of opioid withdrawal.
Topics: Animals; Locus Coeruleus; Mice; Morphine; Motor Activity; Neurons; Norepinephrine; Opiate Alkaloids; Orexins; Substance Withdrawal Syndrome; Tyrosine 3-Monooxygenase
PubMed: 34853083
DOI: 10.1523/JNEUROSCI.1557-21.2021 -
Fortschritte Der Neurologie-Psychiatrie Dec 2022Opiate addiction is common among offenders, and many opiate-dependent lawbreakers are treated in the correctional system according to § 64 STGB. While substitution...
Opiate addiction is common among offenders, and many opiate-dependent lawbreakers are treated in the correctional system according to § 64 STGB. While substitution treatment in prisons has become common practice, substitution treatment in forensic hospitals in the traditionally abstinence-oriented prison system is controversial and also varies from region to region. Basic data on this are lacking so far. The problem is discussed against the background of a current expert opinion case. Current figures from a large forensic hospital in Munich-East show that almost 30% of the patients are treated with substitutes (n=186). The problem of substitution treatment in the prison system is discussed.
Topics: Humans; Opiate Alkaloids; Analgesics, Opioid; Opioid-Related Disorders; Forensic Psychiatry; Hospitals; Opiate Substitution Treatment; Prisoners
PubMed: 35100637
DOI: 10.1055/a-1669-9033 -
Behavioural Brain Research Feb 2023Gender differences have been observed in the vulnerability to drug abuse and in the different stages of the addictive process. In opiate dependence, differences between...
Gender differences have been observed in the vulnerability to drug abuse and in the different stages of the addictive process. In opiate dependence, differences between sexes have been shown in humans and laboratory animals in various phases of opiate addiction, especially in withdrawal-associated negative affective states. Using a Y-maze conditioned place aversion paradigm, we investigated potential sex differences in the expression and extinction of the aversive memory of precipitated opiate withdrawal state in morphine-dependent rats. No significant difference between sexes was observed in the occurrence of withdrawal signs following naloxone injection during conditioning. Moreover, opiate withdrawal memory expression and extinction following repeated testing was demonstrated in both male and female rats, with no significant differences between sexes. Finally, we report spontaneous recovery following extinction of opiate withdrawal memory. Altogether these data provide further evidence that persistent withdrawal-related memories may be strong drivers of opiate dependence, and demonstrate that both males and females can be used in experimental rodent cohorts to better understand opiate-related effects, reward, aversive state of withdrawal, abstinence and relapse.
Topics: Humans; Rats; Animals; Female; Male; Opiate Alkaloids; Substance Withdrawal Syndrome; Avoidance Learning; Naloxone; Analgesics, Opioid; Morphine Dependence; Opioid-Related Disorders; Morphine; Narcotic Antagonists
PubMed: 36174840
DOI: 10.1016/j.bbr.2022.114122