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Pharmacy (Basel, Switzerland) Nov 2022Background: Once a widely used analgesic in the United States (US), meperidine offered an alternative opioid to other opioids as a pain reliever and was widely assumed...
Background: Once a widely used analgesic in the United States (US), meperidine offered an alternative opioid to other opioids as a pain reliever and was widely assumed to be safer with acute pancreatitis. However, within the last two decades meperidine, has gone from a frequently used drug to being used only when patients exhibit atypical reactions to opioids (e.g., morphine and hydromorphone), to being taken off the World Health Organization List of Essential Medications and receiving strong recommendations for overall avoidance. The aim of this study was to identify changes in meperidine distribution in the US, and regional disparities as reported to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (DEA ARCOS) and Medicaid. Methods: Data related to meperidine distribution was obtained through ARCOS (2001−2021) and Medicaid public use files (2016−2021). Heat maps were used to visualize regional disparities in distribution by state. States outside a 95% confidence interval were statistically significant. Results: Meperidine distribution between 2001 and 2021 decreased by 97.4% (R = −0.97, p < 0.0001). There was a 34-fold state-level difference in meperidine distribution between Arkansas (16.8 mg/10 persons) and Connecticut (0.5 mg/10 persons) in 2020. Meperidine distribution in 2020 was elevated in Arkansas, Mississippi, and Alabama. In 2021, meperidine distribution was highest in Arkansas (16.7 mg/10 persons) and lowest in Connecticut (0.8 mg/10 persons). Total prescriptions of meperidine as reported by Medicaid decreased by 73.8% (R = −0.67, p = 0.045) between 2016 and 2021. Conclusion: We observed a decrease in the overall distribution of meperidine in the past two decades, with a similar recent decline in prescribing it to Medicaid enrollees. The shortage of some parenteral formulations is an important contributor to these declines, however, the most likely explanation for this global decline in use is related to an increased recognition of safety concerns related to important drug interactions and a neurotoxic metabolite. This data may reflect plans to phase out the use of this opioid, especially in the many situations where safer and more preferred opioids are available.
PubMed: 36412830
DOI: 10.3390/pharmacy10060154 -
Frontiers in Veterinary Science 2022In medicine, the transversus abdominis plane (TAP) block has been shown as an effective method of analgesia in several surgical procedures. In this context, this...
BACKGROUND
In medicine, the transversus abdominis plane (TAP) block has been shown as an effective method of analgesia in several surgical procedures. In this context, this prospective, randomized, blinded study aimed to evaluate the analgesic efficacy of TAP block, guided by ultrasound in female dogs submitted to ovariectomy.
METHODS
Therefore, 32 animals randomly assigned in two groups ( = 16) were used. Groups consisted of TAP block control (TBC) which received water injection (0.2 ml kg point), and TAP block bupivacaine (TBB) which received bupivacaine (0.2 ml kg point at 0.25%); both groups were submitted to four-point approach. Animals were pre-medicated with acepromazine (0.03 mg kg) and meperidine (2 mg kg) IM, propofol was used as anesthetic induction (3-5 mg kg) IV, and isoflurane was used to maintain. To standardize groups, the animals received a continuous infusion of remifentanil (0.2μg kg min) and rocuronium (0.6 mg kg) IV in the intraoperative period. Variables measured were the heart and respiratory rates, blood pressure, temperature, peripheral oxyhemoglobin saturation, exhaled carbon dioxide concentration, exhaled isoflurane concentration, serum cortisol, analgesia, and sedation. Before the pre-anesthetic medication (Baseline) and 1, 2, 4, 6, and 8 h after extubation, pain and sedation were assessed using a numeric rating scale (NRS), Glasgow composite measure pain scale (GCMPS-SF), and sedation scale. Moreover, serum cortisol was measured at different moments.
RESULTS
The results show that in the intraoperative period, there was no significant difference between groups. After surgery, in TBC, 13 out of 16 animals required analgesic rescue, whereas, in TBB, this occurred only in one animal. Regarding the measurement of serum cortisol, the TBC group showed a significant difference when compared to the baseline time in the traction of the first ovary ( < 0.0001), 2 h ( = 0.0441), and 8 h ( = 0.0384) after extubation. In TBB, cortisol showed a significant increase only in the traction of the first ovary and 2 h after extubation ( < 0.0001).
CONCLUSION
The technique using ultrasound-guided TAP block in two points approach by hemiabdomen with 0.2 ml kg bupivacaine 0.25% was effective in providing post-operative analgesia in dogs undergoing ovariectomy.
PubMed: 36387373
DOI: 10.3389/fvets.2022.1031345 -
Veterinary Ophthalmology Mar 2023The aims of this study were to compare the central corneal thickness (CCT) measured by an ultrasonic pachymeter (SP-100, Tomey, Japão) versus the Galilei G6™ (Ziemer...
OBJECTIVE
The aims of this study were to compare the central corneal thickness (CCT) measured by an ultrasonic pachymeter (SP-100, Tomey, Japão) versus the Galilei G6™ (Ziemer Ophthalmics System AG, Port, Switzerland) and to compare the simulated keratometry (SimK) measured by an autokeratometer (KM 500 Nidek) versus the Galilei G6™.
ANIMAL STUDIED
Eighteen mixed-breed cats, 10 males, and eight females, aged between 18 and 48 months, were evaluated (n = 36 eyes).
PROCEDURE(S)
The cats were manually restrained using a blanket. The operator held the autokeratometer close to the eye and measured the SimK. Next, one anesthetic eye drop was applied; the operator lightly touched the corneal using the ultrasound pachymeter and measured the CCT. At another moment, the cats were sedated using meperidine and xylazine and then evaluated using the Galilei. Student's t-test was employed to perform the statistical analyzes.
RESULTS
Considering the CCT, the ultrasound pachymeter provided mean ± SD of 623.03 ± 48.17 μm and the Galilei 617.34 ± 53.38 μm. The autokeratometer produced a SimK of 38.20 ± 0.84D (8.84 ± 0.20 mm) and the Galilei 38.37 ± 0.83D (8.80 ± 0.19 mm). The CCT and SimK did not differ statistically regardless of the device used.
CONCLUSION
To the best of the authors' knowledge, this is the first work to compare the CCT measured by the Galilei versus the ultrasonic pachymeter and to compare the SimK measured by the Galilei versus the keratometer in cats. No statistical difference was found considering the CCT and the SimK measured by the different devices.
Topics: Male; Female; Cats; Animals; Ultrasonics; Reproducibility of Results; Prospective Studies; Cornea; Ultrasonography
PubMed: 36383444
DOI: 10.1111/vop.13039 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2022The aim: To compare the pain in patients with combined pathology of the anal canal and rectum after combined operations using modern high-frequency electrosurgical and...
OBJECTIVE
The aim: To compare the pain in patients with combined pathology of the anal canal and rectum after combined operations using modern high-frequency electrosurgical and radio-surgical devices and a conventional metal scalpel.
PATIENTS AND METHODS
Materials and methods: The results of treatment of 635 patients with combined pathology of the anal canal and rectum using high-frequency electrosurgery and radio-wave surgery, which were divided into 4 study groups, as well as 112 patients using a metal surgical scalpel were analyzed.
RESULTS
Results: Assessing the pain syndrome on the first day of the postoperative period, it was found that it was most pronounced in control group patients, where the need for anal¬gesia 2 % promedol solution was 4±1 ml and in the first, third and fourth study groups patients needed for analgesia 2±1 ml of 2 % promedol solution when using "Surgitron" radio-wave surgery device, "EFA" and "KLS Martin" high-frequency electrosurgical devices respectively. When using device "ERBE ICC 200", the need for a 2 % promedol solution for analgesia was 3±1 ml.
CONCLUSION
Conclusions: Using of radio-wave surgery device and high-frequency electrosurgery devices is much better compared to the use of a surgical metal scalpel because they cause much less pain due to the formation of a thin layer of coagulation necrosis, promoting the formation of a delicate elastic scar and preventing formation of scar anal strictures.
Topics: Humans; Cicatrix; Promedol; Anal Canal; Rectum; Rectal Diseases
PubMed: 36378702
DOI: 10.36740/WLek202209211 -
Journal of Personalized Medicine Sep 2022Background: This study aimed to evaluate whether a low- or high-pressure alveolar recruitment maneuver (ARM) might reduce postoperative pain and improve the quality of...
Effect of Low or High Pressure Alveolar Recruitment Maneuver on Postoperative Pain and Quality of Recovery in Patients with Obesity Undergoing Laparoscopic Sleeve Gastrectomy.
Background: This study aimed to evaluate whether a low- or high-pressure alveolar recruitment maneuver (ARM) might reduce postoperative pain and improve the quality of recovery after laparoscopic bariatric surgery. Methods: 90 patients with a body mass index > 30 kg/m2 scheduled for laparoscopic sleeve gastrectomy were randomly assigned to control (n = 30), low ARM (n = 30), or high ARM groups (n = 30). For the low and high ARM groups, ARM was repeated five times to hold the peak airway pressure at 30 cmH2O and 60 cmH2O for 5 s, respectively, before removal of the trocar. Conventional methods to reduce post-laparoscopic pain, such as intraperitoneal saline irrigation, hemovac drainage, and gentle abdominal compression were performed in all patients, regardless of the assigned group. Results: Shoulder and surgical site pain scores 24 h postoperatively and rescue meperidine requirement were similar between the groups (p = 0.141, 0.101, and 0.82, respectively). The quality of recovery 40 (QoR40) score 24 h postoperatively was similar between the groups (p = 0.755). Postoperative pulmonary complications were similar between the groups (p = 0.124). Conclusion: Application of a low- or high-pressure ARM in addition to conventional methods to remove remnant peritoneal CO2 gas did not reduce postoperative shoulder or surgical site pain or improve the quality of recovery after laparoscopic sleeve gastrectomy.
PubMed: 36294691
DOI: 10.3390/jpm12101550 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Nov 2022Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Long-term complications of hemophilia such as arthropathy,...
BACKGROUND
Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Long-term complications of hemophilia such as arthropathy, synovitis, and arthritis can lead to the development of recurrent chronic pain. Pain is therefore a critical aspect of hemophilia. The gold standard treatment for end-stage hemophilic knee arthropathy is total knee arthroplasty (TKA). The hypothesis of this study was that after knee replacement surgeries that cause severe post-operative pain, hemophilia patients with chronic analgesic consumption may experience higher levels of pain than non-hemophilic patients, and use more opioid and non-opioid drugs.
METHODS
This retrospective study included 82 patients who were hemophilic and non-hemophilic TKA patients operated under general anesthesia. Seventy-three patients were evaluated and divided into two groups according to the diagnosis of hemophilia: 36 patients were investigated in the hemophilic group and 37 patients in the non-hemophilic group.
RESULTS
Post-operative tramadol consumption (p=0.002) and pethidine consumption (p=0.003) were significantly higher in the group hemophilia. The length of stay in the hospital was also significantly longer in the hemophilic group (p=0.0001).
CONCLUSION
In the light of these informations, we think that acute post-operative pain management of hemophilia patients should be planned as personalized, multimodal preventive, and pre-emptive analgesia.
Topics: Humans; Arthroplasty, Replacement, Knee; Factor VIII; Hemophilia A; Retrospective Studies; Tramadol; Joint Diseases; Pain; Analgesics; Meperidine
PubMed: 36282160
DOI: 10.14744/tjtes.2021.47482 -
Scientific Reports Oct 2022Continuous wound infusion with local anesthesia is an effective method for reducing postoperative pain after laparoscopic colorectal surgery. However, most subcutaneous... (Randomized Controlled Trial)
Randomized Controlled Trial
Continuous wound infusion with local anesthesia is an effective method for reducing postoperative pain after laparoscopic colorectal surgery. However, most subcutaneous local anesthesia is delivered through continuous injection, which can be inconvenient for patients. This study compared the effectiveness of postoperative pain relief from the application of a local poloxamer 407-based ropivacaine hydrogel (Gel) to the incision site with continuous infusion-type ropivacaine administration (On-Q) in patients undergoing laparoscopic colorectal surgery. This prospective, randomized, non-inferiority study included 61 patients who underwent laparoscopic colorectal surgery with an incision length of 3-6 cm. All 61 patients were randomly assigned to the Gel group (poloxamer 407-based 0.75% ropivacaine, 22.5 mg) or the On-Q group (0.2% ropivacaine, 4 mg/hour for two days). Postoperative analgesia was induced in all patients with intravenous patient-controlled analgesia (IV-PCA). The outcome measures, which were assessed for 72 h after surgery, included the total amount of fentanyl consumed via IV-PCA (primary endpoint), and the amount of rescue analgesia (pethidine) and postoperative pain intensity assessed using a numeric rating scale (NRS) [secondary endpoints]. The Gel was administered to 31 patients and On-Q was used for 30 patients. There was no significant difference in the total usage of fentanyl between the two groups (Gel group, 1623.98 mcg; On-Q group, 1595.12 mcg; P = 0.806). There was also no significant difference in the frequency of analgesic rescue medication use (P = 0.213) or NRS scores (postoperative 6 h, P = 0.860; 24 h, P = 0.333; 48 h, P = 0.168; and 72 h, P = 0.655) between the two groups. The Gel, which continuously delivers a local anesthetic to operative sites, can thus be considered an effective device for analgesia and pain relief for midline incisions in laparoscopic colorectal surgery.
Topics: Humans; Anesthetics, Local; Ropivacaine; Anesthesia, Local; Colorectal Surgery; Prospective Studies; Poloxamer; Analgesics, Opioid; Analgesia, Patient-Controlled; Pain, Postoperative; Fentanyl; Analgesics; Meperidine; Hydrogels
PubMed: 36261491
DOI: 10.1038/s41598-022-22454-z -
Journal of Clinical Anesthesia Dec 2022We evaluated the perioperative analgesic effects of the inter-semispinal plane (ISP) block in patients undergoing posterior cervical spine surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
STUDY OBJECTIVE
We evaluated the perioperative analgesic effects of the inter-semispinal plane (ISP) block in patients undergoing posterior cervical spine surgery.
DESIGN
Prospective, randomized, controlled, double-blinded trial.
SETTING
Operating room and surgical ward.
PATIENTS
60 patients aged 18-60 years of either gender, ASA I-II, undergoing elective posterior cervical spine surgery.
INTERVENTIONS
Patients were randomly assigned into a control group (general anesthesia only), ISP group received bilateral ultrasound guided ISP block at the level of C5 using 20 ml bupivacaine 0.25% on each side.
MEASUREMENTS
Visual analog scale (VAS), intraoperative fentanyl and 24 h postoperative pethidine consumptions and time to first rescue analgesic request were documented.
MAIN RESULTS
The median (quartiles) of 24 h postoperative rescue pethidine consumption was significantly lower in the ISP group [0 (0-46.25) mg] compared to that of the control group [143 (116.75-169.00) mg]; P < 0.001). VAS was significantly lower in the ISP group at 30 min, 1 h, 2 h,4 h, 6 h, 8 h and 12 h postoperative compared to control group (P < 0.05). At 18 and 24 h, VAS was not significantly different between groups. The median (quartiles) of intraoperative fentanyl consumption in the ISP group [0 (0-40.75) μg] was significantly lower compared to that of the control group [63.5 (39.5-90.25) μg]; P < 0.001]. The time to first rescue analgesic administration was significantly longer in the ISP group compared to the control group (P < 0.001).
CONCLUSION
Bilateral ultrasound-guided ISP block can provide decreased 24 h postoperative analgesic consumption as well as lower pain scores in the first 12 postoperative hours in patients undergoing posterior cervical spine surgery.
Topics: Humans; Nerve Block; Pain, Postoperative; Prospective Studies; Double-Blind Method; Fentanyl; Meperidine; Analgesics; Analgesia; Cervical Vertebrae; Ultrasonography, Interventional; Analgesics, Opioid
PubMed: 36228453
DOI: 10.1016/j.jclinane.2022.110974 -
Journal of Opioid Management 2022This study sought to determine if there were any changes in opioid prescribing habits of providers at a single institution after the implementation of legislation to...
UNLABELLED
This study sought to determine if there were any changes in opioid prescribing habits of providers at a single institution after the implementation of legislation to increase opioid prescribing regulations. Our study demonstrated a 39.5 percent decrease in overall morphine milligram equivalent (MME) prescribed the year after the laws took effect when compared with the year prior. It is clear that these laws have been effective in decreasing the number of opioids prescribed at discharge from Mercy Health Grand Rapids.
INTRODUCTION
Opioid use disorder has become an epidemic with approximately 130 people dying every day in the United States due to prescription and illegal opioid overdoses. In December 2017, the Michigan legislature ratified a package of 10 acts to address a variety of problems through several layers of regulations including more restrictive prescribing rules, which took effect in June 2018.
OBJECTIVE
To evaluate the impact of legislation on the opioid prescribing habits of providers who discharged patients from a community-based academic teaching hospital.
DESIGN, SETTING, AND PARTICIPANTS
A retrospective cohort study was performed using data from a community-based academic teaching hospital with 303 beds, a medical ICU, labor and delivery unit, and a 42-room emergency department. All patients discharged from in-patient or observation status in the 12 months before and after June 1, 2018 were included.
MAIN OUTCOMES AND MEASURES
The primary outcome was MMEs of opioids prescribed at discharge before (June 1, 2017 to May 31, 2018) and after (June 1, 2018 to May 31, 2019) legislation. Medications included morphine, hydrocodone, oxycodone, fentanyl, methadone, hydromorphone, tramadol, codeine, and meperidine.
RESULTS
There were 17,227 patients discharged during the first 12-month period and 15,855 patients discharged in the second 12-month period. There were 14,064 new opioid prescriptions in total during these time periods. Total MME prescribed during the study period showed a 39.5 percent decrease from pre- (2,268,460 MME) to post-legislation (1,372,424 MME), while average MMEs/discharge significantly decreased (135.1 ± 321.2 vs. 87.6 ± 187.4; p < 0.001). Total pill/patch count decreased by almost 40 percent. For patients who were prescribed opioids, average MME/discharge showed significant decline after legislation implementation (309.6 ± 427.1 vs. 212.2 ± 242.1; p < 0.001). Average daily MME/patient prescribed an opioid remained similar between the time periods (52.4 ± 37.0 vs. 51.6 ± 35.0; p = 0.21). Significant reductions (p < 0.05) were seen in MMEs for each individual medication with the exception of acetaminophen-codeine and methadone.
CONCLUSIONS AND RELEVANCE
Our results indicate that the legislation implemented in Michigan to regulate opioid prescriptions was associated with a reduction in opioids prescribed to patients discharged from a community-based academic teaching hospital.
Topics: Acetaminophen; Analgesics, Opioid; Codeine; Endrin; Fentanyl; Humans; Hydrocodone; Hydromorphone; Meperidine; Methadone; Michigan; Oxycodone; Pain, Postoperative; Patient Discharge; Practice Patterns, Physicians'; Retrospective Studies; Tramadol; United States
PubMed: 36226786
DOI: 10.5055/jom.2022.0740 -
Respiratory Investigation Jan 2023We explored whether a combination of an opioid (fentanyl or pethidine) and midazolam could safely sedate Japanese patients undergoing bronchoscopic procedures. We... (Review)
Review
We explored whether a combination of an opioid (fentanyl or pethidine) and midazolam could safely sedate Japanese patients undergoing bronchoscopic procedures. We searched the PubMed Medline and Igaku Chuo Zasshi (ICHUSHI) databases from 1980 to 2022 for papers on sedatives used during bronchoscopy, especially opioids (fentanyl and pethidine) and midazolam. The keywords were "bronchoscopy" and "sedation" ("kikanshikyo" and "chinsei", respectively, in Japanese). The results showed that midazolam was the preferred sedation agent during flexible bronchoscopy; with midazolam sedation is rapid, and the drug is associated with anterograde amnesia and decreased discomfort. A combination of an opioid (fentanyl or pethidine) and midazolam improved the patient tolerance and willingness to undergo a repeat procedure and also improved the working conditions for the physician. The British Thoracic Society guideline of 2013 suggested that a combination of an opioid (fentanyl or alfentanil) and midazolam should be considered to improve bronchoscopic tolerance. The American College of Chest Physicians Consensus Statement of 2011 suggested that fentanyl should be preferred; the onset of action and peak effect are rapid, and the effects are of relatively short duration. Emphasis has been placed on safety aspects, such as patient monitoring, the precautions that should be taken in patients with certain conditions, prevention and management of complications, adequate staffing, and optimal sedation and disinfection. In conclusion a combined opioid (fentanyl or pethidine) and midazolam sedation is optimal for diagnostic and therapeutic flexible bronchoscopy in Japanese patients.
Topics: Humans; Midazolam; Analgesics, Opioid; Japan; Hypnotics and Sedatives; Fentanyl; Meperidine; Conscious Sedation
PubMed: 36220691
DOI: 10.1016/j.resinv.2022.09.003