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Brazilian Journal of Anesthesiology... Oct 2021Post-spinal back pain is suggested to occur as a result of a localized inflammatory response that is often associated with some degree of muscle spasm. We aimed to...
BACKGROUND
Post-spinal back pain is suggested to occur as a result of a localized inflammatory response that is often associated with some degree of muscle spasm. We aimed to evaluate the effect of platelet-rich plasma (PRP) in reducing the incidence of post-spinal back pain.
METHODS
One hundred patients were randomly enrolled and scheduled for elective gynecological surgery under spinal anesthesia. After the subarachnoid block, group A (placebo) received 2 mL of sodium chloride 0.9% injected into the track of spinal needle during its withdrawal (2 mm after outward withdrawal in muscles and subcutaneous tissues). While patients in group B (PRP); received 2 ml of PRP injected into the track of the spinal needle during its withdrawal. The primary outcome was the number of patients who developed post-spinal low back pain within the first week following the subarachnoid block. Secondary outcomes included the time of the first analgesic request and total meperidine consumption during the first 24 h postoperatively.
RESULTS
Fifteen patients in the PRP group developed low back pain during the first week following subarachnoid block compared to 26 patients in the placebo group (p = 0.037). There was a significant decrease in the mean meperidine consumption during first 24 h postoperatively in PRP group (174 ± 14 mg) compared to placebo group (210 ± 22 mg) (p < 0.0001). Also, the first analgesic request was significantly delayed in PRP group (243 ± 21 min.) compared to placebo group (185 ± 31 min.) (p < 0.0001).
CONCLUSION
This study demonstrated the positive effects of platelet-rich plasma on the prevention of post-spinal backache.
PubMed: 34624370
DOI: 10.1016/j.bjane.2021.09.009 -
Neurocritical Care Apr 2022Targeted temperature management (TTM) is endorsed by various guidelines to improve neurologic outcomes following cardiac arrest. Shivering, a consequence of hypothermia,... (Observational Study)
Observational Study
BACKGROUND
Targeted temperature management (TTM) is endorsed by various guidelines to improve neurologic outcomes following cardiac arrest. Shivering, a consequence of hypothermia, can counteract the benefits of TTM. Despite its frequent occurrence, consensus guidelines provide minimal guidance on the management of shivering. The purpose of this study was to evaluate the impact of a pharmacologic antishivering protocol in patients undergoing TTM following cardiac arrest on the incidence of shivering.
METHODS
A retrospective observational cohort study at a large academic medical center of adult patients who underwent TTM targeting 33 °C following out-of-hospital (OHCA) or in-hospital cardiac arrest (IHCA) was conducted between January 2013 and January 2019. Patients were included in the preprotocol group if they received TTM prior to the initiation of a pharmacologic antishivering protocol in 2015. The primary outcome was incidence of shivering between pre- and postprotocol patients. Secondary outcomes included time from arrest (IHCA) or admission to the hospital (OHCA) to goal body temperature, total time spent at goal body temperature, and percentage of patients alive at discharge. All pharmacologic agents listed as part of the antishivering protocol were recorded.
RESULTS
Fifty-one patients were included in the preprotocol group, and 80 patients were included in the postprotocol group. There were no significant differences in baseline characteristics between the groups, including percentage of patients experiencing OHCA (75% vs. 63%, p = 0.15) and time from arrest to return of spontaneous circulation (17.5 vs. 17.9 min, p = 0.96). Incidence of patients with shivering was significantly reduced in the postprotocol group (57% vs. 39%, p = 0.03). Time from arrest (IHCA) or admission to the hospital (OHCA) to goal body temperature was similar in both groups (5.1 vs. 5.3 h, p = 0.57), in addition to total time spent at goal body temperature (17.7 vs. 18 h, p = 0.93). The percentage of patients alive at discharge was significantly improved in the postprotocol group (35% vs. 55%, p = 0.02). Patients in the postprotocol group received significantly more buspirone (4% vs. 73%, p < 0.01), meperidine (8% vs. 34%, p < 0.01), and acetaminophen (12% vs. 65%, p < 0.01) as part of the pharmacologic antishivering protocol. Use of neuromuscular blockade significantly decreased post protocol (19% vs. 6%, p = 0.02).
CONCLUSIONS
In patients undergoing TTM following cardiac arrest, the implementation of a pharmacologic antishivering protocol reduced the incidence of shivering and the use neuromuscular blocking agents. Prospective data are needed to validate the results and further evaluate the safety and efficacy of an antishivering protocol on clinical outcomes.
Topics: Adult; Cardiopulmonary Resuscitation; Humans; Hypothermia, Induced; Observational Studies as Topic; Out-of-Hospital Cardiac Arrest; Prospective Studies; Retrospective Studies
PubMed: 34498206
DOI: 10.1007/s12028-021-01327-9 -
Archives of Iranian Medicine Aug 2021Pain control methods after cesarean section may interfere with infant breast-feeding. The aim of this study was to evaluate the effect of pethidine on breast feeding of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pain control methods after cesarean section may interfere with infant breast-feeding. The aim of this study was to evaluate the effect of pethidine on breast feeding of infants born via cesarean section with spinal anesthesia.
METHODS
In this randomized double-blind clinical trial, we evaluated 116 infants born via cesarean section in Gerash Amiralmomenin hospital (Southern Iran) in 2017. The subjects were selected through purposive sampling and randomly by permuted block randomization and assigned to intervention and control groups. The test group received 100 mg of pethidine as intravenous infusion and the control group received only routine cares. Infants' breast feeding behavior in both groups was recorded within 48 hours of hospitalization, using the standard tool for rapid assessment of infant feeding behavior, which consists of 4 main components of breastfeeding, including readiness to feed, rooting, latching, and sucking with a score range of 0 to 3 for each component evaluated at 1, 6, 12, 24, 36, and 48 hours postnatally. Data were analyzed using independent t tests and chi-square test.
RESULTS
The highest score of breast-feeding behavior pertained to sucking reflexes in the control group and the lowest score to breast feeding readiness in the pethidine group. Readiness for feeding in the control group (2.09±0.53) was significantly higher than the pethidine group (1.81±0.61) (95% CI: 0.0552, 0.5092 and =0.015). Sucking reflex (95% CI: -0.1461, 0.2208 and =0.687), latching (95% CI: -0.3012, 0.0345 and =0.118) and rooting reflexes (95% CI: -0.1685, 0.2342 and =0.747) were almost equal in the control group (2.54±0.49, 2.52±0.38, 2.5±0.48, respectively) and pethidine groups (2.51±0.43, 2.65±0.45, 2.46±0.53, respectively). The total score of feeding behavior in the control group (9.66±1.04) was higher than that of the pethidine group (9.44 ±.69) (95% CI: -0.2032, 0.6412 and =0.306). There was no significant difference between the infants' feeding frequency (95% CI: -0.269, 1.930 and =0.137) and duration of feeding (95% CI: -3.2067, 0.4597 and =0.14).
CONCLUSION
Evaluation of infants in the first 48 hours after birth showed that those babies whose mothers received pethidine were less willing to start breast-feeding. However, other components of breast-feeding behaviors were similar.
Topics: Anesthesia, Spinal; Breast Feeding; Cesarean Section; Female; Humans; Infant; Meperidine; Mothers; Pregnancy
PubMed: 34488326
DOI: 10.34172/aim.2021.84 -
Journal of Opioid Management 2021Examine the relationship between prescription opioid analgesic use during pregnancy and preterm birth or term low birthweight.
OBJECTIVE
Examine the relationship between prescription opioid analgesic use during pregnancy and preterm birth or term low birthweight.
DESIGN, SETTING, AND PARTICIPANTS
We analyzed data from the National Birth Defects Prevention Study, a US multisite, population-based study, for births from 1997 to 2011. We defined exposure as self-reported prescription opioid use between one month before conception and the end of pregnancy, and we dichotomized opioid use duration by ≤7 days and >7 days.
MAIN OUTCOME MEASURES
We examined the association between opioid use and preterm birth (defined as gestational age <37 weeks) and term low birthweight (defined as <2500 g at gestational age ≥37 weeks).
RESULTS
Among 10,491 singleton mother/infant pairs, 470 (4.5 percent) reported opioid use. Among women reporting opioid use, 236 (50 percent) used opioids for > 7 days; codeine (170, 36 percent) and hydrocodone (163, 35 percent) were the most commonly reported opioids. Opioid use was associated with slightly increased risk for preterm birth [adjusted odds ratio, 1.4; 95 percent confidence interval, 1.0, 1.9], particularly with hydrocodone [1.6; 1.0, 2.6], meperidine [2.5; 1.2, 5.2], or morphine [3.0; 1.5, 6.1] use for any duration; however, opioid use was not significantly associated with term low birthweight.
CONCLUSIONS
Preterm birth occurred more frequently among infants of women reporting prescription opioid use during pregnancy. However, we could not determine if these risks relate to the drug or to indications for use. Patients who use opioids during pregnancy should be counseled by their practitioners about this and other potential risks associated with opioid use in pregnancy.
Topics: Analgesics, Opioid; Birth Weight; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Premature Birth; Prescriptions
PubMed: 34259333
DOI: 10.5055/jom.2021.0632 -
Agri : Agri (Algoloji) Dernegi'nin... Jan 2021This study was an analysis of the effect of different dosages of intrathecal meperidine (40 mg, 50 mg, 60 mg, and 70 mg) on hemodynamic parameters, the duration of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This study was an analysis of the effect of different dosages of intrathecal meperidine (40 mg, 50 mg, 60 mg, and 70 mg) on hemodynamic parameters, the duration of neural blockade, and the incidence of meperidine-related side effects in patients who underwent an open prostatectomy.
METHODS
Sixty patients who underwent an open prostatectomy with combined spinal-epidural anesthesia were included. The patients were allocated to receive 1 of 4 different dosages of intrathecal meperidine (n=15 for each group): Group I: 40 mg, Group II: 50 mg, Group III: 60 mg, and Group IV: 70 mg. The duration of the block procedure, surgery duration, highest sensory block level, and anesthetic complications were recorded and analyzed.
RESULTS
At 20 minutes after the spinal injection, the maximum sensory block level was T6 in Group I and II, and it was T5 in Group III and IV. The mean motor block scores at 20 minutes after the spinal injection were lower in Group I compared with the other groups (p<0.001 for all). The motor block duration was significantly shorter in Group I and II than in Group III and IV (p<0.001 for all). Surgeon satisfaction was greater in Group II, III, and IV compared with Group I (p<0.001 for all). Patient satisfaction was better in Group III and IV compared with Groups I and II (p<0.001 for all).
CONCLUSION
Intrathecal meperidine at a dose of 60 mg exerted a sufficient analgesic effect with minimum side effects in patients undergoing open prostatectomy.
Topics: Anesthesia, Spinal; Double-Blind Method; Humans; Injections, Spinal; Male; Meperidine; Prospective Studies; Prostate
PubMed: 34254658
DOI: 10.14744/agri.2020.90377 -
Anesthesiology and Pain Medicine Oct 2020Meperidine is known as the gold standard drug for shivering after spinal anesthesia (SA). This drug has been used widely and safely during the Cesarean Section (CS).
INTRODUCTION
Meperidine is known as the gold standard drug for shivering after spinal anesthesia (SA). This drug has been used widely and safely during the Cesarean Section (CS).
CASE PRESENTATION
This case report presents an anaphylaxis reaction to a single intravenous dose of 25 mg meperidine, aiming to control shivering during CS under SA a few minutes after surgical incision.
CONCLUSIONS
The condition was well managed with timely intervention. This rare fetal reaction to meperidine is worthy of reporting to make the medical team aware of the potential risks of anaphylaxis due to many routine safe drugs.
PubMed: 34150563
DOI: 10.5812/aapm.104796 -
Anesthesiology and Pain Medicine Oct 2020Postoperative pain is a common problem after middle ear surgery. Several analgesic agents are available for pain relief, but they cause numerous side effects. Therefore,...
BACKGROUND
Postoperative pain is a common problem after middle ear surgery. Several analgesic agents are available for pain relief, but they cause numerous side effects. Therefore, complementary analgesic methods are developed to reduce patient's postoperative pain and discomfort.
OBJECTIVES
The current study aimed to investigate the effect of the acupressure on post middle ear surgery pain, applying pressure on the Yinmen acupoint of the sciatic nerve.
METHODS
In this randomized clinical trial, 100 adult patients who were candidate for elective middle ear surgery were selected and divided into two groups of Yinmen and placebo, each with 50 subjects. After admission to the ward, patients' postoperative pain score was measured using the visual analog score (VAS) tool. Then, patients were placed in the prone position. In the Yinmen group, using a fist, we applied a continuous pressure (11 - 20 kg) to the posterior aspect of the thighs at the Yinmen acupoint for 2 minutes. In the placebo group, only soft contact was kept between the fist and Yinmen point for the same period. The maneuver repeated every two hours for four times. The pain intensity surveyed 10 minutes after the first maneuver, then every hour for 8 hours. For those with a VAS score ≥ 4, intravenous paracetamol and/or meperidine was administered. Any nausea and vomiting was managed using ondansetron 2 mg, IV. The pain score, paracetamol, and meperidine consumption were recorded and compared between the two groups. The chi-square and student t-tests were used to compare the two groups.
RESULTS
No significant difference was found between patients' characteristics and the first pain score. For all measurements, pain intensity was lower in the Yinmen group (P value < 0.01). The pain after the first maneuver was relieved exactly when the acupressure was true. The intervention could reduce patients' need to take paracetamol (6.68 ± 2.58 vs. 10.42 ± 3.87 mg/kg) and meperidine (0.21 ± 0.17 vs. 0.39 ± 0.23 mg/kg) in the Yinmen group. The two groups were not significantly different concerning the need to take ondansetron to manage postoperative nausea and vomiting.
CONCLUSIONS
Applying 2 minutes pressure (11 - 20 kg) on the Yinmen acupoint of the sciatic nerves can reduce post middle ear surgery pain and analgesic consumption.
PubMed: 34150560
DOI: 10.5812/aapm.103328 -
Pharmacology Research & Perspectives Aug 2021There have been increasing concerns about adverse effects and drug interactions with meperidine. The goal of this study was to characterize meperidine use in the United...
There have been increasing concerns about adverse effects and drug interactions with meperidine. The goal of this study was to characterize meperidine use in the United States. Meperidine distribution data were obtained from the Drug Enforcement Administration's Automated of Reports and Consolidated Orders System. The Medicare Part D Prescriber Public Use File was utilized to capture overall trends in national prescriptions in this observational report. Nationally, meperidine distribution decreased by 94.6% from 2001 to 2019. In 2019, Arkansas, Alabama, Oklahoma, and Mississippi saw significantly greater distribution when compared with the US state average of 9.27 mg per 10 persons (SD = 6.82). Meperidine distribution showed an 18-fold difference between the highest state (Arkansas = 36.8 mg) and lowest state (Minnesota = 2.1 mg). Five of the six states with the lowest distribution were in the Northeast. Meperidine distribution per state was correlated with the prevalence of adult obesity (r(48) = +0.48, p < .001). Family medicine and internal medicine physicians accounted for 28.9% and 20.5%, respectively, of meperidine total daily supply (TDS) in 2017. Interventional pain management (5.66) and pain management (3.48) physicians accounted for the longest TDS per provider. The use of meperidine declined over the last two decades. Meperidine varied by geographic region with south-central states, and those with more obesity, showing greater distribution. Primary care doctors continue to account for the majority of meperidine daily supply. Increasing knowledge of meperidine's undesirable adverse effects like seizures and serious drug-drug interactions is likely responsible for these pronounced reductions.
Topics: Analgesics, Opioid; Drug Utilization; Humans; Meperidine; Obesity; Pain; Practice Patterns, Physicians'; United States
PubMed: 34128348
DOI: 10.1002/prp2.809 -
Anesthesia, Essays and Researches 2020The addition of dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but may aggravate hypotension after tourniquet deflation.
BACKGROUND AND AIMS
The addition of dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but may aggravate hypotension after tourniquet deflation.
METHODS
Fifty patients were included in this prospective, double-blinded, randomized study, randomly divided into two equal groups of 25 patients each. Spinal anesthesia was performed using 2.5 mL of 0.5% hyperbaric bupivacaine plus 0.5 mL of normal saline in control group (Group C) or 2.5 mL of 0.5% hyperbaric bupivacaine plus 0.5 mL (5 μg) of dexmedetomidine in (Group D). Tourniquet pain was treated by 50 mg of meperidine and repeated in a dose of 20 mg, and the total meperidine consumption was calculated. After tourniquet deflation, heart rate and mean blood pressure were measured for 15 min in the operating room and at these times: before induction of anesthesia (baseline), after inflating tourniquet (inflation), 1 min before deflating tourniquet (predeflation), after tourniquet deflation (10 min postdeflation), and maximum blood pressure and heart rate changes. Duration of time that started before the minimum blood pressure and maximum heart rate was changed until recovery was recorded.
RESULTS
Pain after torniquet inflation was significantly higher in the Group C compared to the Group D. The maximal change of blood pressure was lower in the dexmedetomidine than in the control group. The mean time between the maximal change in blood pressure reached and started to recover was 135 ± 14 s in the dexmedetomidine group and 80 ± 31 s in the control group ( < 0.01) and maximal heart rate change was lower in dexmedetomidine group than the control group. The time between the maximal heart rate changes until recovery was 113.2 ± 19 s in the dexmedetomidine group and 53.2 ± 11 s in the control group < 0.01.
CONCLUSION
Adding dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but aggravates the hemodynamic effect of tourniquet deflation.
PubMed: 34092869
DOI: 10.4103/aer.AER_7_21 -
Drugs - Real World Outcomes Sep 2021The USA is in the midst of an opioid overdose epidemic. To address the epidemic, we conducted a large-scale population study on opioid overdose.
BACKGROUND
The USA is in the midst of an opioid overdose epidemic. To address the epidemic, we conducted a large-scale population study on opioid overdose.
OBJECTIVES
The primary objective of this study was to evaluate the temporal trends and risk factors of inpatient opioid overdose. Based on its patterns, the secondary objective was to examine the innate properties of opioid analgesics underlying reduced overdose effects.
METHODS
A retrospective cross-sectional study was conducted based on a large-scale inpatient electronic health records database, Cerner Health Facts, with (1) inclusion criteria for participants as patients admitted between 1 January, 2009 and 31 December, 2017 and (2) measurements as opioid overdose prevalence by year, demographics, and prescription opioid exposures.
RESULTS
A total of 4,720,041 patients with 7,339,480 inpatient encounters were retrieved from Cerner Health Facts. Among them, 30.2% patients were aged 65+ years, 57.0% female, 70.1% Caucasian, 42.3% single, 32.0% from the South, and 80.8% in an urban area. From 2009 to 2017, annual opioid overdose prevalence per 1000 patients significantly increased from 3.7 to 11.9 with an adjusted odds ratio (aOR): 1.16, 95% confidence interval (CI) 1.15-1.16. Compared to the major demographic counterparts, being in (1) age group: 41-50 years (overall aOR 1.36, 95% CI 1.31-1.40) or 51-64 years (overall aOR 1.35, 95% CI 1.32-1.39), (2) marital status: divorced (overall aOR 1.19, 95% CI 1.15-1.23), and (3) census region: West (overall aOR 1.32, 95% CI 1.28-1.36) were significantly associated with a higher odds of opioid overdose. Prescription opioid exposures were also associated with an increased odds of opioid overdose, such as meperidine (overall aOR 1.09, 95% CI 1.06-1.13) and tramadol (overall aOR 2.20, 95% CI 2.14-2.27). Examination on the relationships between opioid analgesic properties and their association strengths, aORs, and opioid overdose showed that lower aOR values were significantly associated with (1) high molecular weight, (2) non-interaction with multi-drug resistance protein 1 or interaction with cytochrome P450 3A4, and (3) non-interaction with the delta opioid receptor or kappa opioid receptor.
CONCLUSIONS
The significant increasing trends of opioid overdose at the inpatient care setting from 2009 to 2017 suggested an ongoing need for efforts to combat the opioid overdose epidemic in the USA. Risk factors associated with opioid overdose included patient demographics and prescription opioid exposures. Moreover, there are physicochemical, pharmacokinetic, and pharmacodynamic properties underlying reduced overdose effects, which can be utilized to develop better opioids.
PubMed: 34037960
DOI: 10.1007/s40801-021-00253-8