Journal of opioid management
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EMBEDA@ (morphine sulfate and naltrexone hydrochloride) extended-release capsules, indicated for management of chronic, moderate-to-severe pain, contain pellets of morphine sulfate with a core of sequestered naltrexone, an opioid antagonist. ⋯ Results suggest that the safety profile of EMBEDA is consistent with that of an extended-release morphine formulation. Reports of exposure to tampered product yielded either withdrawal reactions or events not typical of opioid abuse. The clinical effects of EMBEDA in the context of misuse and abuse require further clinical and epidemiological exploration.
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Randomized Controlled Trial
A comparative study on the effects of intrathecal morphine added to levobupivacaine for spinal anesthesia.
In this prospective, randomized, double-blind, controlled study, we investigated the sensory, motor, and analgesic block characteristics oftwo diferent doses of morphine compared with saline when added to 0.5 percent levobupivacaine. ⋯ In patients undergoing cesarean delivery with CSEA, adding intrathecal morphine (0.1 and 0.2 mg) to 15 mg of spinal levobupivacaine prolonged the duration of spinal analgesia and provided rapid onset of action and longer time to first analgesic request without causing any significant side effect compared to saline.
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In response to the need for physician education on proper opioid prescribing, the Federation of State Medical Boards (FSMB) and the FSMB Foundation, the philanthropic arm of the FSMB, commissioned and distributed Responsible Opioid Use: A Physician's Guide to more than 165, 000 licensed physicians in the United States. The book, written by pain management specialist Scott Fishman, MD, seeks tofurtherphysicians' continuing medical education by providing information on how to properly prescribe opioids to treat patients in pain. Although the book has been widely distributed, there have been no systematic studies of its impact. To address this knowledge gap, the authors surveyed licensed physicians in Georgia who received a copy of the book to determine whether it added to their knowledge about prescribing opioids, and if they planned to make changes in theirpractice based on reading the book. ⋯ The results from this state-wide survey of licensed physicians demonstrate the value of educating physicians about how to appropriately prescribe, document, and treat patients who need opioid medications for pain management. The findings should be of value to organizations seeking to better educate physicians about appropriate opioid prescribing by providing insight into which physician population would be the most receptive to the type of information presented in Dr. Fishman's book. When faced with limited resources, an organizational strategy that first targets solo and primary care practitioners may improve physician educational efforts about prescribing opioids better than a strategy targeting medical and surgical specialists or those physicians participating in group practice settings.
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Case Reports
A remifentanil/ketamine sedation in surgical cancer patients having severe Parkinson's disease: two case reports.
Symptoms of Parkinson's disease are related to a progressive loss of substancia nigra's dopaminergic neurons in addition to persistent activation of N-methyl-D-aspartate receptors. In specific situations such as sedation for minor surgery, tremor and dyskinesia can be very disabling. ⋯ The patients were scheduled for elective oncological plastic surgery under sedation, for which dyskinesia and tremor needed to be quickly abolished to permit surgery. Both procedures were completed with this drug combination resulting with no major side effects.
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To describe dosing regimens and efficacy of continuous infusion hydromorphone in mechanically ventilated children. ⋯ Continuous infusion hydromorphone appears to be an effective adjunctive analgesic in mechanically ventilated children.