Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Mar 2022
ReviewContinuous Intravenous Inotropic Support for Advanced Heart Failure: Palliative Considerations.
The global prevalence of heart failure (HF) is increasing. Advancements in guideline-directed medical and device therapy have resulted in improved survival. Thus, there are more patients living - and living longer - with advanced HF. ⋯ While initial concerns regarding increased mortality have been assuaged in the modern era of guideline-directed medical therapy, palliative inotropes are certainly not without burden. Risks of infection and medication-related adverse effects, need for routine laboratory monitoring, frequent dressing changes, and presence of a reliable caregiver must be carefully considered prior to initiation. This review addresses pharmacology, guideline recommendations, benefits and burdens, considerations related to hospice and end-of-life care, and future directions of CIIS in advanced HF care.
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J Pain Palliat Care Pharmacother · Mar 2022
The Effect of Patient Opioid Education on Opioid Use, Storage, and Disposal Patterns.
We evaluated the impact of patient education over opioid use, storage, and disposal on opioid handling patterns of palliative and chronic nonmalignant pain patients. We compared patient surveys before and after education and conducted further analysis for individual clinics due to group differences found prior to education. A total of 100 patients were included. ⋯ Proper methods of disposal increased, including mixing with unpalatable substances (96% vs. 13%; P < 0.01) and utilizing drug-take-back programs (78% vs. 24%; P < 0.01). This project found that patient education improves knowledge and behavior related to opioid handling patterns. Further initiatives should help to identify higher-risk patients and develop educational tools.
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J Pain Palliat Care Pharmacother · Mar 2022
An Evaluation of Docusate Monotherapy and the Prevention of Opioid-Induced Constipation after Surgery.
Our purpose was to determine if docusate monotherapy is effective in preventing opioid-induced constipation in patients receiving opioids following orthopedic surgery. Our single-center, retrospective, cohort study evaluated 212 orthopedic patients who received opioids between May 1, 2018, and December 31, 2018. All patients were aged 18 years and older, hospitalized for more than 48 hours, and received docusate for primary prevention of constipation post-operatively. ⋯ Docusate monotherapy was not effective in preventing constipation in patients receiving opioids following elective orthopedic surgery. Based on these findings, we propose utilization of stimulant bowel products with proven efficacy as primary therapy after surgery to prevent constipation. Future multi-centered, randomized controlled trials are necessary to evaluate the differences in efficacy and safety between common bowel regimens in treating opioid-induced constipation in patients who undergo elective orthopedic surgery.
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J Pain Palliat Care Pharmacother · Mar 2022
Case ReportsThoracic Epidural Analgesia Use in Large Recurrent Desmoid Fibromatosis Resection: A Case Report.
We present a case report of the successful use of thoracic epidural analgesia for the surgical resection of a large recurrent desmoid tumor and forequarter amputation in an adolescent male. Spinal anesthesia has been reported for intra-operative management of desmoid tumor resection, however, there are no reported cases of thoracic epidural analgesia for this tumor. Thoracic epidural should be used with caution in this patient population due to risk of de novo tumor creation but can be useful adjuvant to multi-modal analgesia to decrease post-operative opioid requirement.
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J Pain Palliat Care Pharmacother · Mar 2022
Case ReportsUse and Discontinuation of Milrinone for Advanced Heart Failure in an Academic Palliative Care Unit: A Case Report and Discussion of Recommendations.
The use of intravenous inotropic medications in advanced heart failure (HF) has been shown to improve symptoms and decrease hospitalizations, prompting support for their use as a palliative measure for symptom management. Recommendations regarding inotrope management and method of discontinuation at the end of life are not specifically detailed in the literature and current guidelines. This case report describes the use of milrinone in a patient with advanced HF during the terminal phase of illness in a non-monitored palliative care unit setting, including dose reduction and discontinuation of milrinone. ⋯ The provision of individualized milrinone therapy in non-monitored palliative care settings is feasible and well-tolerated using the presented detailed recommendations for its use and administration, monitoring, dose reduction and discontinuation and proactive symptom management at the end of life. Further research is needed for the optimal management of terminally ill patients with advanced HF. Supplemental data for this article is available online at here. show.