Articles: opioid-analgesics.
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Acta Anaesthesiol Scand · Jan 2025
Procedure time-of-day effects on postoperative opioid requirements in children.
Postoperative analgesic requirements in adults follow circadian rhythm patterns with requirements for opioids and local anesthetics highest in the morning. Procedure time of day may also potentially affect circadian rhythm patterns with surgery at night promoting wakefulness during nighttime hours. This disruption may produce a shift in the circadian rhythm and potentially affect when postoperative opioid requirements are highest. We hypothesized that children undergoing surgery at night would have higher postoperative opioid requirements during nighttime hours secondary to a shift in the circadian rhythm with those requirements remaining higher than daytime requirements for the duration of the hospital stay. ⋯ We found that procedure time of day did not impact postoperative opioid requirements in children undergoing a laparoscopic appendectomy for complicated appendicitis. Both children undergoing an appendectomy during the day or at night required more morphine equivalents during daytime hours than during nighttime hours. Surgery at night did not produce a shift in opioid requirements postoperatively from daytime hours to nighttime hours in children undergoing an appendectomy at night.
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Anesthesia and analgesia · Jan 2025
Differences in Acute Postoperative Opioid Use by English Proficiency, Race, and Ethnicity After Total Knee and Hip Arthroplasty.
There is increasing interest in documenting disparities in pain management for racial and ethnic minorities and patients with language barriers. Previous studies have found differential prescription patterns of opioids for racial and ethnic minority group and patients having limited English proficiency (LEP) after arthroplasty. However, there is a knowledge gap regarding how the intersection of these sociodemographic factors is associated with immediate postoperative pain management. This study aimed to explore language and racial-ethnic disparities in short-term opioid utilization after total hip and knee arthroplasty. ⋯ We identified an association between LEP, racial-ethnic identity, and short-term postoperative OME utilization after total knee and hip arthroplasty. The observed differences in opioid utilization imply there may be language and racial-ethnic disparities in acute pain management and perioperative care.
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Acta Anaesthesiol Scand · Jan 2025
Does cytochrome 2D6 genotype affect the analgesic efficacy of codeine after ambulatory surgery? Prospective trial in 987 adults.
Paracetamol-codeine combination tablet is widely used in pain management after day surgery. For safety reasons, its use has decreased in recent years. Codeine is a prodrug metabolised in the liver by the cytochrome P450 2D6 (CYP2D6) enzyme to morphine that produces the analgesic effect of codeine. CYP2D6 is highly polymorphic, and based on genotypes, individuals can be divided into four categories: poor-, intermediate-, normal- and ultrarapid metabolisers. Differences in morphine and its metabolite concentrations have been described between different CYP2D6 genotypes following codeine administration. The aim of the study was to investigate the possible effect of CYP2D6 genotype on codeine efficacy and adverse effects in a large cohort of adult patients undergoing ambulatory surgery. ⋯ CYP2D6 genotype appears to be of minor importance for the analgesic efficacy of oral paracetamol-codeine combination therapy after ambulatory surgery in adult patients undergoing similar types of surgery as in the present study but it may affect the risk of constipation.
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To determine the association between PPOU and the long-term risk of OUD and opioid overdose. ⋯ Surgical patients who develop PPOU are at increased risk of both OUD and overdose as compared to surgical patients who do not develop persistent use.
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Paediatric anaesthesia · Jan 2025
Review Meta Analysis Comparative StudyErector spinae plane block versus intravenous opioid for analgesia in pediatric cardiac surgery: A systematic review and meta-analysis.
The erector spinae plane block (ESPB) has recently emerged as a regional anesthesia technique for perioperative pain management in pediatric cardiac surgery. However, evidence comparing its effectiveness with intravenous (IV) opioid-based analgesia is limited. We aimed to evaluate and compare the analgesic efficacy of ESPB versus IV opioids in this setting. ⋯ CRD 42024526961.