Articles: opioid-analgesics.
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Modified-release opioid tablets were introduced into surgical practice in the belief that they provided superior pain relief and reduced nursing workload, and they rapidly became embedded into many perioperative pathways. Although national and international guidelines for the management of postoperative pain now advise against the use of modified-release opioids, they continue to be prescribed in many centres. ⋯ Their slow onset and offset make rapid and safe titration of these opioids impossible, including down-titration as the patient recovers; pain relief may be less effective; they have been associated with an increased incidence of opioid-related adverse drug events, increased length of hospital stay, and higher readmission rates; and they lead to higher rates of opioid-induced ventilatory impairment and persistent postoperative opioid use. Evidence indicates that modified-release opioids should not be used routinely in the postoperative period.
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Review
Emergency department opioid discharge instructions: a multidisciplinary national Delphi study.
Currently, there are no Canadian guidelines for discharge instruction to be given to patients receiving an opioid prescription in the ED. This likely contributes to inadequate discharge instructions for these potentially dangerous medications. The principal goal of this study was to develop an interdisciplinary Canadian consensus regarding important concepts to be included in written opioid discharge instructions within the ED setting. ⋯ This Delphi study with a national, multidisciplinary panel achieved consensus on 21 concepts that should be included in written discharge instructions to patients receiving an opioid prescription upon discharge from the ED.
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J Pain Palliat Care Pharmacother · Sep 2022
Topical Morphine Gel as a Systemic Opioid Sparing Technique.
Use of topical morphine gel was explored retrospectively for treatment of painful chronic wounds in hospitalized adults. Systemic opioid use and pain intensity were characterized before and after morphine gel initiation using morphine equivalent daily dose (MEDD) and the Defense and Veterans Pain Rating Scale (DVPRS) score at 24 hours before compared to 24 hours, 48 hours, and one week after morphine gel initiation. Twenty-three patients received 371 applications of topical morphine gel. ⋯ Median change in DVPRS score 24 hours after morphine gel initiation was 0.0 [-0.5 to 1.5] (n = 13), 48 hours after was -0.5 [-3.25 to 0.0] (n = 14), and one week after was 1.0 [-1.0 to 3.5] (n = 9). In this single-center analysis, patients with painful chronic wounds treated with morphine gel required lower doses of systemic opioids. Topical morphine gel may provide analgesia while sparing systemic opioid use.
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Palliative care providers are frequently called to consult on patients with tenuous hemodynamics caused by an underlying serious illness. In this article, we describe a patient with end-stage renal disease who developed hypotension and severe pain due to calciphylaxis. ⋯ We describe challenges encountered when trying to attend to the providers' concerns and guide shared medical decision making with the patient and family. We also summarize the current limited knowledge about the effect of opioids on hemodynamics and highlight a topic in need of further exploration.
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Nonopioid analgesics are more effective for most oral pain, but data suggest that dental prescribing of opioids is excessive. This study evaluates the extent to which opioids exceed recommendations and the characteristics associated with opioid overprescribing by Veterans Health Administration dentists. ⋯ Nearly 1 in 3 opioids prescribed by Veterans Health Administration dentists exceed guidelines. Prescribing higher potency and quantities of opioids, especially on Fridays and to certain demographic groups, should be addressed as part of dental opioid stewardship programs.