Articles: opioid-analgesics.
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Southern medical journal · Oct 2021
Observational StudyAssociation between Opioids Prescribed to Medical Inpatients with Pain and Long-Term Opioid Use.
Opioid receipt during medical hospitalizations may be associated with subsequent long-term use. Studies, however, have not accounted for pain, which may explain chronic use. The objective of this study was to identify the association between opioid exposure during a medical hospitalization and use 6 to 12 months later. ⋯ Although opioid receipt at discharge was associated with long-term use, the number of patients this applied to was small. Pain severity was an important predictor of long-term use and should be accounted for in future studies.
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J Pain Symptom Manage · Oct 2021
A National Survey of Challenges Faced by Hospices during the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death.
No national data exist on hospice medication shortages, the frequency that opioid medications go missing, and drug disposal practices. ⋯ Hospices face numerous challenges during the national opioid crisis. Interventions are needed to ensure access to needed treatments, mitigation of diversion, and safe medication disposal.
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Anesthesia and analgesia · Oct 2021
Observational StudyQuantitative Pupillometry as a Predictor of Pediatric Postoperative Opioid-Induced Respiratory Depression.
Safe postoperative pain relief with opioids is an unmet critical medical need in children. There is a lack of objective, noninvasive bedside tool to assess central nervous system (CNS) effects of intraoperative opioids. Proactive identification of children at risk for postoperative respiratory depression (RD) will help tailor analgesic therapy and significantly improve the safety of opioids in children. Quantitative pupillometry (QP) is a noninvasive, objective, and real-time tool for monitoring CNS effect-time relationship of opioids. This exploratory study aimed to determine the association of QP measures with postoperative RD, as well as to identify the best intraoperative QP measures predictive of postoperative RD in children. ⋯ A model based on pre- and intraoperative pupillometry measures including CONQ, MIN, along with weight-based morphine dose-predicted postoperative RD in our cohort of children undergoing tonsillectomy. More studies with a larger sample size are required to validate this finding.
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Pediatric emergency care · Oct 2021
Unintentional Opioid Ingestions Presenting to a Pediatric Emergency Department.
The purpose of this study was to describe unintentional opioid exposures in young children, including demographics, medical interventions, and clinical outcomes. ⋯ While opioid exposures in young children are a common and potentially life-threatening problem, most children remain asymptomatic. The majority of patients are able to be discharged from the ED after observation, and of those who are admitted, most have favorable outcomes and brief hospital stays. A small number of these patients require considerable medical interventions.
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The complication profile and higher cost of care associated with preoperative opioid use and spinal fusion is well described. However, the burden of opioid use and its impact in patients undergoing lumbar discectomy is not known. Knowledge of this, especially for a relatively benign and predictable procedure will be important in bundled and value-based payment models. ⋯ Chronic preoperative opioid use was present in 12% of a national cohort of lumbar discectomy patients. Such opioid use was associated with significantly higher post-operative healthcare utilization, risk of revision surgery, and costs at 90-days and 1-year postoperatively. Two-third of chronic preoperative opioid users had continued long-term postoperative opioid use. However, a 3-month prescription free period before surgery in chronic opioid users reduces the risk of long-term postoperative use. This data will be useful for patient education, pre-operative opioid use optimization, and risk-adjustment in value-based payment models.