Articles: opioid-analgesics.
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Randomized Controlled Trial
Opioid sparing anesthesia in patients with liver cirrhosis undergoing liver resection: a controlled randomized double-blind study.
Opioid metabolism and pharmacodynamics may be affected in hepatic patients. Ketamine and dexmedetomidine are conventional anesthetics used in our daily practice. The opioid-sparing effects of this combination have not been evaluated in patients with liver cirrhosis undergoing liver resection. We aimed to investigate the potential peri-operative opioid-sparing effects of intra-operative dexmedetomidine and ketamine infusions in patients with Child A liver cirrhosis undergoing liver resection. ⋯ Administering dexmedetomidine and ketamine infusions intra-operatively to patients with Child A liver cirrhosis undergoing liver resection resulted in notable opioid-sparing effects, with reductions of approximately 40% intra-operatively and 55% postoperatively. The opioid-sparing group exhibited improved postoperative outcomes, including reduced pain, decreased incidence of opioid-related side effects and shorter ICU stays.
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In 2016, Oregon developed an innovative policy to improve care for Medicaid patients with back pain. The objective of this study was to identify the factors associated with dose reduction and discontinuation among Medicaid patients using chronic opioid therapy after implementation of this policy. ⋯ Most Medicaid beneficiaries had a dose reduction after implementation of Oregon's back pain policy. Opioid discontinuation was associated with factors that suggest that providers pursue this strategy for patients at higher overdose risk.
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To identify predictors of persistent opioid use in opioid-naïve individuals undergoing total joint arthroplasty. ⋯ This predictive model for persistent opioid use after total joint arthroplasty shows promise as an evidence-based, validated, and standardized tool for identifying high-risk patients before surgery in order to target strategies and interventions to reduce the reliance on opioids for postoperative pain control.
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Emerg Med Australas · Feb 2025
A cluster of multi-drug intoxications involving xylazine, benzimidazole opioids (nitazenes) and novel benzodiazepines in South Australia.
To highlight the detection of xylazine and nitrazolam in conjunction with benzimidazole opioids (nitazenes) and other novel benzodiazepines in a cluster of patients after putative heroin use. ⋯ This is the first signal of xylazine and nitrazolam use in Australia. These results demonstrate toxico-surveillance programmes with analytical confirmation of drugs are invaluable in monitoring illicit drug use.
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J Pain Symptom Manage · Feb 2025
Distributed Opioids in Morphine Equivalent: A Global Measure of Availability for Palliative Care.
Estimates of serious health-related suffering (SHS) demonstrate immense unmet need for palliative care, predominately in low- and middle-income countries (LMICs). Because opioids are essential medicines in palliative care (PC), measuring their availability can be used to evaluate the capacity of health systems to meet need. ⋯ DOME and DOME%SHSNEED can be used to monitor health system progress to redress disparities and promote access to medically indicated opioid therapy in palliative care.