Articles: opioid.
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Yonsei medical journal · Jul 2014
Randomized Controlled TrialEfficacy of intrathecal morphine combined with intravenous analgesia versus thoracic epidural analgesia after gastrectomy.
Epidural analgesia has been the preferred analgesic technique after major abdominal surgery. On the other hand, the combined use of intrathecal morphine (ITM) and intravenous patient controlled analgesia (IVPCA) has been shown to be a viable alternative approach for analgesia. We hypothesized that ITM combined with IVPCA is as effective as patient controlled thoracic epidural analgesia (PCTEA) with respect to postoperative pain control after conventional open gastrectomy. ⋯ ITM-IVPCA is not as effective as PCTEA in patients undergoing gastrectomy, with respect to pain control, ambulation, postoperative ileus and pulmonary complications.
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J Intensive Care Med · Jul 2014
Agitation during prolonged mechanical ventilation at a long-term acute care hospital: risk factors, treatments, and outcomes.
The prevalence, risk factors, treatment practices, and outcomes of agitation in patients undergoing prolonged mechanical ventilation (PMV) in the long-term acute care hospital (LTACH) setting are not well understood. We compared agitation risk factors, management strategies, and outcomes between patients who developed agitation and those who did not, in LTACH patients undergoing PMV. ⋯ Agitation among the LTACH patients undergoing PMV is associated with greater delirium and use of antipsychotics and restraints but does not influence weaning success or LTACH stay. Strategies focused on agitation prevention and treatment in this population need to be developed and formally evaluated.
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Substance use is overrepresented in dental clinics that provide affordable care and dental clinics provide potential access to opioid analgesics. Research is needed to better understand prescription opioid misuse in this population. ⋯ Within this sample from a dental clinic, nonmedical use of prescription pain medications was more common than in the general population. This suggests that dental clinics may be an appropriate setting for provider education and patient-based intervention strategies to reduce nonmedical use of pain medications.
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J Pediatr Pharmacol Ther · Jul 2014
Development and implementation of a pharmacist-managed, neonatal and pediatric, opioid-weaning protocol.
To compare the length of wean and abstinence severity in neonatal and pediatric patients with neonatal abstinence syndrome or iatrogenic opioid dependence treated with a pharmacist-managed, methadone-based protocol compared with physician-managed patients treated with either methadone or dilute tincture of opium (DTO). ⋯ Use of a pharmacist-managed, methadone-based weaning protocol standardizes patient care and has the potential to decrease abstinence severity and shorten duration of wean versus physician-managed patients exposed to opioids in utero. Additionally, a methadone wean of 10% to 20% per day was well tolerated in both neonatal and pediatric patients.
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This study aimed to determine if intravenous acetaminophen [paracetamol] (IV APAP) could decrease visual analog pain scores (VAS), opioid exposure and subsequent opioid related adverse effects (nausea, vomiting, constipation) in spinal surgery patients. ⋯ It appears IV APAP can be used effectively as an adjuvant pain management therapy in spinal surgery patients to decrease opioid exposure, but does not necessarily reduce the incidence of opioid related adverse effects or VAS pain scores.