Articles: opioid.
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Anesthesia and analgesia · Mar 2024
Randomized Controlled TrialInfluence of Intravenous S-Ketamine on the Pharmacokinetics of Oral Morphine in Healthy Volunteers.
Subanesthetic ketamine may reduce perioperative consumption of opioids. We studied whether intravenous S-ketamine alters the pharmacokinetics of oral morphine in healthy volunteers. ⋯ Intravenous S-ketamine inhibited the metabolism of oral morphine and delayed its absorption, resulting in a net reduction in the exposure to morphine during the first 1.5 hours. Intravenous S-ketamine may delay the absorption and impair the efficacy of orally administered analgesics and other drugs.
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Buprenorphine is effective for chronic pain and safer than full-agonist opioids; however, limited education about and support for buprenorphine can result in under-prescribing in primary care and reduced access in specialty pain clinics. The purpose of this quality improvement initiative was to optimize and evaluate procedures for transferring patients stable on buprenorphine for chronic pain from a specialty pain clinic back to primary care. ⋯ This quality improvement initiative suggests that a facilitated transfer procedure can be useful in increasing buprenorphine prescribing for pain in primary care. Future efforts to increase primary care provider comfort and address systemic barriers to buprenorphine prescribing are needed.
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The American College of Emergency Physicians (ACEP) Emergency Medicine Quality Network (E-QUAL) Opioid Initiative was launched in 2018 to advance the dissemination of evidence-based resources to promote the care of emergency department (ED) patients with opioid use disorder. This virtual platform-based national learning collaborative includes a low-burden, structured quality improvement project, data benchmarking, tailored educational content, and resources designed to support a nationwide network of EDs with limited administrative and research infrastructure. As a part of this collaboration, we convened a group of experts to identify and design a set of measures to improve opioid prescribing practices to provide safe analgesia while reducing opioid-related harms. ⋯ Measures include proportion of opioid administration in the ED, proportion of alternatives to opioids as first-line treatment, proportion of opioid prescription, opioid pill count per prescription, and patient medication safety education among ED visits for atraumatic back pain, dental pain, or headache. The proportion of benzodiazepine and opioid coprescribing for ED visits for atraumatic back pain was also evaluated. This project developed and effectively implemented a collection of 6 potential measures to evaluate opioid analgesic prescribing across a national sample of community EDs, representing the first feasibility assessment of opioid prescribing-related measures from rural and community EDs.
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J Pain Palliat Care Pharmacother · Mar 2024
The Impact of a Clinical Pharmacist Practitioner on Perioperative Pain Management for Orthopedic Surgeries.
The objective of this quality improvement (QI) project was to assess the impact of an evidence based clinical pharmacist practitioner (CPP) model applied to perioperative pain management by integrating a CPP into the perioperative orthopedic surgery clinical pathway. Secondary objective was to assess the effect of CPP pain management service on surgical team satisfaction. This QI project expanded CPP pain management services for patients who were scheduled for an orthopedic surgery. ⋯ The impact of the Pain CPP on perioperative pain management was demonstrated by improvement in the Clinically Aligned Pain Assessment Tool, which was similar in patients where CPP recommendations were accepted compared to surgeon only recommended regimens (p = 0.048). Five orthopedic surgical providers responded to our satisfaction survey, 80% (n = 4/5) strongly agree that a pain management CPP should become a permanent member of the care team. Through an evidence-based CPP model we observed a reduction in quantity of opioid prescribed and morphine equivalent daily dose utilized in patients who underwent an orthopedic surgery.
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A growing body of literature describes the use of buprenorphine for the treatment of chronic pain in people with sickle cell disease. The experiences of people with sickle cell disease who have tried buprenorphine have not yet reported. This qualitative descriptive study was conducted to explore perspectives on buprenorphine for chronic pain in sickle cell disease. ⋯ The experience of adulthood living with sickle cell disease before and after starting buprenorphine is qualitatively different with significant improvements in social functioning. PERSPECTIVE: This study examined the experience of adults with sickle cell disease and chronic pain transitioning from full agonist opioids to buprenorphine. It is the first qualitative study of buprenorphine in people with sickle cell disease, contributing to a small but growing literature about buprenorphine and sickle cell disease.