Minimal important difference in postoperative morphine consumption after hip and knee arthroplasty using nausea, vomiting, sedation and dizziness as anchors

Acta Anaesthesiologica Scandinavica, Год журнала: 2024, Номер 68(5), С. 610 - 618

Опубликована: Фев. 21, 2024

Abstract Background Morphine‐sparing effects are often used to evaluate non‐opioid analgesic interventions. The exact effect that would warrant the implementation of these interventions in clinical practice (a minimally important difference) remains unclear. We aimed determine this with anchor‐based methods. Methods This was a post hoc analysis three studies investigating pain management after hip or knee arthroplasty (PANSAID [NCT02571361], DEX‐2‐TKA [NCT03506789] and Pain Map [NCT02340052]). overall population median aged 70, ASA 2, 54% female. examined correlation between 0 24 h postoperative iv morphine equivalent consumption severity nausea, vomiting, sedation dizziness. anchor different degrees opioid‐related adverse events. primary outcome difference patients experiencing no versus only mild Secondary outcomes included moderate severe Hodges–Lehmann differences, Wilcoxon–Mann–Whitney tests quantile regression. Results 6 mg (95% confidence interval: 4–8) events, 5 (2–8) events (−4 4) Conclusions In populations comparable post‐hoc (orthopaedic surgery, age 70 2), we suggest for 0–24 consumption.

Язык: Английский

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Safety and efficacy of low-dose esketamine in laparoscopic cholecystectomy: a prospective, double-blind randomized controlled trial

BMC Anesthesiology, Год журнала: 2024, Номер 24(1)

Опубликована: Фев. 1, 2024

Abstract Background Esketamine, recognized for its analgesic, sedative, and anti-inflammatory qualities, is integral in multimodal analgesia. However, the potential opioid-sparing effects of intravenous esketamine, along with impact on inflammatory responses, cognitive function during laparoscopic surgery, remain unexplored. Methods In this study, 90 patients scheduled cholecystectomy were equally randomized into three groups: a normal saline control group (NS), low-dose esketamine (LS) high-dose (HS). Subsequently, we monitored several parameters: hemodynamics, levels stress intraoperative doses sufentanil, remifentanil, propofol, 24-hour postoperative sufentanil requirements. We also evaluated alterations function, perioperative indicators, adverse reactions among groups. Results Compared to their 5 minutes prior anesthesia (T 0 ) 30 post-operation 4 ), NS exhibited more significant decrease Mean Arterial Pressure (MAP) Heart Rate (HR) at various time intervals: after skin incision 1 post-incision 2 conclusion operation 3 compared LS HS groups( P < 0.05). Furthermore, greater increase adrenaline (AD), noradrenaline (NE), endothelin (ET), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) T , so than other two 24 hours had significantly higher Montreal Cognitive Assessment (MoCA) scores those group( The groups required lower surgery ( 0.05), experienced shorter recovery times, incidences nausea, vomiting, respiratory depression Conclusion administration has been shown be safe, effective, dependable context gallbladder surgery. It capacity stabilize hemodynamic ameliorate both from hastens recovery. it fosters restoration function. Notably, when combined nalbuphine, exhibits effects, reducing outcomes. Trial registration trial registered China Clinical Trials Registry Registration Number: ChiCTR2300067596. Retrospectively (date registration: 12/01/2023).

Язык: Английский

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Opioid use and abuse in adolescents and young adults; dealing with science, laws and ethics: Charming the COBRAS

Disease-a-Month, Год журнала: 2025, Номер unknown, С. 101853 - 101853

Опубликована: Янв. 1, 2025

Язык: Английский

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The Development of Opioid Vaccines as A Novel Strategy for the Treatment of Opioid Use Disorder and Overdose Prevention

The International Journal of Neuropsychopharmacology, Год журнала: 2025, Номер unknown

Опубликована: Янв. 20, 2025

Abstract Opioid use disorder (OUD) affects over 40 million people worldwide, creating significant social and economic burdens. Medication for opioid (MOUD) is often considered the primary treatment approach OUD. MOUD, including methadone, buprenorphine, naltrexone effective some, but its benefits may be limited by poor adherence to recommendations. Immunopharmacotherapy offers an innovative using vaccines generate antibodies that neutralize opioids, blocking them from crossing blood-brain barrier reducing their psychoactive effects. To date, only three clinical trials have been published. While these studies demonstrated potential of relapse prevention, there currently no standardized protocol evaluating effectiveness. We reviewed recent preclinical efficacy targeting heroin, morphine, oxycodone, hydrocodone, fentanyl. These showed against opioids reduced drug reinforcement, decreased opioid-induced antinociception, increased survival rates lethal doses. also importance vaccine formulation adjuvants in enhancing antibody production specificity. Finally, we highlighted strengths concerns associated with treatment, ethical considerations.

Язык: Английский

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Clinical Pharmacology, Toxicity, and Abuse Potential of Opioids

The Journal of Clinical Pharmacology, Год журнала: 2021, Номер 61(S2)

Опубликована: Авг. 1, 2021

Abstract Opioids were the most common drug class resulting in overdose deaths United States 2019. Widespread clinical use of prescription opioids for moderate to severe pain contributed ongoing opioid epidemic with subsequent emergence fentanyl‐laced heroin. More potent analogues fentanyl and structurally diverse receptor agonists such as AH‐7921 MT‐45 are fueling an increasingly illicit supply. Overdose from synthetic high binding affinities may not respond a typical naloxone dose, thereby rendering autoinjectors less effective, requiring higher antagonist doses or confusing picture health care providers. Nonscheduled drugs loperamide dextromethorphan associated dependence risk easier access makes them attractive users. Despite opioid‐mediated pathway, several present unique pharmacodynamic properties leading acute toxicity development. Pharmacokinetic considerations involve half‐life parent its metabolites well toxicity, is established tramadol, codeine, oxycodone. considerations, toxicities, treatment approaches notable reviewed.

Язык: Английский

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Current Perspectives on Selective Dopamine D3 Receptor Antagonists/Partial Agonists as Pharmacotherapeutics for Opioid and Psychostimulant Use Disorders

Current topics in behavioral neurosciences, Год журнала: 2022, Номер unknown, С. 157 - 201

Опубликована: Янв. 1, 2022

Язык: Английский

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Oxycodone: A Current Perspective on Its Pharmacology, Abuse, and Pharmacotherapeutic Developments

Pharmacological Reviews, Год журнала: 2023, Номер 75(6), С. 1062 - 1118

Опубликована: Июнь 15, 2023

Oxycodone, a semisynthetic derivative of naturally occurring thebaine, an opioid alkaloid, has been available for more than 100 years. Although thebaine cannot be used therapeutically due to the occurrence convulsions at higher doses, it converted number other widely compounds that include naloxone, naltrexone, buprenorphine, and oxycodone. Despite early identification oxycodone, was not until 1990s clinical studies began explore its analgesic efficacy. These were followed by pursuit several preclinical examine effects abuse liability oxycodone in laboratory animals subjective human volunteers. For years forefront crisis, playing significant role contributing misuse abuse, with suggestions led transitioning opioids. Several concerns expressed as 1940s had potential similar heroin morphine. Both animal have confirmed, some cases amplified, these warnings. sharing structure morphine pharmacological actions also mediated μ-opioid receptor, there are differences pharmacology neurobiology The data emerged from many efforts analyze molecular mechanism generated considerable insight into actions, reviewed here, which, turn, provided new information on receptor pharmacology. SIGNIFICANCE STATEMENT: agonist, synthesized 1916 introduced use Germany 1917. It studied extensively therapeutic acute chronic neuropathic pain alternative Oxycodone drug widespread abuse. This article brings together integrated, detailed review recent advances identify analgesics without liability.

Язык: Английский

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Differential Patterns of Synaptic Plasticity in the Nucleus Accumbens Caused by Continuous and Interrupted Morphine Exposure

Journal of Neuroscience, Год журнала: 2022, Номер 43(2), С. 308 - 318

Опубликована: Ноя. 17, 2022

Opioid exposure and withdrawal both cause adaptations in brain circuits that may contribute to abuse liability. These vary magnitude direction following different patterns of opioid exposure, but few studies have systematically manipulated the pattern administration while measuring neurobiological impact. In this study, we compared cellular synaptic nucleus accumbens shell caused by morphine was either continuous or interrupted daily bouts naloxone-precipitated withdrawal. At behavioral level, psychomotor tolerance, which reversed when continuity action Using ex vivo slice electrophysiology female male mice, investigated how these altered intrinsic excitability plasticity medium spiny neurons (MSNs) expressing D1 D2 dopamine receptor. We found morphine-evoked at excitatory synapses were predominately conserved between administration, there divergent effects on inhibitory subsequent balance input. Overall, our data suggest produces dampen output D1-MSNs, are canonically thought promote reward-related behaviors. Interruption otherwise does not D1-MSN functional same extent, enhance responses exposure. Our findings support hypothesis maintaining could be an effective therapeutic strategy minimize vulnerability use disorders. SIGNIFICANCE STATEMENT Withdrawal plays a key role cycle addiction opioids like morphine. studied repeated cycles from can change function accumbens, is important region for reward addiction. Different unique changes communication nature depended type neuron being studied. The specific increase This highlights importance reducing preventing experience during treatment.

Язык: Английский

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Modulation of α7nAchR by Melatonin Alleviates Ischemia and Reperfusion-Compromised Integrity of Blood–Brain Barrier Through Inhibiting HMGB1-Mediated Microglia Activation and CRTC1-Mediated Neuronal Loss

Cellular and Molecular Neurobiology, Год журнала: 2021, Номер 42(7), С. 2407 - 2422

Опубликована: Июль 1, 2021

Язык: Английский

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Recent advances in exhaled breath sample preparation technologies for drug of abuse detection

TrAC Trends in Analytical Chemistry, Год журнала: 2022, Номер 157, С. 116828 - 116828

Опубликована: Ноя. 11, 2022

Язык: Английский

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