1
|
Pantabtim C, Chumpathong S, Vichitvejpaisal P, Limsettho W, Mangmeesri P. Comparative Analysis of Nebulized Versus Intravenous Fentanyl for Pain Control After Tonsillectomy: A Double-Blind, Randomized, Controlled Trial. Ann Otol Rhinol Laryngol 2024:34894241259376. [PMID: 38874203 DOI: 10.1177/00034894241259376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Effective posttonsillectomy analgesia is crucial for patient comfort and recovery. Fentanyl, notable for its potency, rapid action, and lipophilicity, has been successfully used in various procedures through multiple administration routes. However, the use of its nebulized form for posttonsillectomy pain has not been extensively explored. This study sought to compare the analgesic efficacy, onset time, and complications between nebulized and intravenous fentanyl in posttonsillectomy patients. METHODS AND METHODS In this randomized controlled trial, adult patients who underwent tonsillectomy were assigned to either an intravenous fentanyl group (1 mcg/kg) or a nebulized fentanyl group (4 mcg/kg). In both groups, fentanyl was administered when pain scores exceeded three. Pain levels were monitored every 5 minutes until they fell below four. The study also recorded the duration until the next analgesia request and noted complications (such as respiratory depression, bradycardia, chest tightness, drowsiness, nausea, pruritus, sweating, and flushing) within 24 hours. Patient exclusions were based on predetermined criteria. RESULTS From an initial cohort of 59 patients, 22 in the intravenous group and 27 in the nebulizer group were eligible for analysis after applying the exclusion criteria. The nebulizer group exhibited a significantly prolonged period before the next analgesia request, with a median of 683.5 minutes (interquartile range 260-1440), in contrast to the 326.7 minutes (145.0-504.7) observed in the intravenous group (P = .009). The time to achieve a pain score less than 4 and the incidence of side effects did not differ significantly between the groups. CONCLUSION Nebulized fentanyl provided a longer duration of analgesia than intravenous fentanyl in posttonsillectomy pain management, with similar onset times and side effect profiles. These findings underscore the potential of nebulized fentanyl as an effective alternative for pain control in posttonsillectomy patients.
Collapse
Affiliation(s)
- Chanitda Pantabtim
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saowapark Chumpathong
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phongthara Vichitvejpaisal
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wilawan Limsettho
- Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peerachatra Mangmeesri
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
2
|
Laryea ET, Nichols JH. Evaluation of a Rapid Drug Test Device for Urine Fentanyl Compared to Mass Spectrometry and 2 Urine Fentanyl Assays. J Appl Lab Med 2024:jfae059. [PMID: 38869381 DOI: 10.1093/jalm/jfae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/10/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND A new Rapid Drug Test Device (RDTD) is available for analysis of urine fentanyl. With the rise in fentanyl abuse in the United States, we evaluated the analytical performance of the RDTD test strip compared to mass spectrometry and 2 urine fentanyl immunoassays. METHODS Leftover, deidentified urine samples collected from inpatients and outpatients from our psychiatric hospital and other clinics were frozen at <-70°C, thawed at room temperature, and centrifuged. Aliquots were tested with the RDTD (CLIA Waived, Inc.) test strips and 2 urine fentanyl immunoassays: the ARK Fentanyl II assay (ARK Diagnostics Inc.) and the Immunalysis SEFRIA Fentanyl assay (Immunalysis Corporation). Both assays were conducted on the Abbott Alinity c chemistry analyzer (Abbott Laboratories). Mass spectrometry analysis was performed at ARUP Laboratories. All assays had a 1 ng/mL positive cutoff. RESULTS A total of 142 urine samples included 70 positive and 72 negative samples. The RDTD strips had lower sensitivity (84.3%) and efficiency (85.9%) and showed a specificity of 87.5% compared to the other assays. The ARK Fentanyl II assay showed identical sensitivity (95.7%) to the Immunalysis SEFRIA Fentanyl assay but had higher specificity (94.4% vs 81.9%) and overall efficiency (95.1% vs 88.7%). CONCLUSIONS Differences were noted in the number of false negatives and positives among the assays. The RDTD demonstrated acceptable performance in detecting urine fentanyl in our patient population and would provide faster test results at point-of-care testing sites in our healthcare enterprise.
Collapse
Affiliation(s)
- Erving T Laryea
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - James H Nichols
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
| |
Collapse
|
3
|
Fink PB, Wheeler AR, Smith WR, Brant-Zawadzki G, Lieberman JR, McIntosh SE, Van Tilburg C, Wedmore IS, Windsor JS, Hofmeyr R, Weber D. Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update. Wilderness Environ Med 2024; 35:198-218. [PMID: 38651342 DOI: 10.1177/10806032241248422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an update of the 2014 version of the "WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments" published in Wilderness & Environmental Medicine 2014; 25:41-49.
Collapse
Affiliation(s)
- Patrick B Fink
- Department of Emergency Medicine, University of Utah, Salt Lake City, UT
| | - Albert R Wheeler
- Department of Emergency Medicine, St. John's Health, Jackson, WY
| | - William R Smith
- Department of Emergency Medicine, St. John's Health, Jackson, WY
| | | | | | - Scott E McIntosh
- Department of Emergency Medicine, University of Utah, Salt Lake City, UT
| | | | - Ian S Wedmore
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Ross Hofmeyr
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - David Weber
- Mountain Rescue Collective, LLC, Park City, UT
| |
Collapse
|
4
|
Ibekwe SO, Everett L, Mondal S. Methadone Should Not Be Used in Cardiac Surgery as Part of Enhanced Recovery After Cardiac Surgery Protocol. J Cardiothorac Vasc Anesth 2024; 38:1272-1274. [PMID: 38503627 DOI: 10.1053/j.jvca.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 03/21/2024]
Affiliation(s)
| | - Lauren Everett
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Samhati Mondal
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD.
| |
Collapse
|
5
|
Cuomo A. Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits. Drugs Context 2023; 12:2023-10-2. [PMID: 38148830 PMCID: PMC10751104 DOI: 10.7573/dic.2023-10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/28/2023] Open
Abstract
Cancer pain is an important challenge in treatment and requires a rapid onset of action for its control. In particular, breakthrough cancer pain (BTcP) should be adequately controlled with a stable dose of a short-acting oral opioid. Fentanyl is a synthetic, highly selective opioid with many advantageous chemical properties, including high lipophilicity and distinct pharmacokinetic properties. It is recommended for pain management in a variety of settings, including acute pain, chronic pain and BTcP. To date, its variously designed formulations allow non-invasive administration; amongst others, sublingual fentanyl has proven useful in the management of BTcP and in improving the quality of life of patients with cancer. This review provides an update on the management of BTcP with fentanyl, with consideration of safety, as it remains an important tool in the treatment of cancer pain.
Collapse
Affiliation(s)
- Arturo Cuomo
- Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples,
Italy
| |
Collapse
|
6
|
Nakhaee S, Saeedi F, Mehrpour O. Clinical and pharmacokinetics overview of intranasal administration of fentanyl. Heliyon 2023; 9:e23083. [PMID: 38144320 PMCID: PMC10746457 DOI: 10.1016/j.heliyon.2023.e23083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Due to the presence of large surfaces and high blood supply, drug delivery through the nasal route of administration is the appropriate route to administrate drugs with rapid onsets of action. Bypassing first-pass metabolism can increase drug bioavailability. The physicochemical properties of fentanyl led to a need to develop formulations for delivery by multiple routes. Several approved inter-nasal fentanyl products in Europe and the USA have been used in prehospital and emergency departments to treat chronic cancer pain and used to treat severe acute abdominal and flank pain. Analgesia durations and onsets were not significantly different between intranasal and intravenous fentanyl in patients with cancer breakthrough pain and were well-tolerated in the long term. Intranasal Fentanyl (INF) at a 50 μg/ml concentration decreased renal colic pain to the lowest level in 30 min. Possible adverse effects specific to INF are epistaxis, nasal wall ulcer, rhinorrhea, throat irritation, dysgeusia, nausea, and vomiting. However, there is limited available literature about the serious adverse effects of INF in adults and children. Intranasal Fentanyl Spray (INFS) results in significantly higher plasma concentrations and has a lower Tmax than oral transmucosal formulation, and the bioavailability of fentanyl in intranasal formulations is very high (89 %), particularly in pectin-containing formulations such as PecFent and Lazanda.
Collapse
Affiliation(s)
- Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Farhad Saeedi
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Omid Mehrpour
- Michigan Poison & Drug Information Center, Wayne State University School of Medicine, Detroit, MI, USA
- AI and Health LLC, Tucson, AZ, USA
| |
Collapse
|
7
|
Weesie YM, van Dijk L, Bouvy ML, Hek K. Immediate release fentanyl in general practices: Mostly off-label prescribing. Eur J Gen Pract 2023; 29:2165644. [PMID: 36695153 PMCID: PMC9879195 DOI: 10.1080/13814788.2023.2165644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The immediacy of the onset of opioids may be associated with the risk of dependency and accidental overdose. Nasal and oromucosal fentanyl dosage forms are so called immediate release fentanyl (IRF). These IRFs have been approved to treat breakthrough pain in patients with cancer who are on chronic opioid treatment only. There are signals of increased off-label prescribing of IRFs in general practices. OBJECTIVES This study aims to provide insight into the frequency of IRF prescription in Dutch general practices and the extent to which IRF is prescribed off-label. METHODS Routinely collected electronic health records of general practices (GPs) participating in Nivel Primary Care Database were used. Adult patients with IRF prescriptions in 2019 were selected from whom dispensing data on 2018 and 2019 was available. Diagnoses were recorded by GPs using International Classification of Primary Care. Descriptive analyses were performed. RESULTS This study included 342 GPs with a patient population of 1,297,942 patients, 1,368 patients received at least one IRF prescription in 2019, which is equal to 1.1 patients per 1,000 registered patients. Most patients (74.9%) with an IRF prescription received an off-label prescription. A slight majority had a cancer diagnosis but nearly 65.2% did not have a maintenance therapy and 14% were opioid-naive before receiving their first IRF prescription. CONCLUSION IRFs are not prescribed frequently in Dutch general practices. However, when prescribed, a relatively large portion of patients received an off-label prescription.
Collapse
Affiliation(s)
- Yvette M. Weesie
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands,Department of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands,CONTACT Yvette M. Weesie Otterstraat 118 – 124, Utrecht, 3513 CR, The Netherlands
| | - Liset van Dijk
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands,Department of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Marcel L. Bouvy
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), Utrecht, The Netherlands
| | - Karin Hek
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| |
Collapse
|
8
|
Sommerfeld-Klatta K, Jiers W, Łukasik-Głębocka M, Tezyk A, Dolińska-Kaczmarek K, Walter K, Świderski P, Rzepczyk S, Zielińska-Psuja B, Żaba C. Severe and Fatal Fentanyl Poisonings from Transdermal Systems after On-Skin and Ingestion Application. TOXICS 2023; 11:872. [PMID: 37888722 PMCID: PMC10610823 DOI: 10.3390/toxics11100872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
In recent years, the administration of fentanyl (FNTL) implicitly in transdermal drug delivery systems (TDDS) has vastly increased in chronic pain treatment. Non-medical and uncontrolled use of FNTL in TFDS (transdermal fentanyl delivery systems) may reveal toxic effects by the route of exposure, dermal or alternative, by ingestion of patches, and drug release in the stomach. The purpose of this study was to present three different cases of FNTL poisonings, two of which resulted in death due to TFDS abuse. The first case is a 66-year-old woman treated for accidental FTNL poisoning resulting in acute respiratory distress syndrome. Two remaining cases are a 31-year-old woman and a 25-year-old man who died as a result of FNTL overdose after on-skin and ingestion application of the drug patches. During the hospitalization of the 66-year-old patient, in blood samples, FNTL was confirmed at a concentration of 10.0 ng/mL. Tests run on blood taken from the corpses of 25- and 31-year-old patients exhibited FNTL presence in concentrations of 29.1 ng/mL and 38.7 ng/mL, respectively. The various routes of administration and ultimately toxic effects are important to present because, in TDDS, fentanyl can be a reason for severe to fatal poisoning, as shown by the three cases above.
Collapse
Affiliation(s)
- Karina Sommerfeld-Klatta
- Department of Toxicology, Poznań University of Medical Sciences, 30 Dojazd Street, 60-631 Poznan, Poland
| | - Wiktoria Jiers
- Department of Toxicology, Poznań University of Medical Sciences, 30 Dojazd Street, 60-631 Poznan, Poland
| | - Magdalena Łukasik-Głębocka
- Department of Emergency Medicine, Poznań University of Medical Sciences, 7 Rokietnicka Street, 60-806 Poznan, Poland
| | - Artur Tezyk
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| | - Klaudia Dolińska-Kaczmarek
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| | - Kamil Walter
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| | - Paweł Świderski
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| | - Szymon Rzepczyk
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| | - Barbara Zielińska-Psuja
- Department of Toxicology, Poznań University of Medical Sciences, 30 Dojazd Street, 60-631 Poznan, Poland
| | - Czesław Żaba
- Department of Forensic Medicine, Poznań University of Medical Sciences, 10 Rokietnicka Street, 60-806 Poznan, Poland
| |
Collapse
|
9
|
Stark CW, Isaamullah M, Hassan SS, Dyara O, Abd-Elsayed A. A Review of Chronic Pain and Device Interventions: Benefits and Future Directions. Pain Ther 2023; 12:341-354. [PMID: 36581788 PMCID: PMC10036715 DOI: 10.1007/s40122-022-00470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022] Open
Abstract
Chronic pain is a debilitating condition with a growing prevalence both in the USA and globally. The complex nature of this condition necessitates a multimodal approach to pain management that extends beyond the established pharmaceutical interventions currently employed. A variety of devices comprising both invasive and noninvasive approaches are available to patients, serving as adjuvants to existing regimens. The benefits of these interventions are notable for their lack of addiction potential, potential for patient autonomy regarding self-administration, minimal to no drug interaction, and overall relative safety. However, there remains a need for further research and more robust clinical trials to assess the true efficacy of these interventions and elucidate if there is an underlying physiological mechanism to their benefit in treating chronic pain or if their effect is predominantly placebo in nature. Regardless, the field of device-based intervention and treatment remains an evolving field with much promise for the future chronic pain management.
Collapse
Affiliation(s)
- Cain W Stark
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Mir Isaamullah
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | | | - Omar Dyara
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA.
| |
Collapse
|
10
|
Chen H, Wang H, Li B, Hong L, Kuang M, Yang L. Analgesic drug use in patients with STEMI: Current perspectives and challenges. Front Med (Lausanne) 2023; 10:1148581. [PMID: 37035322 PMCID: PMC10073464 DOI: 10.3389/fmed.2023.1148581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Therapy for patients with ST-elevation myocardial infarction (STEMI) has been a controversial topic since the introduction of thrombolytic agents in the 1980s. The use of morphine, fentanyl and lidocaine has increased substantially during this period. However, there is still limited evidence on their advantages and limitations. In this review, the clinical application, as well as future considerations of morphine, fentanyl and lidocaine in patients with ST segment elevation myocardial infarction were discussed.
Collapse
Affiliation(s)
- Huaigang Chen
- Medical College of Nanchang University, Nanchang, Jiangxi Province, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Hong Wang
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Bin Li
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Lang Hong
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Maobin Kuang
- Medical College of Nanchang University, Nanchang, Jiangxi Province, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Liu Yang
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- *Correspondence: Liu Yang,
| |
Collapse
|
11
|
Severe, Nondelirium Agitation as an Underreported Characteristic of Precipitated Fentanyl Withdrawal: A Case Report. J Addict Med 2023; 17:111-113. [PMID: 35914120 DOI: 10.1097/adm.0000000000001017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Opioid overdose deaths continue to rise in conjunction with a surge in fentanyl use. Treating withdrawal and initiating recovery may involve rapid initiations of medications for opioid use disorder, such as buprenorphine, but there is a high risk of precipitated withdrawal. We report a case of a 30-year-old man in police custody who experienced precipitated fentanyl withdrawal, and it was refractory to continued buprenorphine escalation. After buprenorphine, he exhibited a particularly dramatic, nondelirium agitation, which we suspect is a common yet underreported characteristic of precipitated withdrawal. Although there was initial concern for delirium secondary to benzodiazepine withdrawal, this was ruled out by mental status examination and verified later by the patient himself. Nondelirium agitation, clarified by mental status testing, ought to be further reported and characterized in future studies of precipitated withdrawal as clinicians and researchers tackle the new challenges of widespread fentanyl use in the United States.
Collapse
|
12
|
Porzio G, Capela A, Giusti R, Lo Bianco F, Moro M, Ravoni G, Zułtak-Baczkowska K. Multidisciplinary approach, continuous care and opioid management in cancer pain: case series and review of the literature. Drugs Context 2023; 12:dic-2022-11-7. [PMID: 37077766 PMCID: PMC10108666 DOI: 10.7573/dic.2022-11-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/10/2023] [Indexed: 04/21/2023] Open
Abstract
Underlying cancer pain has heterogenous aetiologies and mechanisms. It requires detailed and comprehensive pain assessment, combined with personalized treatment. A multidisciplinary team is essential to providing the best management of cancer pain at every disease stage, improving the quality of life and outcomes in patients with cancer. This narrative literature review emphasizes the value of providing all patients with multidisciplinary pain management in their preferred care setting. Real-life experiences are also reported to witness the efforts of physicians to properly manage cancer pain. This article is part of the Management of breakthrough cancer pain Special Issue: https://www.drugsincontext.com/special_issues/management-of-breakthrough-cancer-pain.
Collapse
Affiliation(s)
| | - Andreia Capela
- Centro Hospitalar Vila Nova de Gaia, Espinho; Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Arcozelo – Vila Nova de Gaia, Portugal
| | - Raffaele Giusti
- Medical Oncology Unit, Sant’Andrea Hospital of Rome, Sapienza University of Rome, Rome, Italy
| | - Francesca Lo Bianco
- Medical Oncology Unit, Sant’Andrea Hospital of Rome, Sapienza University of Rome, Rome, Italy
| | - Mirella Moro
- Medical Oncology Unit, Sant’Andrea Hospital of Rome, Sapienza University of Rome, Rome, Italy
| | - Giulio Ravoni
- Tuscany Tumor Association, Home Care Service, Florence, Italy
| | - Katarzyna Zułtak-Baczkowska
- Zakład Zdrowia Publicznego, Wydział Nauk o Zdrowiu, Pomorski Uniwersytet Medyczny w Szczecinie, Stettin, Poland
| |
Collapse
|
13
|
Jobski K, Bantel C, Hoffmann F. Abuse, dependence and withdrawal associated with fentanyl and the role of its (designated) route of administration: an analysis of spontaneous reports from Europe. Eur J Clin Pharmacol 2023; 79:257-267. [PMID: 36525039 PMCID: PMC9879804 DOI: 10.1007/s00228-022-03431-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Fentanyl, a highly potent synthetic opioid used in cancer and non-cancer pain, is approved for various routes of administration. In Europe, fentanyl consumption increased substantially in the last decades but information on abuse, dependence and withdrawal associated with fentanyl is scarce, especially with respect to its different formulations. METHODS We analysed case characteristics of spontaneous reports of suspected fentanyl-associated abuse, dependence or withdrawal from European countries recorded in the EudraVigilance database up to 2018 with respect to the (designated) routes of administration and potential indications. RESULTS A total of 985 reports were included (mainly from France and Germany) with 43% of cases referring to transdermal fentanyl. Median age was 45 years (48.8% female) and 21.6% had musculoskeletal disorders. Only 12.6% of those using transdermal fentanyl had a cancer diagnosis compared to 40.2% and 26.8% of those using intranasal and oral transmucosal fentanyl, respectively. Depression was common (10.7%) and highest in cases with musculoskeletal disorders (24.9%) as was the use of benzodiazepines. Overall, 39.5% of reports resulted in a prolonged hospital stay and for 23.2% a fatal outcome was recorded. The respective proportions were especially high in cases with musculoskeletal disorders (56.3% with prolonged hospitalisation) and in those using transdermal fentanyl (35.2% fatalities). CONCLUSIONS In suspected cases of abuse, dependence or withdrawal, fentanyl was mainly used for non-cancer pain indications and most often as transdermal formulations. Depression and prolonged hospitalisations were common, especially in patients with musculoskeletal disorders, indicating a vulnerable patient group and complex treatment situations.
Collapse
Affiliation(s)
- Kathrin Jobski
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 114-118, 26129 Oldenburg, Germany
| | - Carsten Bantel
- University Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Klinikum Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 114-118, 26129 Oldenburg, Germany
| |
Collapse
|
14
|
Manetti F, David MC, Gariglio S, Consalvo F, Padovano M, Scopetti M, Grande A, Santurro A. Atypical Fentanyl Transdermal Patch Consumption and Fatalities: Case Report and Literature Review. TOXICS 2022; 11:toxics11010046. [PMID: 36668772 PMCID: PMC9863810 DOI: 10.3390/toxics11010046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 06/01/2023]
Abstract
Fentanyl is a synthetic L-opioid receptor agonist, approximately 100 times more potent than morphine, that is experiencing an upward trend in the field of abuse. Fentanyl patches' abusive consumption can occur either by transdermal absorption or through other atypical and ingenious routes. In the present case, a 29-year-old man with a history of illicit drug use was found dead in a suburban neighborhood of an Italian city. At autopsy, lungs appeared increased in weight and showed minute subpleural hemorrhages. Airways contained abundant reddish foamy material; in addition, a fentanyl patch protective film was found inside the left main bronchus. Toxicological analysis revealed the presence of morphine, fentanyl, BEG and ethyl alcohol in peripheric blood; 6-MAM was also revealed in urine. Findings collected during post-mortem investigations allowed us to identify fentanyl consumption as the cause of death. Fentanyl consumption presumably took place by chewing of a transdermal patch, with subsequent aspiration of the protective film. The pathophysiology of death can be identified as combined respiratory failure-both central suppression and a fentanyl-induced increase in muscular stiffness; a further minor contribution may be identified in the mechanical airflow obstruction caused by the presence of the protective film at the bronchial level.
Collapse
Affiliation(s)
- Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Chiara David
- Ministry of the Interior, Department of Public Security, Health Central Directorate, State Police, 00185 Rome, Italy
| | - Sara Gariglio
- DIFAR—Department of Pharmacy, University of Genova, 16148 Genova, Italy
| | - Francesca Consalvo
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Matteo Scopetti
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Antonio Grande
- Department of Public Security, Anti-Crime Central Directorate, Scientific Police Service, 00174 Rome, Italy
| | - Alessandro Santurro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| |
Collapse
|
15
|
Guastella V, Delorme J, Chenaf C, Authier N. The Prevalence of Off-label Prescribing of Transmucosal Immediate-Release Fentanyl in France. J Pain Symptom Manage 2022; 63:980-987. [PMID: 35192879 DOI: 10.1016/j.jpainsymman.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/22/2022]
Abstract
CONTEXT The abuse of opioids and opioid-related harms, including deaths, in the United States are well documented. In the European Union, opioid use has also been increasing, particularly of fentanyl. OBJECTIVE We assessed the prevalence of off-label prescribing of transmucosal immediate-release fentanyl (TIRF), in France, in 2019. We looked at the patients' and prescribers' characteristics and compared the population of patients who received TIRF in off-label prescriptions with those taking it on-label. We also examined the differences between the patients with and without cancer in the off-label use population. METHODS This was a population-based cross-sectional study conducted in 2019, using the French national insurance claims database Système National d'Informations Inter-Régimes de l'Assurance Maladie, covering 98.8% of the French population, or 66 million people. RESULTS We selected 224,000 patients with fentanyl prescriptions. Among them, 23,209 had at least one TIRF delivered. The median age was 71 years (59-85) and most patients were female (55.8%). The prevalence of off-label prescribing of TIRF was 51.8% (n = 12,031), corresponding to 9827 patients not diagnosed with cancer. The three main pharmaceutical TIRF specialties prescribed in two groups were Abstral, Pecfent, and Instanyl. Overall, TIRF was mainly prescribed by private general practitioners (64.8%). CONCLUSION The prevalence of off-label prescribing of TIRF in France is extremely high. A field survey is now needed 1) to better understand why TIRF is used in conditions not indicated in its marketing authorization, and in what clinical situations, and 2) to determine whether the benefit/risk ratio of such use is favorable.
Collapse
Affiliation(s)
- Virginie Guastella
- Université de Clermont Auvergne (V.G.), CHU Clermont-Ferrand, Inserm, Neuro-Dol, Palliative Care Center, Clermont-Ferrand, France.
| | - Jessica Delorme
- Université de Clermont Auvergne (J.D., C.C., N.A.), CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service Pharmacologie médicale, Centres d'Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la douleur, Clermont-Ferrand, France; Observatoire français des Médicaments Antalgiques (OFMA/French Monitoring Centre for Analgesic Drugs) (J.D., C.C., N.A.), Université Clermont-Ferrand, Clermont-Ferrand, France; Institut Analgésia (J.D.), Faculté de Médecine, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université de Clermont Auvergne (J.D., C.C., N.A.), CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service Pharmacologie médicale, Centres d'Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la douleur, Clermont-Ferrand, France; Observatoire français des Médicaments Antalgiques (OFMA/French Monitoring Centre for Analgesic Drugs) (J.D., C.C., N.A.), Université Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas Authier
- Université de Clermont Auvergne (J.D., C.C., N.A.), CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service Pharmacologie médicale, Centres d'Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la douleur, Clermont-Ferrand, France; Observatoire français des Médicaments Antalgiques (OFMA/French Monitoring Centre for Analgesic Drugs) (J.D., C.C., N.A.), Université Clermont-Ferrand, Clermont-Ferrand, France; Observatoire français des Médicaments Antalgiques (OFMA/French Monitoring Centre for Analgesic Drugs (N.A.), Université Clermont-Ferrand, Clermont-Ferrand, France
| |
Collapse
|
16
|
Bossi P, Escobar Y, Pea F. Rapid-Onset Opioids for Management of Breakthrough Cancer Pain: Considerations for Daily Practice. FRONTIERS IN PAIN RESEARCH 2022; 3:893530. [PMID: 35721659 PMCID: PMC9204512 DOI: 10.3389/fpain.2022.893530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objective Rapid-onset opioids (ROOs) are effective treatments for breakthrough cancer pain (BTcP) given their rapid onset of action and relatively short duration of analgesia. The aim of this article is to describe specific considerations for the use of ROOs in daily practice, focusing on dose titration and treatment of specific populations. Type of Review We conducted a narrative review on the use of ROOs for BTcP. We selected papers according to the following search terms: “breakthrough cancer pain” and “rapid onset opioids”. Results ROOs may be considered as the most suitable drugs to treat BTcP and can be used “on-demand”. Several fentanyl formulations are available and have been associated with control of BTcP and with improvement in quality of life. Various titration schemes have been used to optimize ROO dosing; however, a dose-proportional scheme could be considered safe and effective in most patients. Specific formulations may be more suitable for specific patient subgroups; for example, patients with oral mucositis may prefer intranasal to oral formulations. Moreover, elderly patients or those without caregivers should be clearly educated on the use of these formulations. A key element in achieving successful treatment of BTcP is awareness of the barriers to pain management, including poor overall assessment, patient reluctance to take opioids or report pain, and physician reluctance to prescribe opioids. Conclusion A personalized approach is fundamental when prescribing a medication for BTcP, and careful attention should be given to drug choice and route of administration, and to the need for alternative therapeutic options.
Collapse
Affiliation(s)
- Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health - Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy
- *Correspondence: Paolo Bossi
| | - Yolanda Escobar
- Medical Oncology, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero Universitaria Sant'Orsola, Bologna, Italy
| |
Collapse
|
17
|
Hoeffe J, Vogel RG, Ammann RA. Pediatric Sedation and Analgesia Outside the Operating Room: Combining Intranasal Fentanyl and Inhaled Nitrous Oxide. J Pediatr Pharmacol Ther 2022; 27:436-442. [DOI: 10.5863/1551-6776-27.5.436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/18/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
Combining intranasal fentanyl (IN FENT) with inhaled nitrous oxide (N2O) seems to have good properties for pediatric procedural sedation and analgesia (PSA). This study aims to assess the side effect rate of the combined use of IN FENT and N2O.
METHODS
We performed a retrospective, single-center study. Patients treated in either the pediatric emergency department (PED) or the pediatric surgery outpatient clinic (PSOC) were included, if they received PSA with IN FENT and nitrous oxide with 50% oxygen (N2O 50%).
RESULTS
Three hundred seventy-five patients were included over a period of 4 years. Median age was 9.4 years (range, 3.1 to 15.9) and 39% of patients were female. Overall side effect rate was 30% (114 patients). Most frequent was dizziness (n = 63, 17%; 95% CI, 13–21), followed by nausea (n = 23, 6%; 95% CI, 4–9) and emesis (n = 14, 4%; 95% CI, 2–6), with 35 patients having either nausea and/or emesis (9%; 95% CI, 7–13). No serious side effects were recorded (0%; 95% CI, 0–0.1). Of 298 patients with information regarding satisfaction, 280 patients would like the same sedation for a similar procedure in the future (94%; 95% CI, 90–96). We found no relation between previously described risk factors and emesis and/or nausea.
CONCLUSIONS
N2O 50% combined with IN FENT can be recommended as an effective and safe treatment in the PED and the PSOC. While the side effect rate, primarily dizziness, nausea and emesis was substantial, antiemetic prophylaxis is not indicated owing to the overall low incidence of nausea and emesis.
Collapse
Affiliation(s)
- Julia Hoeffe
- Department of Pediatric Emergency Medicine, Department of Pediatrics (JH), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Roland A. Ammann
- Division of Pediatric Hematology and Oncology, Department of Pediatrics (RAA), Inselspital, Bern University Hospital, University of Bern, Switzerland
| |
Collapse
|
18
|
Pre- and Postnatal Maturation are Important for Fentanyl Exposure in Preterm and Term Newborns: A Pooled Population Pharmacokinetic Study. Clin Pharmacokinet 2021; 61:401-412. [PMID: 34773609 PMCID: PMC8891207 DOI: 10.1007/s40262-021-01076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Fentanyl is an opioid commonly used to prevent and treat severe pain in neonates; however, its use is off label and mostly based on bodyweight. Given the limited pharmacokinetic information across the entire neonatal age range, we characterized the pharmacokinetics of fentanyl across preterm and term neonates to individualize dosing. METHODS We pooled data from two previous studies on 164 newborns with a median gestational age of 29.0 weeks (range 23.9-42.3), birthweight of 1055 g (range 390-4245), and postnatal age (PNA) of 1 day (range 0-68). In total, 673 plasma samples upon bolus dosing (69 patients; median dose 2.1 μg/kg, median 2 boluses per patient) or continuous infusions (95 patients; median dose 1.1 μg/kg/h for 30 h) with and without boluses were used for population pharmacokinetic modeling in NONMEM® 7.4. RESULTS Clearance in neonates with birthweight of 2000 and 3000 g was 2.8- and 5.0-fold the clearance in a neonate with birthweight of 1000 g, respectively. Fentanyl clearance at PNA of 7, 14, and 21 days was 2.7-fold, 3.8-fold, and 4.6-fold the clearance at 1 day, respectively. Bodyweight-based dosing resulted in large differences in fentanyl concentrations. Depending on PNA and birthweight, fentanyl concentrations increased slowly after the start of therapy for both intermittent boluses and continuous infusion and reached a maximum concentration at 12-48 h. CONCLUSIONS As both prenatal and postnatal maturation are important for fentanyl exposure, we propose a birthweight- and PNA-based dosage regimen. To provide rapid analgesia in the first 24 h of treatment, additional loading doses need to be considered.
Collapse
|
19
|
Chaudhary S, Chaudhary S, Kumar M, Salhotra R. Fentanyl versus nalbuphine for intubating conditions during awake fiberoptic bronchoscopy: A randomized double-blind comparative study. J Anaesthesiol Clin Pharmacol 2021; 37:378-382. [PMID: 34759547 PMCID: PMC8562462 DOI: 10.4103/joacp.joacp_359_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/20/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background and Aims: Patient cooperation, sedation, anxiolysis, and topicalization are important prerequisites for the successful and safe conduct of awake intubation. Because of the pharmacological properties, opioids can facilitate this process. Fentanyl is an opioid agonist and nalbuphine is an agonist-antagonist. This study aims to compare these two opioids for their effect on sedation and intubating conditions during awake fiberoptic intubation. Material and Methods: This randomized double-blind controlled study was conducted on 62 ASA I/II patients of either sex between the age of 20 and 60 years, weight between 40 and 80 kg, with MP class I/II airways requiring general anesthesia with endotracheal intubation. All patients received standard airway topicalization and nebulization. Patients were randomly allocated to one of the two groups according to a computer-generated random number table. Group F (n = 31) received fentanyl 2 μg/kg i.v. and group N (n = 31) received nalbuphine 0.2 mg/kg i.v. over 10 min before intubation. Fiberoptic intubation was attempted and lignocaine spray and propofol boluses were administered as and when required. Hemodynamic responses and intubating conditions were recorded. Repeated measure ANOVA, McNemar test, and Chi-square test or Fischer's exact test were used for data analysis. A P < 0.05 was considered significant. Results: Cough score (P = 0.458), post-intubation score (P = 1.000), and sedation score (P = 1.000) were comparable among the two groups. Hemodynamic responses and propofol and lignocaine requirements were also comparable. Conclusion: Both fentanyl and nalbuphine provide comparable intubating conditions when used before awake fiberoptic intubation with minimal adverse effects on hemodynamic profile.
Collapse
Affiliation(s)
- Sujata Chaudhary
- Department of Anesthesiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - Sachin Chaudhary
- Department of Anesthesiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - Mahendra Kumar
- Department of Anesthesiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - Rashmi Salhotra
- Department of Anesthesiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| |
Collapse
|
20
|
Danisan G, Taydas O. Ultrasound-Guided Subgluteal Sciatic Nerve Block for Pain Management during Endovascular Treatment for Below-the-Knee Arterial Occlusions. J Vasc Interv Radiol 2021; 33:279-285. [PMID: 34756997 DOI: 10.1016/j.jvir.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/09/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the ability of subgluteal sciatic nerve block (SSNB) to provide pain control during endovascular treatment of below-the-knee (BTK) occlusions. MATERIALS AND METHODS This randomized prospective controlled study evaluated 60 consecutive adult patients who underwent endovascular treatment for BTK occlusions. The patients were randomized into 2 equal groups; the SSNB group underwent SSNB in the subgluteal space under ultrasound guidance, while the control group received fentanyl as an analgesic. The visual analog scale (VAS) and Face, Legs, Activity, Cry, Consolability (FLACC) scale scores were recorded. RESULTS Compared with the control group, the SSNB group showed significantly lower median VAS (0 [range, 0-30] vs 70 [range, 20-100], P < .001) and median FLACC scale (0 [range, 0-2] vs 6 [range, 3-10], P < .001) scores. There was no statistically significant difference between the 2 groups regarding the remaining parameters. There was a very strong correlation between the VAS and FLACC scale scores in both the SSNB (r = 0.805, P < .001) and control (r = 0.950, P < .001) groups. The procedure time and total balloon inflation time correlated with the VAS (r = 0.411, P = .024, and r = 0.402, P = .031, respectively) and FLACC scale (r = 0.431, P = .017, and r = 0.414, P = .022, respectively) scores in the control group but not in the SSNB group (r = 0.364, P = .056, and r = 0.300, P =.085, respectively, for correlation with VAS score and r = 0.730, P = .068, and r = 0.704, P = .075, respectively, for correlation with the FLACC scale score). CONCLUSIONS SSNB is a highly effective and safe pain management modality for the endovascular treatment of BTK occlusions.
Collapse
Affiliation(s)
- Gurkan Danisan
- Department of Radiology, Sakarya University Faculty of Medicine, Sakarya, Turkey.
| | - Onur Taydas
- Department of Radiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| |
Collapse
|
21
|
Mariani JJ, Mahony AL, Podell SC, Brooks DJ, Brezing C, Luo SX, Naqvi NH, Levin FR. Open-label trial of a single-day induction onto buprenorphine extended-release injection for users of heroin and fentanyl. Am J Addict 2021; 30:470-476. [PMID: 34223681 PMCID: PMC8459386 DOI: 10.1111/ajad.13193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Fentanyl and other highly potent synthetic opioids are the leading cause of opioid overdose deaths in the United States. METHODS This study was an open-label, uncontrolled 12-week outpatient clinical trial to test the feasibility of a single-day induction onto extended-release buprenorphine (BXR) injection treatment for five adults (N = 5) with opioid use disorder using heroin-containing fentanyl. Participants were planned to receive three monthly BXR injections (300, 300, and 100 mg). RESULTS After receiving 24 mg sublingual buprenorphine (SL-BUP), all five participants received the BXR 300 mg injection on the first day of induction. All five participants were retained for the full 3-month study period postinduction and received all three scheduled BXR injections. DISCUSSION AND CONCLUSION This study provides preliminary evidence supporting the feasibility of inducting users of heroin-containing fentanyl onto BXR 300 mg in a single day. SCIENTIFIC SIGNIFICANCE The ability to administer a long-acting injection of BXR that assures therapeutic serum levels for a month on the first day of treatment contact is a promising development for the treatment of OUD.
Collapse
Affiliation(s)
- John J. Mariani
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032, USA
- Columbia University Irving Medical Center, Department of Psychiatry, 630 West 168th Street, New York, NY 10032, USA
| | - Amy L. Mahony
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032, USA
| | | | - Daniel J. Brooks
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032, USA
| | - Christina Brezing
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032, USA
- Columbia University Irving Medical Center, Department of Psychiatry, 630 West 168th Street, New York, NY 10032, USA
| | - Sean X. Luo
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032, USA
- Columbia University Irving Medical Center, Department of Psychiatry, 630 West 168th Street, New York, NY 10032, USA
| | - Nasir H. Naqvi
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032, USA
- Columbia University Irving Medical Center, Department of Psychiatry, 630 West 168th Street, New York, NY 10032, USA
| | - Frances R. Levin
- New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, New York, NY 10032, USA
- Columbia University Irving Medical Center, Department of Psychiatry, 630 West 168th Street, New York, NY 10032, USA
| |
Collapse
|
22
|
Edinoff AN, Kaplan LA, Khan S, Petersen M, Sauce E, Causey CD, Cornett EM, Imani F, Moradi Moghadam O, Kaye AM, Kaye AD. Full Opioid Agonists and Tramadol: Pharmacological and Clinical Considerations. Anesth Pain Med 2021; 11:e119156. [PMID: 34692448 PMCID: PMC8520671 DOI: 10.5812/aapm.119156] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/03/2021] [Indexed: 12/22/2022] Open
Abstract
Opioids are mu receptor agonists and have been an important part of pain treatment for thousands of years. In order to use these drugs appropriately and successfully in patients, whether to control pain, to treat opiate-induced side effects, or opiate withdrawal syndromes, a solid understanding of the pharmacology of such drugs is crucial. The most recognized full agonist opioids are heroin, morphine, codeine, oxycodone, meperidine, and fentanyl. Phenanthrenes refer to a naturally occurring plant-based compound that includes three or more fused rings. The opioids derived from the opium plant are phenanthrene derivatives, whereas most synthetic opioids are simpler molecules that do not have multiple rings. Methadone acts as a synthetic opioid analgesic similar to morphine in both quality and quantity; however, methadone lasts longer and in oral form, has higher efficacy, and is considered a diphenylheptane. Fentanyl is a strong synthetic phenylpiperdine derivative that exhibits activity as a mu-selective opioid agonist approximately 50 to 100 times more potent than morphine. Meperidine is another medication which is a phenylpiperdine. Tramadol is considered a mixed-mechanism opioid drug, as it is a centrally acting analgesic that exerts its effects via binding mu receptors and blocking the reuptake of monoamines. Some of the most common adverse effects shared among all opioids are nausea, vomiting, pruritus, addiction, respiratory depression, constipation, sphincter of Oddi spasm, and miosis (except in the case of meperidine). Chronic opioid usage has also established a relationship to opioid-induced hypogonadism and adrenal suppression. Physicians must be stewards of opioid use and use opioids only when necessary.
Collapse
Affiliation(s)
- Amber N. Edinoff
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Leah A. Kaplan
- Louisiana State University Shreveport, School of Medicine, Shreveport, LA, USA
| | - Sami Khan
- American University of the Caribbean, School of Medicine, USA
| | - Murray Petersen
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Emily Sauce
- Louisiana State University New Orleans, School of Medicine, New Orleans, LA, USA
| | | | - Elyse M. Cornett
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Moradi Moghadam
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Adam M. Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, USA
| | - Alan D. Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| |
Collapse
|
23
|
Khandelwal H, Negi A, Govil N, Singh A, Parag K, Bhardwaj BB. Comparative evaluation of analgesic efficacy of buprenorphine transdermal patch and fentanyl patch in management of postoperative pain after arthroscopic lower limb surgery: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2021; 37:272-278. [PMID: 34349379 PMCID: PMC8289665 DOI: 10.4103/joacp.joacp_405_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/13/2020] [Accepted: 12/23/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Transdermal opioids are newer modality in use for the control of postoperative pain, because of its noninvasiveness, longer duration of action, sustained blood levels, and with minimal side effects. The study was aimed to evaluate the efficacy of analgesia of buprenorphine patch 10, 20 μg·h-1 and fentanyl patch 25 μg·h-1 for relief of pain in the postoperative period in patients undergoing arthroscopic lower limb surgeries. Materials and Methods It was a randomized, double-blinded, prospective study in which adult patients undergoing lower limb arthroscopic surgery were randomly segregated into three groups. In Group 1 (fentanyl patch 25 μg·h-1), Group 2 (buprenorphine patch 10 μg·h-1), and Group 3 (buprenorphine patch 20 μg·h-1), transdermal patches were applied 12 h prior to surgery. Mean NRS score, total rescue analgesic requirement, drug-related adverse effects, and hemodynamic status were evaluated till 72 h in the postoperative period. Results Out of 175 screened patients, 150 patients were finally analyzed. Baseline characteristics were the same among all the three groups. Median NRS score was lowest in Group 3 [P value < 0.05 at 2, 4, 8, 12, and 24 h after surgery (Kruskal Wallis test). The total consumption of postoperative rescue analgesic diclofenac was the lowest in Group 3 as compared to other groups without any significant increase in adverse events. Conclusions In arthroscopic lower limb surgery, buprenorphine patch (20 μg·h-1) applied 12 h prior to surgery is an effective postoperative analgesic and it is not associated with any significant adverse effects.
Collapse
Affiliation(s)
- Hariom Khandelwal
- Department of Anesthesia, SGRRIM and HS Dehradun, Rishikesh, Uttarakhand, India
| | - Anoop Negi
- Department of Anesthesia, SGRRIM and HS Dehradun, Rishikesh, Uttarakhand, India
| | - Nishith Govil
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashutosh Singh
- Department of Anesthesia, SGRRIM and HS Dehradun, Rishikesh, Uttarakhand, India
| | - Kumar Parag
- Department of Cardiac Anesthesia, SGRRIM and HS Dehradun, Rishikesh, Uttarakhand, India
| | - Bharat Bhushan Bhardwaj
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| |
Collapse
|
24
|
Phadke A, Amin P. A Recent Update on Drug Delivery Systems for Pain Management. J Pain Palliat Care Pharmacother 2021; 35:175-214. [PMID: 34157247 DOI: 10.1080/15360288.2021.1925386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pain remains a global health challenge affecting approximately 1.5 billion people worldwide. Pain has been an implicit variable in the equation of human life for many centuries considering different types and the magnitude of pain. Therefore, developing an efficacious drug delivery system for pain management remains an open challenge for researchers in the field of medicine. Lack of therapeutic efficacy still persists, despite high throughput studies in the field of pain management. Research scientists have been exploiting different alternatives to curb the adverse side effects of pain medications or attempting a more substantial approach to minimize the prevalence of pain. Various drug delivery systems have been developed such as nanoparticles, microparticles to curb adverse side effects of pain medications or minimize the prevalence of pain. This literature review firstly provides a brief introduction of pain as a sensation and its pharmacological interventions. Second, it highlights the most recent studies in the pharmaceutical field for pain management and serves as a strong base for future developments. Herein, we have classified drug delivery systems based on their sizes such as nano, micro, and macro systems, and for each of the reviewed systems, design, formulation strategies, and drug release performance has been discussed.
Collapse
|
25
|
Varrassi G, Coluzzi F, Guardamagna VA, Puntillo F, Sotgiu G, Vellucci R. Personalizing Cancer Pain Therapy: Insights from the Rational Use of Analgesics (RUA) Group. Pain Ther 2021; 10:605-617. [PMID: 33730338 PMCID: PMC8119556 DOI: 10.1007/s40122-021-00248-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/15/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction A previous Delphi survey from the Rational Use of Analgesics (RUA) project involving Italian palliative care specialists revealed some discrepancies between current guidelines and clinical practice with a lack of consensus on items regarding the use of strong opioids in treating cancer pain. Those results represented the basis for a new Delphi study addressing a better approach to pain treatment in patients with cancer. Methods The study consisted of a two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of 17 statements using a 5-point Likert scale (0 = totally disagree and 4 = totally agree). Consensus on a statement was achieved if the median consensus score (MCS) (expressed as value at which at least 50% of participants agreed) was at least 4 and the interquartile range (IQR) was 3–4. Results This survey included input from 186 palliative care specialists representing all Italian territory. Consensus was reached on seven statements. More than 70% of participants agreed with the use of low dose of strong opioids in moderate pain treatment and valued transdermal route as an effective option when the oral route is not available. There was strong consensus on the importance of knowing opioid pharmacokinetics for therapy personalization and on identifying immediate-release opioids as key for tailoring therapy to patients’ needs. Limited agreement was reached on items regarding breakthrough pain and the management of opioid-induced bowel dysfunction. Conclusion These findings may assist clinicians in applying clinical evidence to routine care settings and call for a reappraisal of current pain treatment recommendations with the final aim of optimizing the clinical use of strong opioids in patients with cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-021-00248-x.
Collapse
Affiliation(s)
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Anesthesiology, Intensive Care, and Pain Medicine Unit, Sant'Andrea University Hospital, Rome, Italy
| | | | - Filomena Puntillo
- Department of Interdisciplinary Medicine (DIM), University of Bari; Anesthesia, Intensive Care and Pain Unit, Policlinico Hospital, 70124, Bari, Italy.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Renato Vellucci
- University of Florence, Pain and Palliative Care Clinic, Careggi Hospital, 50139, Florence, Italy
| | | |
Collapse
|
26
|
Sakamoto R, Koyama A. Fentanyl Infusion Is Effective in the Treatment of Dyspnea in End-Stage Heart Failure With Renal Failure: A Case Report. Cureus 2021; 13:e12673. [PMID: 33604211 PMCID: PMC7880850 DOI: 10.7759/cureus.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patients with end-stage heart failure may require hospitalization for the treatment of respiratory distress. Morphine may be used to relieve symptoms. However, use of morphine is problematic because heart failure is often associated with renal dysfunction. In this case report, intravenous fentanyl infusion reduced dyspnea in a patient with end-stage heart failure who was on dialysis induction to treat renal failure. The patient was able to eat and sleep after administration of an intravenous fentanyl solution and experienced no apparent respiratory depression as a side effect of fentanyl. There have been few reports of dyspnea relief with fentanyl infusion. Because of its adjustable duration of effect, intravenous fentanyl may be a more effective and useful option than rapid or extended-release agents in cases such as this one.
Collapse
Affiliation(s)
- Ryo Sakamoto
- Psychosomatic Medicine, Kindai University Faculty of Medicine, Osakasayama City, JPN
| | - Atsuko Koyama
- Psychosomatic Medicine, Kindai University Faculty of Medicine, Osakasayama City, JPN
| |
Collapse
|
27
|
Fernando H, Shaw JA, Myles PS, Peter K, Stub D. The opioid-P2Y12 inhibitor interaction: Potential strategies to mitigate the interaction and consideration of alternative analgesic agents in myocardial infarction. Pharmacol Ther 2021; 217:107665. [DOI: 10.1016/j.pharmthera.2020.107665] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/13/2020] [Indexed: 01/04/2023]
|
28
|
Degrauwe S, Roffi M, Lauriers N, Muller O, Masci PG, Valgimigli M, Iglesias JF. Influence of intravenous fentanyl compared with morphine on ticagrelor absorption and platelet inhibition in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: rationale and design of the PERSEUS randomized trial. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 5:158-163. [PMID: 30101278 DOI: 10.1093/ehjcvp/pvy031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/17/2018] [Accepted: 08/07/2018] [Indexed: 01/17/2023]
Abstract
AIMS Recent evidence demonstrates that intravenous morphine significantly reduces absorption and delays onset of action of oral P2Y12 receptor inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). We aimed to assess the influence of intravenous fentanyl compared with morphine on pharmacokinetics and pharmacodynamics of ticagrelor and its active metabolite (AR-C124910XX) in patients undergoing pPCI for STEMI. METHODS AND RESULTS Single-centre, prospective, open-label, randomized controlled study that will randomly assign in a 1:1 ratio patients with STEMI undergoing pPCI to receive intravenous fentanyl or morphine following a pre-hospital 180-mg loading dose of ticagrelor (ClinicalTrials.gov Identifier: NCT02531165). Pharmacokinetic and pharmacodynamic analyses will be performed at baseline and 1, 2, 4, 6, and 12 h post-loading dose. Pharmacodynamic assessments will include P2Y12 reaction units (PRU) measured by VerifyNow P2Y12. Pharmacokinetic assessments include determination of maximal observed plasma concentrations, time for maximal plasma concentration, and area under the plasma concentration vs. time curve from time 0 to the last measurable concentration (AUC0-t) for ticagrelor and AR-C124910XX. The primary endpoint is platelet reactivity assessed by PRU at 2 h post ticagrelor loading dose. CONCLUSION PERSEUS will provide randomized data regarding the impact of fentanyl administration, in patients with STEMI undergoing pPCI, on platelet inhibition and ticagrelor absorption and total exposure.
Collapse
Affiliation(s)
- Sophie Degrauwe
- Department of Cardiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Nathalie Lauriers
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Pier Giorgio Masci
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern, Switzerland
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| |
Collapse
|
29
|
Abstract
Analgesics, particularly opioids, have been routinely used in the emergency treatment of ischemic chest pain for a long time. In the past two decades; however, several studies have raised the possibility of the harmful effects of opioid administration. In 2014, the American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) changed the guidelines regarding the use of opioids from class IC to class IIb for non-ST elevation acute coronary syndrome. And in 2015, the European Society of Cardiology (ESC) guidelines incidentally noted the side effects of opioids. In ST-segment elevation myocardial infarction, both ESC and AHA/ACCF still recommend the use of opioids. Given the need for adequate pain relief in ischemic chest pain in the emergency setting, it is necessary to understand the adverse effects of analgesia, while still providing sufficiently potent options for analgesia. The primary purpose of this review is to quantify the effects of analgesics commonly used in the prehospital and emergency department in patients with ischemic chest pain.
Collapse
|
30
|
Jiao H, Wang H, Jiang Z, Hu J. Comparative efficacy of ancillary drugs in sevoflurane-related emergence agitation after paediatric adenotonsillectomy: A Bayesian network meta-analysis. J Clin Pharm Ther 2020; 45:1039-1049. [PMID: 32255203 DOI: 10.1111/jcpt.13133] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/08/2020] [Accepted: 02/27/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The comparative efficacy of ancillary drugs on sevoflurane-related emergence agitation (EA) in paediatric anaesthesia for adenotonsillectomy remains unclear. The purpose of this Bayesian network meta-analysis was to investigate the efficacy of ancillary drugs on sevoflurane-related EA in paediatric anaesthesia for adenotonsillectomy. METHODS MEDLINE, Embase, the Cochrane Library and Web of Science databases were electronically searched to identify randomized controlled trials (RCTs) of different ancillary drugs used in adenotonsillectomy from inception to April 2019. Two reviewers independently screened the literature, extracted data and assessed the risk of bias in included studies. Subsequently, a network meta-analysis was performed using the R software and RevMan 5.3 software. RESULTS AND DISCUSSION We included 25 RCTs, involving 2151 participants. The proportion of patients with sevoflurane-related EA was significantly lower in the dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil and clonidine groups than in the placebo group (P < .05). Fentanyl was superior to sufentanil (P < .05), whereas dexmedetomidine was superior to fentanyl (P < .05). Among ancillary drugs, dexmedetomidine (90.04%) showed the highest possibility of reducing the risk of EA, followed by fentanyl (87.45%), remifentanil (63.85%), ketamine (52.07%), midazolam (51.27%), clonidine (49.94%), propofol (29.89%), sufentanil (21.38%) and placebo (4.09%). WHAT IS NEW AND CONCLUSION Evidence suggests that the effects of dexmedetomidine in reducing the risk of sevoflurane-related EA in paediatric anaesthesia for adenotonsillectomy were better than the effects of other drugs. However, large, high-quality RCTs are required to further confirm this.
Collapse
Affiliation(s)
- Hongmei Jiao
- Department of Anesthesiology, Linyi Cancer Hospital, Linyi City, China
| | - Hongwei Wang
- Department of Anesthesiology, Linyi Cancer Hospital, Linyi City, China
| | - Ziru Jiang
- Department of Anesthesiology, Linyi Cancer Hospital, Linyi City, China
| | - Jingli Hu
- Department of Anesthesiology, Linyi Cancer Hospital, Linyi City, China
| |
Collapse
|
31
|
Wang Z, Tao Y, Song C, Liu P, Wang C, Li Y, Cui W, Xie K, Zhang L, Wang G. Spinal hevin mediates membrane trafficking of GluA1-containing AMPA receptors in remifentanil-induced postoperative hyperalgesia in mice. Neurosci Lett 2020; 722:134855. [PMID: 32088196 DOI: 10.1016/j.neulet.2020.134855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Hevin, a matricellular protein involved in tissue repair and remodeling, is crucial for initiation and development of excitatory synapses. Besides, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA) is an ionotropic transmembrane receptor for glutamate that mediates fast synaptic transmission in the central nervous system (CNS). This study aimed to investigate the correlation between spinal Hevin and AMPA receptors in remifentanil-induced postoperative hyperalgesia in mice. METHODS Remifentanil (1.33 μg/kg/min for 60 min) was subcutaneously injected into a mouse model of postoperative pain. The von Frey and hot plate tests were performed to assess mechanical and thermal hyperalgesia. The gene and protein expression of Hevin and the membrane trafficking of GluA1-containing AMPA receptors in the dorsal horn of spinal cord were detected by quantitative reverse transcription polymerase chain reaction (RT-qPCR) and Western blot analysis. In addition, Hevin-shRNA, exogenous Hevin, and 1-naphtylacetyl-spermine (NASPM) were administrated intrathecally to assess the relationship between spinal Hevin and AMPA receptors. RESULTS Perioperative administration of remifentanil can aggravate and prolong incision-induced mechanical and thermal hyperalgesia. Treatment with remifentanil increased the expression of spinal Hevin and the membrane trafficking of AMPA receptors. Additionally, knockdown of spinal Hevin attenuated pain hypersensitivity and downregulated membrane trafficking of AMPA receptors after treatment with remifentanil. Meanwhile, preadministration of NASPM reversed spontaneous pain and membrane trafficking of spinal GluA1-containing AMPA receptors induced by exogenous Hevin in naïve mice. CONCLUSIONS Spinal Hevin was involved in the maintenance of remifentanil-induced postoperative hyperalgesia via modulating membrane trafficking of AMPA receptors.
Collapse
Affiliation(s)
- Zhen Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Yuzhu Tao
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Chengcheng Song
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Peng Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Chunyan Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Yize Li
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Wei Cui
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Keliang Xie
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Linlin Zhang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China.
| | - Guolin Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China.
| |
Collapse
|
32
|
Mariani JJ, Mahony A, Iqbal MN, Luo SX, Naqvi NH, Levin FR. Case Series: Rapid Induction Onto Long Acting Buprenorphine Injection for High Potency Synthetic Opioid Users. Am J Addict 2020; 29:345-348. [PMID: 32167629 DOI: 10.1111/ajad.13018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/16/2020] [Accepted: 02/16/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Highly potent synthetic opioids (HPSO) are increasingly responsible for opioid overdose deaths in the United States. METHODS In an open-label, uncontrolled trial to test the feasibility of extended-release buprenorphine (BXR) injection treatment of heroin-using individuals with opioid use disorder testing positive for HPSO, participants were enrolled and began an induction with sublingual BXR (n = 5). During the induction, ancillary medications (clonidine, clonazepam, zolpidem, and prochlorperazine) were provided for breakthrough opioid withdrawal symptoms. RESULTS Two participants received the BXR injection on the second day of the induction and three participants on the third day. DISCUSSION AND CONCLUSION All five participants were retained at least 1-month postinduction. SCIENTIFIC SIGNIFICANCE It may be feasible to provide BXR treatment to HPSO-positive heroin users rapidly to achieve clinical stabilization. (Am J Addict 2020;00:00-00).
Collapse
Affiliation(s)
- John J Mariani
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York.,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Amy Mahony
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York
| | - Muhammad N Iqbal
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York
| | - Sean X Luo
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York.,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Nasir H Naqvi
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York.,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Frances R Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York.,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| |
Collapse
|
33
|
Ramírez Fernández MDM, Wille SM, Jankowski D, Hill V, Samyn N. Development of an UPLC–MS/MS method for the analysis of 16 synthetic opioids in segmented hair, and evaluation of the polydrug history in fentanyl analogue users. Forensic Sci Int 2020; 307:110137. [DOI: 10.1016/j.forsciint.2019.110137] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
|
34
|
Henche Ruiz AI. [Transmucosal fentanyl and breakthrough pain: The other side of the coin]. Rev Esp Geriatr Gerontol 2020; 55:56-57. [PMID: 31307779 DOI: 10.1016/j.regg.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/02/2019] [Accepted: 02/08/2019] [Indexed: 06/10/2023]
|
35
|
Manirakiza A, Irakoze L, Manirakiza S, Bizimana P. Efficacy and Safety of Fentanyl Compared With Morphine among Adult Patients with Cancer: A Meta-Analysis. East Afr Health Res J 2020; 4:8-16. [PMID: 34308214 PMCID: PMC8279272 DOI: 10.24248/eahrj.v4i1.617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 04/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Cancer pain is experienced by numerous patients; thus, the main pain-relieving opioid analgesics, fentanyl and morphine, are of great importance. However, their analgesic efficacy and safety are different among individuals and are still controversial. The aim of this study was to compare the safety and efficacy of fentanyl and morphine among patients with cancer. Methods: We performed a meta-analysis by searching PubMed and the Cochrane Library up to 01 April 2019. The search terms were fentanyl, morphine, opioids and cancer pain. All randomised controlled trials comparing fentanyl and morphine were included in the analysis. Results: Overall, the initial search identified 2970 published studies; among them, 9 studies were included in the efficacy analysis and 8 studies were included in the safety analysis. The oral morphine versus oral transmucosal fentanyl subgroup analysis showed a mean difference(MD)=0.47[Confidence interval(CI):0.35-0.58] with an overall effect, Z=8.10, P<.00001. The outcome of the oral morphine versus nasal/transdermal fentanyl subgroup indicated a MD=0.20[CI:0.3-0.37] with an overall effect, Z=2.24 and P=.02. For the oral morphine versus buccal/sublingual fentanyl subgroup, the analysis revealed a MD=1.80[CI:1.35-2.25] with an overall effect, Z=7.87 and P<.00001. The oral morphine versus other forms of fentanyl subgroup showed a MD=0.70[95%CI:0.34-1.06] with the test for the overall effect, Z=3.81 and P=.0001. Constipation, drowsiness, confusion and dry mouth were more common in the morphine group than in the fentanyl group, with a risk ratio=0.60[CI:0.37-0.97]; 0.93[CI:0.69-1.25]; 0.85[CI:0.23-3.13] and 0.54[CI:0.05-6.43], respectively. Conclusions: Compared with oral morphine, fentanyl is safer and more effective. Moreover, fentanyl presents fewer side effects than morphine, especially constipation, drowsiness, confusion and dry mouth.
Collapse
|
36
|
Is pain part of a systemic syndrome in head and neck cancer? Support Care Cancer 2019; 28:451-459. [PMID: 31713692 DOI: 10.1007/s00520-019-05147-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022]
Abstract
Head and neck cancers (HNC) represent 5% of all malignancies worldwide with about 180,000 cancer deaths per year. Patients with HNC are characterized by a systemic inflammatory state, generally associated with worse outcomes. Treatment-related toxicity is common among HNC patients and causes systemic consequences such as fatigue or cognitive dysfunction. The therapeutic treatments of HNC involve the release in circulation of inflammatory systemic mediators, whose effects trigger a vicious circle that may lead to functional and behavioral alterations. The areas of the head and neck are highly sensitive to pain. Literature data confirm that in HNC patients, pain is one of the most distressing symptoms across all the phases of treatment. Pain is associated with worse general conditions, depression, fatigue, impaired cognitive functions, and lower survival rate. The treatment of advanced HNC cases is multimodal and requires a multidisciplinary psycho-socio-pharmacological approach mediated by a team of experts. The pharmacological approach in management of HNC patients with pain is fundamental and involves the use of opioids, NSAIDs, steroids, or other drugs. Opioids in pain management therapy in patients with HNC could allow the pain level to be adequately monitored, thus improving quality of life. The integration of opioid and non-opioid therapy as well as non-pharmacological interventions is essential for the rehabilitation of physical, social, and psychological functions and to achieve pain control in patients with HNC. Opioid treatment is the mainstay for pain control, being used both for background and breakthrough cancer pain (BTcP) episodes. Fentanyl, easily absorbed and generally well tolerated, appears to be a possible choice due to its versatility. Non-pharmacological interventions, such as tailored yoga, physical exercise, and acupuncture, may have a role in pain management in patients with HNC.
Collapse
|
37
|
The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies. Transl Psychiatry 2019; 9:282. [PMID: 31712552 PMCID: PMC6848196 DOI: 10.1038/s41398-019-0625-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/10/2019] [Accepted: 10/20/2019] [Indexed: 12/11/2022] Open
Abstract
Fentanyl is a powerful opioid anesthetic and analgesic, the use of which has caused an increasing public health threat in the United States and elsewhere. Fentanyl was initially approved and used for the treatment of moderate to severe pain, especially cancer pain. However, recent years have seen a growing concern that fentanyl and its analogs are widely synthesized in laboratories and adulterated with illicit supplies of heroin, cocaine, methamphetamine, and counterfeit pills, contributing to the exponential growth in the number of drug-related overdose deaths. This review summarizes the recent epidemic and evolution of illicit fentanyl use, its pharmacological mechanisms and side effects, and the potential clinical management and prevention of fentanyl-related overdoses. Because social, economic, and health problems that are related to the use of fentanyl and its analogs are growing, there is an urgent need to implement large-scale safe and effective harm reduction strategies to prevent fentanyl-related overdoses.
Collapse
|
38
|
Geist MJP, Ziesenitz VC, Bardenheuer HJ, Burhenne J, Skopp G, Mikus G. Minor contribution of cytochrome P450 3A activity on fentanyl exposure in palliative care cancer patients. Sci Rep 2019; 9:14635. [PMID: 31601999 PMCID: PMC6786992 DOI: 10.1038/s41598-019-51279-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/29/2019] [Indexed: 12/02/2022] Open
Abstract
Transdermal fentanyl is widely used to control pain in cancer patients. The high pharmacokinetic variability of fentanyl is assumed to be due to cytochrome P450 3A-mediated (CYP3A) N-dealkylation to norfentanyl in humans. However, recently published clinical studies question the importance of the described metabolic pathway. In this small study in palliative cancer patients under real-life clinical conditions, the influence of CYP3A on fentanyl variability was investigated. In addition to the determination of midazolam plasma concentration to reveal CYP3A activity, plasma concentrations of fentanyl and its metabolite, norfentanyl, were measured in identical blood samples of 20 patients who participated in an ongoing trial and had been on transdermal fentanyl. Fentanyl, norfentanyl, midazolam, and 1′-OH-midazolam were quantified by liquid chromatography/tandem mass spectrometry. Plasma concentrations of fentanyl and norfentanyl exhibited a large variability. Mean estimated total clearance of fentanyl and mean metabolic clearance of midazolam (as a marker of CYP3A activity) were 75.5 and 36.3 L/h. Both clearances showed a weak correlation and hence a minimal influence of CYP3A on fentanyl elimination.
Collapse
Affiliation(s)
- Marcus J P Geist
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.,Palliative-Care-Team Leuchtturm, Groß-Gerau, Germany
| | - Victoria C Ziesenitz
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Pediatric Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hubert J Bardenheuer
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Juergen Burhenne
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Gerd Mikus
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany.
| |
Collapse
|
39
|
Listos J, Łupina M, Talarek S, Mazur A, Orzelska-Górka J, Kotlińska J. The Mechanisms Involved in Morphine Addiction: An Overview. Int J Mol Sci 2019; 20:ijms20174302. [PMID: 31484312 PMCID: PMC6747116 DOI: 10.3390/ijms20174302] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/23/2019] [Accepted: 08/29/2019] [Indexed: 12/22/2022] Open
Abstract
Opioid use disorder is classified as a chronic recurrent disease of the central nervous system (CNS) which leads to personality disorders, co-morbidities and premature death. It develops as a result of long-term administration of various abused substances, along with morphine. The pharmacological action of morphine is associated with its stimulation of opioid receptors. Opioid receptors are a group of G protein-coupled receptors and activation of these receptors by ligands induces significant molecular changes inside the cell, such as an inhibition of adenylate cyclase activity, activation of potassium channels and reductions of calcium conductance. Recent data indicate that other signalling pathways also may be involved in morphine activity. Among these are phospholipase C, mitogen-activated kinases (MAP kinases) or β-arrestin. The present review focuses on major mechanisms which currently are considered as essential in morphine activity and dependence and may be important for further studies.
Collapse
Affiliation(s)
- Joanna Listos
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, Chodzki 4a St., 20-093 Lublin, Poland.
| | - Małgorzata Łupina
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, Chodzki 4a St., 20-093 Lublin, Poland.
| | - Sylwia Talarek
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, Chodzki 4a St., 20-093 Lublin, Poland.
| | - Antonina Mazur
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, Chodzki 4a St., 20-093 Lublin, Poland.
| | - Jolanta Orzelska-Górka
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, Chodzki 4a St., 20-093 Lublin, Poland.
| | - Jolanta Kotlińska
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, Chodzki 4a St., 20-093 Lublin, Poland.
| |
Collapse
|
40
|
Tan D, Xia H, Sun S, Wang F. Effect of ancillary drugs on sevoflurane related emergence agitation in children undergoing ophthalmic surgery: a Bayesian network meta-analysis. BMC Anesthesiol 2019; 19:138. [PMID: 31370793 PMCID: PMC6670177 DOI: 10.1186/s12871-019-0810-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/25/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The comparative efficacy of ancillary drugs on sevoflurane related emergence agitation (EA) in children undergoing ophthalmic surgery remains controversial. METHODS The databases were retrieved in an orderly manner from the dates of their establishment to October, 2018, including PubMed, The Cochrane Library and Web of Science, to collect randomized controlled trials (RCT) of different anesthetic drugs combined with sevoflurane for ophthalmic surgery. Then a network meta-analysis was conducted using R and Stata 12.0 softwares. RESULTS The meta-analysis showed that, in reducing sevoflurane related EA, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil and clonidine were superior to placebo (P < 0.05). The network meta-analysis showed that the effects of ancillary drugs combine with sevoflurane in reducing risk of EA in children undergoing ophthalmic surgery was superior to placebo: dexmedetomidine (OR = 0.17, 95% CrI 0.12-0.22), ketamine (OR = 0.30, 95% CrI 0.11-0.49), propofol (OR = 0.24, 95% CrI 0.09-0.63), fentanyl (OR = 0.16, 95% CrI 0.08-0.56), midazolam (OR = 0.20, 95% CrI 0.09-0.40), sufentanil (OR = 0.27, 95% CrI 0.14-0.41), remifentanil (OR = 0.18, 95% CrI 0.08-0.54) and clonidine (OR = 0.14, 95% CrI 0.07-0.41). The SUCRA of placebo, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil, clonidine were respectively 0.26, 77.93, 27.71, 42.8, 69.43, 52.89, 59.83, 57.62 and 61.53%. CONCLUSIONS The effects of dexmedetomidine combine with sevoflurane in reducing risk of emergence agitation in children undergoing ophthalmic surgery was superior to other drugs.
Collapse
Affiliation(s)
- Dan Tan
- Editorial Office, Journal of New Medicine, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.
| | - Haifa Xia
- Department of Anesthesiology, Institute of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shujun Sun
- Department of Anesthesiology, Institute of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fuquan Wang
- Department of Anesthesiology, Institute of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
41
|
Nara A, Yamada C, Saka K, Kodama T, Yoshida M, Iwahara K, Takagi T. A Fatal Case of Poisoning with Fentanyl Transdermal Patches in Japan. J Forensic Sci 2019; 64:1936-1942. [DOI: 10.1111/1556-4029.14127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Akina Nara
- Division of Legal Medicine Faculty of Medicine Tohoku Medical and Pharmaceutical University 1‐15‐1 Fukumuro, Miyagino‐ku Sendai‐shi Miyagi983‐8536 Japan
| | - Chiho Yamada
- Division of Legal Medicine Faculty of Medicine Tohoku Medical and Pharmaceutical University 1‐15‐1 Fukumuro, Miyagino‐ku Sendai‐shi Miyagi983‐8536 Japan
| | - Kanju Saka
- Department of Forensic Medicine Graduate School of Medicine The University of Tokyo 7‐3‐1 Hongo Bunkyo‐ku Tokyo113‐0033 Japan
| | - Takanori Kodama
- Division of Legal Medicine Faculty of Medicine Tohoku Medical and Pharmaceutical University 1‐15‐1 Fukumuro, Miyagino‐ku Sendai‐shi Miyagi983‐8536 Japan
| | - Masaki Yoshida
- Division of Legal Medicine Faculty of Medicine Tohoku Medical and Pharmaceutical University 1‐15‐1 Fukumuro, Miyagino‐ku Sendai‐shi Miyagi983‐8536 Japan
- Department of Legal Medicine Kyorin University 6‐20‐2 Shinkawa Mitaka‐shi Tokyo181‐8611 Japan
| | - Kaori Iwahara
- Division of Legal Medicine Faculty of Medicine Tohoku Medical and Pharmaceutical University 1‐15‐1 Fukumuro, Miyagino‐ku Sendai‐shi Miyagi983‐8536 Japan
- Center of Legal Medicine of Dentistry The Nippon Dental University School of Dentistry at Tokyo 1‐9‐20 Fujimi Chiyoda‐ku Tokyo102‐8159 Japan
| | - Tetsuya Takagi
- Division of Legal Medicine Faculty of Medicine Tohoku Medical and Pharmaceutical University 1‐15‐1 Fukumuro, Miyagino‐ku Sendai‐shi Miyagi983‐8536 Japan
- Center of Legal Medicine of Dentistry The Nippon Dental University School of Dentistry at Tokyo 1‐9‐20 Fujimi Chiyoda‐ku Tokyo102‐8159 Japan
| |
Collapse
|
42
|
Wang J, Wei H, Dong T. Efficacy and Safety of Preoperative Local Infiltration with Lidocaine vs. Levobupivacaine in Hernia Surgeries. INT J PHARMACOL 2019. [DOI: 10.3923/ijp.2019.428.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
43
|
Jobski K, Bantel C, Hoffmann F. Utilization of transdermal fentanyl in German nursing home residents from 2010 to 2014. Pharmacoepidemiol Drug Saf 2019; 28:754-759. [PMID: 30861622 DOI: 10.1002/pds.4753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 01/03/2019] [Accepted: 01/22/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Kathrin Jobski
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carsten Bantel
- University Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Klinikum Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| |
Collapse
|
44
|
Abdi M, Pourrahimi A, Yousefi K, Nouri Khaneghah Z, Rabie Siahkali S, Torkmandi H. A Preventive Approach to the Risk of Substance Abuse in Medical Personnel with Migraine: A Case Report. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2019. [DOI: 10.29252/pcnm.8.4.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
45
|
Gisev N, Pearson SA, Larance B, Larney S, Blanch B, Degenhardt L. A population-based study of transdermal fentanyl initiation in Australian clinical practice. Eur J Clin Pharmacol 2018; 75:401-408. [PMID: 30392109 DOI: 10.1007/s00228-018-2588-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Although guidelines caution against initiation of transdermal (TD) fentanyl among those who are opioid naïve, there is concern that not all people receive adequate prior opioid exposure. This study examined the percentage of people who are opioid naïve at the time of TD fentanyl initiation in Australia; strengths initiated; and characteristics associated with being opioid naïve. METHODS This is a national retrospective cohort study derived from a 10% sample of Pharmaceutical Benefits Scheme concessional beneficiaries initiating TD fentanyl between 29 September 2009-31 December 2013. Individuals were deemed opioid naïve if they had no opioid dispensings in the previous 90 days. Logistic regression was used to determine characteristics associated with being opioid naïve, including socio-demographics, likely comorbidities and previous analgesic use. RESULTS A total of 13,166 people initiated TD fentanyl; 60.4% were female and 76.2% were aged ≥ 65 years. Three in ten (30.4%) were opioid naïve and 63.2% initiated the 12 mcg/h patch. Those who were opioid naïve were more likely to be female (adjusted odds ratio (aOR) 1.35; 95% CI 1.25-1.46), older (aOR 1.85; 95% CI 1.54-2.28 for those ≥ 85 years) and previously dispensed medicines for dementia (aOR 1.37; 95% CI 1.04-1.80). People previously dispensed medicines for cancer were less likely to be opioid naïve (aOR 0.57; 95% CI 0.48-0.67). CONCLUSIONS Three in ten Australians initiating TD fentanyl are opioid naïve. Our findings suggest that specific patient sub-populations already at increased risk of opioid-related adverse events are not receiving prior opioid treatment before initiation, highlighting the need for greater adherence to current treatment guidelines.
Collapse
Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | | | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, 2052, Australia
| |
Collapse
|
46
|
Novel Synthetic Opioids: The Pathologist's Point of View. Brain Sci 2018; 8:brainsci8090170. [PMID: 30200549 PMCID: PMC6162684 DOI: 10.3390/brainsci8090170] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 02/03/2023] Open
Abstract
Background: New Psychoactive Substances (NPS) constitute a broad range of hundreds of natural and synthetic drugs, including synthetic opioids, synthetic cannabinoids, synthetic cathinones, and other NPS classes, which were not controlled from 1961 to 1971 by the United Nations drug control conventions. Among these, synthetic opioids represent a major threat to public health. Methods: A literature search was carried out using public databases (such as PubMed, Google Scholar, and Scopus) to survey fentanyl-, fentanyl analogs-, and other synthetic opioid-related deaths. Keywords including “fentanyl”, “fentanyl analogs”, “death”, “overdose”, “intoxication”, “synthetic opioids”, “Novel Psychoactive Substances”, “MT-45”, “AH-7921”, and “U-47700” were used for the inquiry. Results: From our literature examination, we inferred the frequent implication of fentanyls and synthetic opioids in side effects, which primarily affected the central nervous system and the cardiovascular and pulmonary systems. The data showed a great variety of substances and lethal concentrations. Multidrug-related deaths appeared very common, in most reported cases. Conclusions: The investigation of the contribution of novel synthetic opioid intoxication to death should be based on a multidisciplinary approach aimed at framing each case and directing the investigation towards targeted toxicological analyses.
Collapse
|
47
|
Fentanyl treatment for end-of-life dyspnoea relief in advanced cancer patients. Support Care Cancer 2018; 27:157-164. [PMID: 29915993 DOI: 10.1007/s00520-018-4309-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/06/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE We assessed the effects of subcutaneous-endovenous fentanyl on dyspnoea in a cohort of advanced cancer patients. METHODS We performed a retrospective study in a cohort of advanced cancer patients with dyspnoea at rest who received subcutaneous or intravenous fentanyl. Patients with no shortness of breath at rest or at minimal exertion, no rescue doses per 24 h, were deemed to be responders to fentanyl. The period of assessment was 6 days from the beginning of fentanyl treatment. RESULTS Seventy-two patients were evaluated: 65% males, 50% ≥ 75 years, Palliative Performance Scale (PPS) median of 30%. Seventy-six percent of the patients were responders to fentanyl. Fentanyl efficacy was not statistically related to age, gender, cancer type, previous opioid treatment, steroid and midazolam doses and PPS. The median fentanyl dose in responders was 25 mcg/h (interquartile range 12-70). It was significantly related to age (37 vs 12 mcg/h, for ≤ 75 vs > 75 years, respectively; p = 0.02). There was not a significant difference between fentanyl doses of responders and non-responder patients. Thirty-six, 23 and 15 patients had sustained improvements in dyspnoea over 48, 72 and 96 h. Fentanyl had no significant toxicity. The length of inclusion in the study and exclusion were related to low performance status (hazard ratio 0.961; 95%CI 0.927-0.996; Cox-regression) but not to fentanyl doses (hazard ratio 0.875; 95%CI 0.620-1.234; Cox-regression). CONCLUSION Our preliminary data suggest that subcutaneous-endovenous fentanyl may be associated with dyspnoea relief in dying patients. Further research is needed to confirm these findings.
Collapse
|
48
|
Pasichow KP, Frizzola M, Miller EG. Palliative Sedation with Oral Medicines in an Infant with Generalized Severe Junctional Epidermolysis Bullosa. J Palliat Med 2018; 21:1048-1052. [PMID: 29775550 DOI: 10.1089/jpm.2018.0054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Generalized severe junctional epidermolysis bullosa is a rare mechanobullous skin disorder that is uniformly fatal. We present the case of an infant who received palliative pain management and ultimately proportionate palliative sedation. However, because of the extent of the patient's skin disease, we were unable to provide palliative medication through parenteral routes. We discuss the provision of enteral palliative sedation, including the pharmacology, and creative use of medications to achieve sufficient palliation in this difficult and unique situation.
Collapse
Affiliation(s)
| | - Meg Frizzola
- 2 Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children , Wilmington, Delaware.,3 Division of Critical Care Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children , Wilmington, Delaware
| | - Elissa G Miller
- 2 Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children , Wilmington, Delaware
| |
Collapse
|
49
|
Severino AL, Shadfar A, Hakimian JK, Crane O, Singh G, Heinzerling K, Walwyn WM. Pain Therapy Guided by Purpose and Perspective in Light of the Opioid Epidemic. Front Psychiatry 2018; 9:119. [PMID: 29740351 PMCID: PMC5925443 DOI: 10.3389/fpsyt.2018.00119] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/21/2018] [Indexed: 12/12/2022] Open
Abstract
Prescription opioid misuse is an ongoing and escalating epidemic. Although these pharmacological agents are highly effective analgesics prescribed for different types of pain, opioids also induce euphoria, leading to increasing diversion and misuse. Opioid use and related mortalities have developed in spite of initial claims that OxyContin, one of the first opioids prescribed in the USA, was not addictive in the presence of pain. These claims allayed the fears of clinicians and contributed to an increase in the number of prescriptions, quantity of drugs manufactured, and the unforeseen diversion of these drugs for non-medical uses. Understanding the history of opioid drug development, the widespread marketing campaign for opioids, the immense financial incentive behind the treatment of pain, and vulnerable socioeconomic and physical demographics for opioid misuse give perspective on the current epidemic as an American-born problem that has expanded to global significance. In light of the current worldwide opioid epidemic, it is imperative that novel opioids are developed to treat pain without inducing the euphoria that fosters physical dependence and addiction. We describe insights from preclinical findings on the properties of opioid drugs that offer insights into improving abuse-deterrent formulations. One finding is that the ability of some agonists to activate one pathway over another, or agonist bias, can predict whether several novel opioid compounds bear promise in treating pain without causing reward among other off-target effects. In addition, we outline how the pharmacokinetic profile of each opioid contributes to their potential for misuse and discuss the emergence of mixed agonists as a promising pipeline of opioid-based analgesics. These insights from preclinical findings can be used to more effectively identify opioids that treat pain without causing physical dependence and subsequent opioid abuse.
Collapse
Affiliation(s)
- Amie L. Severino
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- UCLA Brain Research Institute, Los Angeles, Los Angeles, CA, United States
| | - Arash Shadfar
- Department of Psychiatry, Western University of Health Sciences, Pomona, CA, United States
| | - Joshua K. Hakimian
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- UCLA Brain Research Institute, Los Angeles, Los Angeles, CA, United States
| | - Oliver Crane
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- UCLA Brain Research Institute, Los Angeles, Los Angeles, CA, United States
| | - Ganeev Singh
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- UCLA Brain Research Institute, Los Angeles, Los Angeles, CA, United States
| | - Keith Heinzerling
- Department of Family Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, United States
| | - Wendy M. Walwyn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- UCLA Brain Research Institute, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
50
|
Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care &Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
| |
Collapse
|