American journal of therapeutics
-
Human cytochrome P4502D6 (CYP2D6) gene is highly polymorphic, leading to wide interindividual ethnic differences in CYP2D6-mediated drug metabolism. Its activity ranges from complete deficiency to excessive activity, potentially causing toxicity of the medication or therapeutic failure with recommended drug dosages. The aim of the study was to find the association of CYP2D6*2 polymorphisms with demographic characters (age, sex, and weight), pain intensity scales [numerical rating scale (NRS) sleep, global perceived effect (GPE)], and adverse drug effects in postherpetic neuralgia (PHN) patients receiving tramadol. ⋯ In addition, CYP2D6*2 genotype was not related to the adverse effects of analgesic therapy. The overall results suggested that CYP2D6*2 polymorphism plays no role in the PHN patients receiving tramadol treatment. The CYP2D6*2 polymorphism may not be a predictor of treatment outcome of patients with respect to PHN-receiving tramadol.
-
Review Case Reports
Effectiveness of full agonist opioids in patients stabilized on buprenorphine undergoing major surgery: a case series.
A review of the medical literature failed to reveal clear, agreed-upon guidelines for practitioners on the postoperative provision of full agonist opioids for patients maintained on buprenorphine. Some controversy appears to exist about whether to maintain patients on their buprenorphine regimen up to the time of surgery. ⋯ Postoperative pain was adequately controlled using full agonist opioids according to self-report and physician assessment. The observations from this case series lend support to the practice of maintaining stable buprenorphine dosing for patients who require major surgery.
-
Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic vomiting associated with chronic cannabis use. As cannabis consumption steadily increases each year, CHS is becoming a commonplace and costly occurrence in hospitals nationwide. Currently, there are no best treatment strategies agreed upon universally. ⋯ CHS is becoming an increasingly prevalent and complicated problem for health care providers and patients. Further research must be done to address the diagnostic and therapeutic challenges of this syndrome.
-
Randomized Controlled Trial
Effect of Perineural Dexamethasone With Bupivacaine in Single Space Paravertebral Block for Postoperative Analgesia in Elective Nephrectomy Cases: A Double-Blind Placebo-Controlled Trial.
Various analgesic modalities have been tried to prolong the duration and to improve the quality of postoperative analgesia for the early rehabilitation and discharge from hospital after nephrectomy. Using local anaesthetic along with perineural steroids as adjuvant may prove promising for peripheral nerve block, especially paravertebral block (PVB). This article aims to assess the efficacy of dexamethasone with bupivacaine as adjuvant for single bolus injection of thoracic PVB in patients undergoing elective nephrectomy. ⋯ The total dose of intravenous fentanyl in the first 24 hours postoperatively in group D was 98.6 ± 14.14 μg as compared with 147.6 ± 18.22 μg in group B. No other significant side effects were noted except for nausea and vomiting in 5 patients of placebo group. Dexamethasone, along with bupivacaine as adjunct for thoracic PVB, helps in improving the quality and enhancing the postoperative analgesia duration in patients undergoing nephrectomy.
-
Comparative Study
Comparison of Arginine Hydrochloride and Acetazolamide for the Correction of Metabolic Alkalosis in Pediatric Patients.
Metabolic alkalosis is a common acid-base disturbance occurring in critically ill pediatric patients. Acetazolamide and arginine hydrochloride are pharmacologic agents used at our institution for patients refractory to first-line therapy or those unable to tolerate fluid replacement. The objective of this retrospective review was to determine if a course of arginine hydrochloride or acetazolamide was more effective at correcting metabolic alkalosis within a 24-hour period. ⋯ Both groups had a similar increase in mean serum chloride concentration (5.7 ± 5.3 vs. 4.4 ± 4.4 mmol/L, P = 0.458). Mean decrease in serum bicarbonate concentration was equivalent between groups (5.6 ± 5.2 vs. 2.8 ± 4.7, mmol/L, P = 0.110). Acetazolamide and arginine hydrochloride appear to be equally effective in correcting metabolic alkalosis in critically ill pediatric patients.