Journal of opioid management
-
Randomized Controlled Trial
Lack of correlation between the effective dose of fentanyl sublingual spray for breakthrough cancer pain and the around-the-clock opioid dose.
To examine the relationship between the dose of fentanyl sublingual spray needed to control breakthrough cancer pain (BTCP) and the dose of around-the-clock (ATC) opioid used to control background pain. ⋯ These findings highlight the importance of titrating the dose of fentanyl sublingual spray to optimize dosing for individual patients.
-
Case Reports
Remifentanil target-controlled infusion: a safe rescue protocol for unexpected severe postoperative pain.
Three cases are reported here in which remifentanil administered as a target-controlled infusion (TCI) was used in Post Anesthesia Care Unit as a fast rescue treatment for acute and unexpected severe postoperative pain, allowing subsequent clinical evaluation and rational titration of analgesia with longer acting opioids. It illustrates the efficacy of this technique to titrate and compensate for variability in opioid requirements. However, its safety requires full knowledge of TCI technique, continuous monitoring of respiratory function, and assisted ventilation equipment immediately available.
-
Prescription opioid analgesics with a wide range of potencies are currently used for the treatment of chronic pain. Yet understanding the clinical relevance and therapeutic consequences of opioid potency remains ill defined. Both patients and clinicians alike have misperceptions about opioid potency, expecting that less-potent opioids will be less effective or fearing that more-potent opioids are more dangerous or more likely to be abused. ⋯ Differences in pharmacologic potency are largely accounted for by the actual doses prescribed, according to individualized patient need. Factors for achieving effective analgesia and reducing the risks involved with opioid use include careful medication selection based on patient characteristics, appropriate dosing titration and opioid rotation practices, knowledge of product formulation characteristics (eg, extended release, immediate release, and tamper-resistant features), and an awareness of differences in opioid pharmacokinetics and metabolism. Clinicians should remain vigilant in monitoring patients on any opioid medication, regardless of classification along the opioid potency continuum.
-
Randomized Controlled Trial
Impact of physical manipulation on in vitro and in vivo release profiles of oxycodone DETERx®: an extended-release, abuse-deterrent formulation.
In vitro: To assess the effect of common crushing techniques on particle size reduction (PSR) and in vitro drug-release kinetics of oxycodone DETERx® (herein DETERx) and of a commercially available oxycodone extended-release (ER) tablet. In vivo: To evaluate the impact of the most effective manipulation method identified in the in vitro study and the effect of chewing on the pharmacokinetics (PK) of DETERx relative to oxycodone solution. ⋯ These mechanical manipulation and PK studies demonstrated that DETERx beads retained their ER properties after mechanical tampering and chewing by study subjects.