Articles: analgesics.
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Ketamine is an NMDA receptor antagonist commonly used as a dissociative anesthetic and analgesic. Though it is conventionally administered via the intravenous, intramuscular, or intranasal route, use as a compounded analgesic cream is becoming increasingly common. This is a case report of a 61-year-old man who was detained by the police for erratic driving. ⋯ His clinical presentation was consistent with ketamine toxicity, and mass spectrometry demonstrated an elevated urine ketamine concentration (32,300 ng/mL). His symptoms resolved spontaneously within a few hours and he was discharged. This is a unique case of systemic toxicity following dermal application of a ketamine pain cream in a patient with impaired skin barrier function due to pyoderma gangrenosum.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Intraoperative Methadone in Adult Cardiac Surgical Patients and Risks for Postoperative QTc Prolongation.
To evaluate the effect of intraoperative intravenous methadone within a standardized enhanced recovery after cardiac surgery pathway on the perioperative corrected QT interval (QTc). ⋯ A single intraoperative intravenous methadone dose did not prolong the QTc significantly or increase the incidence of arrhythmias and may be safe in adult cardiac surgical patients.
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Lung cancer surgery is associated with a high incidence of chronic postsurgical pain (CPSP), which necessitates long-term analgesic prescriptions. However, while essential for managing pain, these have shown various adverse effects. Current guidelines recommend using peripheral nerve blocks over epidural anaesthesia for perioperative analgesia in minimally invasive thoracic surgery (MITS). However, the impact of perioperative analgesia on chronic analgesic prescriptions remains unclear. Therefore, this study investigated chronic analgesic prescription patterns following MITS in patients with lung cancer who received either perioperative epidural anaesthesia or nerve block. ⋯ This nationwide retrospective study suggests that the choice between perioperative epidural anaesthesia or nerve block in patients with lung cancer undergoing MITS does not influence the proportion of postoperative chronic analgesic prescriptions.
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Journal of anesthesia · Feb 2025
The effects of frailty on opioid consumption after total knee arthroplasty.
This study evaluated the effects of frailty on postoperative opioid consumption in elderly patients. ⋯ Our study results indicate that frailty, easily assessed preoperatively in elderly surgical patients, is a significant predictor of postoperative opioid consumption.
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The concomitant epidemics of chronic pain and opioid misuse in the United States have led to a call for novel analgesics with limited abuse potential. Previously, we have shown that co-delivery of a novel combination targeting both μ- and δ-opioid receptors in the peripheral and central nervous systems can produce synergistic analgesia. Loperamide, a peripherally restricted μ-opioid agonist, and oxymorphindole, a δ-opioid receptor partial agonist, synergize in multiple mouse models of hyperalgesia. ⋯ From these data we conclude that the combination of oxymorphindole and loperamide or the combination of N-benzyl-oxymorphindole and loperamide reverse incisional hyperalgesia, likely by acting in the periphery, in a large animal model without adverse effects on respiration or heart rate. PERSPECTIVE: This article presents novel opioid combinations, the μ-opioid agonist loperamide with a δ-opioid agonist, either oxymorphindole (OMI) or N-benzyl-oxymorphindole (BOMI), that relieve pain in mice and pigs without adverse side effects. These therapies could help clinicians manage pain in patients while reducing overall opioid burden and limiting side effects.