Articles: opioid-analgesics.
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To identify predictors of persistent opioid use in opioid-naïve individuals undergoing total joint arthroplasty. ⋯ This predictive model for persistent opioid use after total joint arthroplasty shows promise as an evidence-based, validated, and standardized tool for identifying high-risk patients before surgery in order to target strategies and interventions to reduce the reliance on opioids for postoperative pain control.
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Rapid opioid reduction or discontinuation among patients on high-dose long-term opioid therapy (HD-LTOT) is associated with increased risk of heroin use, overdose, opioid use disorder, and mental health crises. We examined the association of residential segregation and health care access with rapid opioid reduction or discontinuation among patients on HD-LTOT and examined effect measure modification of individual-level characteristics. ⋯ Health care providers need to address potential biases toward patients living in underserved and marginalized communities, as well as intersectionality with mental health stigma, by prioritizing training and education in delivering unbiased care during opioid tapering.
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J Pain Symptom Manage · Feb 2025
Genomic Study in Opioid-Treated Cancer Patients Identifies Variants Associated With Nausea-Vomiting.
Opioids are the mainstay therapy for patients affected by cancer pain. However, about 10%-20% of patients do not benefit from the received analgesic treatment or experience side effects. Genetic variability might account for the variation in individual responses to opioids, both in terms of efficacy and toxicity. ⋯ This is the first GWAS, performed in more than two thousand individually genotyped patients treated with opioids for cancer pain, that investigated the genetic bases of opioid-induced nausea-vomiting. Although further studies are needed to confirm our findings and to characterize the functional role of the identified variants, our results emphasize the importance of performing large pharmacogenomic studies to identify germline variants associated with opioid response, with the ultimate goal of tailoring cancer pain therapies.
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Anesthesia and analgesia · Feb 2025
Meta AnalysisOpioid-Sparing Anesthesia Versus Opioid-Free Anesthesia for the Prevention of Postoperative Nausea and Vomiting after Laparoscopic Bariatric Surgery: A Systematic Review and Network Meta-Analysis.
Patients who undergo laparoscopic bariatric surgery (LBS) are susceptible to postoperative nausea and vomiting (PONV). Opioid-free anesthesia (OFA) or opioid-sparing anesthesia (OSA) protocols have been proposed as solutions; however, differences between the 2 alternative opioid protocols for anesthesia maintenance in obese patients remain uncertain. A network meta-analysis was conducted to compare the impacts of OFA and OSA on PONV. ⋯ OFA is more effective than OSA in reducing the occurrence of PONV during the early postoperative period of LBS, although it may associate with an increased risk of bradycardia. Patients who received either opioid-alternative strategy demonstrated similar effects in reducing postoperative opioid consumption and alleviating pain intensity.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Multicenter StudyThe Use of Methadone and Ketamine for Intraoperative Pain Management in Cardiac Surgery: A Retrospective Cohort Study.
To evaluate whether the addition of ketamine to intraoperative methadone is associated with superior postoperative pain management and decreased opioid consumption compared with methadone alone in cardiac surgery patients. ⋯ Adding ketamine to methadone prolonged the time to first opioid consumption postoperatively but showed no benefits beyond POD 0. Future studies should consider protocolized dosing to optimize pain control.