Articles: narcotic-antagonists.
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Anesthesia and analgesia · Nov 2009
Randomized Controlled Trial Comparative StudyAn ultra-low dose of naloxone added to lidocaine or lidocaine-fentanyl mixture prolongs axillary brachial plexus blockade.
In this prospective, randomized, double-blind study, we evaluated the effect of an ultra-low dose of naloxone added to lidocaine and fentanyl mixture on the onset and duration of axillary brachial plexus block. ⋯ The addition of an ultra-low dose of naloxone to lidocaine 1.5% solution with or without fentanyl solution in axillary brachial plexus block prolongs the time to first postoperative pain and motor blockade but also lengthens the onset time.
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Intrathecal opioids (ITOs) have been used for decades to control postoperative pain. Intrathecal opioid dosing is limited, however, by opioid-related side effects, most importantly respiratory depression. To overcome these limitations, we combined intrathecal morphine with a continuous intravenous (IV) postoperative naloxone infusion to control opioid-related side effects. The purpose of this study is to document the efficacy and safety of high-dose intrathecal morphine combined with postoperative naloxone infusion to provide postoperative analgesia after major surgery. After IRB approval, a retrospective chart analysis was performed on 35 patients who had a radical prostatectomy from 2004 to 2006. All patients received a single injection of ITOs before anesthesia, a typical general Anesthestic, followed by naloxone infusion at 5 microg/kg/h started 1 hour post-ITOs and continued for 22 hours postoperatively. The following information was collected: patient age, height, weight, anesthesia technique/time, and dose of ITOs given. Postoperative pain relief was assessed for 48 hours using the Visual Analog Score (VAS) for pain (0, no pain; 10, worst pain), perioperative opioid use, NSAID consumption, and ability of patient to ambulate. The safety of this novel treatment was assessed with opioid-related side effects and vital signs. All data are reported as mean (SD). ⋯ High-dose ITOs combined with postoperative IV naloxone infusion provided excellent analgesia for radical prostate surgery. IV naloxone infusion appeared to control opioid side effects without diminishing the analgesia. No serious adverse effects were noted.
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J Pain Symptom Manage · Nov 2009
Randomized Controlled TrialMethylnaltrexone treatment of opioid-induced constipation in patients with advanced illness.
Methylnaltrexone, a peripherally acting mu-opioid receptor antagonist with restricted ability to cross the blood-brain barrier, reverses opioid-induced constipation (OIC) without affecting analgesia. A double-blind study in patients with advanced illness and OIC demonstrated that methylnaltrexone significantly induced laxation within four hours after the first dose compared with placebo. In this study, patients with advanced illness and OIC on stable doses of opioids and laxatives were randomized to methylnaltrexone 0.15mg/kg (n=62) or placebo (n=71) subcutaneously every other day for two weeks. ⋯ Higher percentages of patients and clinicians rated bowel status as improved in the methylnaltrexone than the placebo group. Fewer methylnaltrexone than placebo patients reported use of common laxative types, particularly enemas, during the study. Subcutaneous methylnaltrexone promptly and predictably induced laxation, improved constipation distress, and was associated with less laxative use in patients with advanced illness and OIC.
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Opioid dependence is common among HIV-infected persons in the United States. Factors associated with HIV care providers recommending buprenorphine for opioid dependence are poorly defined. Using vignettes, we sought to identify HIV provider characteristics associated with endorsing buprenorphine treatment in primary care. ⋯ HIV providers infrequently endorsed buprenorphine treatment in primary care for vignette patients. Generalist and African American providers and those with previous buprenorphine prescribing experience are more likely to endorse buprenorphine treatment in primary care. Targeting generalist and minority providers may be one strategy to promote effective integration of HIV care and opioid addiction treatment.