Articles: opioid.
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Anesthesia and analgesia · Oct 2022
Observational StudyKetamine Associated Intraoperative Electroencephalographic Signatures of Elderly Patients With and Without Preoperative Cognitive Impairment.
Ketamine is typically used by anesthesiologists as an adjunct for general anesthesia and as a nonopioid analgesic. It has been explored for prevention of postoperative delirium, although results have been contradictory. In this study, we investigated the association of ketamine with postoperative delirium and specific encephalographic signatures. Furthermore, we examined these associations in the context of baseline neurocognition as measured by a validated assessment. ⋯ Ketamine-related changes in EEG are observed in a heterogeneous group of patients receiving spine surgery. This result was driven primarily by the effect of ketamine on cognitively normal patients and not observed in patients that were cognitively impaired at baseline. Furthermore, patients who were cognitively impaired at baseline and who had received ketamine were more likely to develop postoperative delirium, suggesting that cognitive vulnerability might be predicted by the lack of a neurophysiologic response to ketamine.
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Opioid use is well documented in several countries: some countries struggle with overuse, whereas others have almost no access to opioids. For Europe, limited data are available. This study analysed Hungarian opioid utilization in ambulatory care between 2006 and 2020. ⋯ This study was one of the recent opioid utilization studies using three volume-based metrics, covering a long time period. To our knowledge, this was also the first national, population level study describing opioid utilization in Hungary. National opioid utilization data suggested not an overuse but rather an underuse of opioid analgesics in a developed, Central European country.
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We assessed the joint effects of back pain and mental health conditions on healthcare utilization and costs in a population-based sample of adults in Ontario. We included Ontario adult respondents of the Canadian Community Health Survey between 2003 and 2012, followed up to 2018 by linking survey data to administrative databases. Joint exposures were self-reported back pain and mental health conditions (fair/poor mental health, mood, and anxiety disorder). ⋯ There was no evidence of synergism for all-cause utilization or costs. Combined effects of back pain and mental health conditions on back pain-specific utilization or opioid prescription were greater than expected, with evidence of synergism. Health services targeting back pain and mental health conditions together may provide greater improvements in outcomes.
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The opioid crisis has changed the culture and expectations of pain management, elevating the importance of nonpharmacologic pain interventions (NPIs) into multimodal pain management programs. Little is known about use of NPIs in hospitalized patients. ⋯ Results suggest that patients and nurses may benefit from education about using NPIs in acute care. Nurses have a critical role influencing positive pain-related outcomes, and tablet technology can enhance patient use of NPIs during hospitalization.
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Chronic pain patients tend to have comorbid depressive symptoms, and empirical data investigating differences related to depressive symptoms classes and opioid misuse are scant. ⋯ These findings may help improve depressive symptoms and chronic pain management by identifying high-risk elderly individuals for early intervention and personalizing treatment according to the depressive symptoms subgroup and severity of opioid misuse.